ICRA ILSM NEPA FY 20 (002).xlsx
XLSX spreadsheet 71 KB Posted
- Attached to
- Z2DA--INSTALL AUTO SHOWER OPERATORS Federal contract opportunity
- Solicitation number
- 36C25620R0148
About this file
This document outlines a federal contract opportunity to install auto shower operators at a Veterans Health Administration medical center. The solicitation will be issued as a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses. Interested offerors will have approximately 30 days to submit proposals in response to solicitation number 36C25620R0148, with contract award anticipated within 30 days thereafter. The performance period is 180 days. Offerors must be registered and verified in the Vendor Information Pages database and System for Award Management to be considered. The work location is the Southeast Louisiana Veterans Health Care System and includes providing all labor, materials, and equipment to install auto shower operators with a construction cost estimated between $500,000 to $1 million.
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Directions
| Instructions |
| 1. On tab 1 fill in information for Project Title or Type of Work, Project No., COR., and Start and Completion Date. |
| 2. Input a brief Description of work. |
| 3. On tab 8 Give a detailed step by step description of work, and all risks/hazards associated with each step of the work, and the step being taken to reduce/ eliminate the risks/ hazards.. |
| 4. review tab 2 and determine what type of work is being done and the level of risk to patients and staff. Once the type and risk level have been determind return to tab1 and input those into the ICRA form just below the Brief Description, then take those findings and locate them on the chart just below that to determine the overall project class. |
| 5. After determining the over all project class go to tab 3. Depending on the over all project class it will tell what precautions that need to be put into place prior to construction starting and remain in place throughout construction, and what steps that need to be done after construction is complete to ensure the work area is completely clean. |
| 6.Review tab 4 for any Life Safety Conditions and answer the questions Yes/No in the top chart, any yes answers will give you measures in the lower chart that need to be put into place prior to construction and remain in place throughout construction. |
| 7. Review tab 9, fill all blpcks a possible. Any question Contact the GEMS coordinator at ext 72015. |
| 7. Once the form has been completed it needs to be sent/ brought to the Construction Safety Committee for review and approval. If anyone has any question about the ICRA they will contact the person submitting the form for clarification prior to approval. |
| 8. Please try to submit ICRA's to the committee the week prior to the start date. |
| 9. The committee will be reviewing ICRA's for all current projects and any new ICRA's that have been submitted for approval on Friday's prior to Construction Safety Rounds. |
| 10. Only emergency ICRA's should be walked through for approval. |
| The committee consists of |
| Safety Management/ Construction/ GEMS Coordinator/ Industrial Hygiene- Michael Adams, Kim Robinson, Latricia Walrath, Matthew Rowley, Kiarra Mackey, Jeremy Sellers |
| Facilities Management/ Project Engineering/ Mainteance & Operations- Kristen Russell, Angela McKenzie, Tony Clark, Kenneth Ward, Gerald Faulkner, Edwin Chin, Femi Osunbunmi, Robert Chaplin, Jabari Jones |
| Police Services- Robert Kenyon, Connie Washington, Joshua Anderson, Rodney Robvias |
| Quality Management/ Infection Control- Serelda Bowman-Young , Lori Jefferson, Debbie Lepre, Jemichael Manora |
| Patient Safety- Randy Decuir, Chris Cahill, Jenny Duplantier |
| Contracting- Leslie Robinson, William Geary (Biloxi) |
| AFGE/ NFFE Representatives- Yolan Bender, Anne Fisher |
| Clinical Engneering- Mariel Paciera, Jennifer Boudreaux, Meghan Glaviano, Austin Sandlin, Liana Soileau |
1-ICRA
| Infection Control Risk Assessment (ICRA) Checksheet | |
| Project Title or Type of Work: Install Auto-Operators Showers and Faucets | Project No. 629-18-140 |
| In-house Representative/ Supervisor______________________________ | Location: Inpatient, TLR, 5D |
| COR/ Representative Shane Brodine | Start Date: TBD |
| Completion Date: TBD |
| Brief description of the construction or maintenance project: |
| Replace existing patient room sink faucets with auto-operated faucets |
| Type of construction project--choose from drop-down box (see "Types & Risk" tab): | B | ||||||||
| Patient Risk Group--choose from drop-down box (see "Types & Risk" tab): | Medium | A | Low | I | |||||
| B | Medium | II | |||||||
| Class of Infection Control Precautions (select from grid) | C | High | III | ||||||
| Construction Project Type | D | Highest | IV | ||||||
| Patient Risk Group | TYPE A | TYPE B | TYPE C | TYPE D | Project Class | ||||
| Low | I | II | II | III/IV | II | ||||
| Medium | I | II | III | IV | |||||
| High | I | II | III/IV | IV | |||||
| Highest | II | III/IV | III/IV | IV |
| Other Considerations | Comments |
| Air Quality | Mininum dust created by cutting into drywall |
| Noise | Noise from power tools |
| Vibrations | None |
| Utilities | Contractor will LOTO live circuits at the breaker |
| Emergency procedures | Dial 5555 |
| Security | Dial 5555 |
| Construction Safety Assessment Team Concurrence | ||
| Member | Signature | Date |
| Construction Safety | ||
| Safety Management | ||
| Engineering Services (CE, M&O, Projects) | ||
| Infection Control/ QM | ||
| Patient Safety | ||
| GEMS | ||
| Industrial Hygiene | ||
| EMS | ||
| SPHM&FPM |
Other Comments
Sheet1
Sheet2
Sheet3
Sheet4
Sheet5
2-Types & Risk TYPE A Inspection and Non-Invasive Activities Includes, but is not limited to:
Removal of ceiling tiles for visual inspection limited to 1 tile per 50 square feet Painting (but not sanding) Wall covering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.
TYPE B Small scale, short duration activities which create minimal dust Includes, but is not limited to:
Installation of telephone and computer cabling Access to chase spaces Cutting of walls or ceiling where dust migration can be controlled TYPE C Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies Includes, but is not limited to:
Sanding of walls for painting or wall covering Removal of floor coverings, ceiling tiles and casework New wall construction Minor duct work or electrical work above ceilings Major cabling activities Any activity which cannot be completed within single work shift TYPE D Major demolition and construction projects Includes, but is not limited to:
Activities which require consecutive work shifts Requires heavy demolition or removal of complete cabling systems New Construction
| Low Risk | Medium Risk | High Risk | Highest Risk |
| Office areas |
Medical records Non-patient care areas Cafeteria Cardiology clinic Echocardiography Endoscopy Nuclear Medicine Physical Therapy Radiology/MRI Respiratory Therapy CCU Emergency Room Laboratories (specimen) Admissions Outpatient Surgery Pharmacy Post Anesthesia Care Unit (PACU) Surgical Units Any area caring for immunocompromised patients Cardiac Cath Lab
SPS
Intensive Care Units Medical Units Negative pressure isolation rooms Oncology Operating rooms Invasive procedure rooms
3-ICRA2
Infection Control Risk Assessment (ICRA) Checksheet (check appropriate requirements)
| December 31, 1899 | ||||
| Class | During Construction Project | Upon Completion of Project | ||
| I | X | Execute work by methods to minimize raising dust from construction operations. | Immediately replace ceiling tile displaced for visual inspection. | |
| II | X | Provide active means to prevent airborne dust from dispersing into atmosphere. | X | Wipe work surfaces with disinfectant. |
| X | Water mist work surfaces to control dust while cutting. | Wet mop and/or vacuum with HEPA-filtered vacuum before leaving work area. | ||
| Seal unused doors with duct tape. | Remove isolation of HVAC system in areas where work is being performed. | |||
| Block off and seal air vents. | Contain construction waste before transport in tightly covered containers. | |||
| Place dust mat at entrance and exit of work area. | ||||
| Remove or isolate HVAC system in areas where work is being performed to prevent contamination of duct system. | ||||
| III | Class II (those checked) plus: | Do not remove barriers from work area until completed project is inspected by Safety and Infection Control and thoroughly cleaned by Environmental Management. | ||
| Complete all critical barriers i.e. sheetrock, plywood, plastic, to seal area from non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins. | Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. | |||
| Maintain negative air pressure within work site utilizing HEPA equipped air filtration units. | Vacuum work area with HEPA filtered vacuums. | |||
| Cover transport receptacles or carts. Tape covering unless solid lid. | Wet mop area with disinfectant. | |||
| IV | Class III (those checked) plus: | See other Classes. | ||
| Seal holes, pipes, conduits, and punctures appropriately. | ||||
| Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving work site or they can wear cloth or paper coveralls that are removed each time the worker leaves the worksite. | ||||
| All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area. |
4-ILSM Const
| Interim Life Safety Measures (ILSM) Assessment for Construction and Maintenance | ||
| Project Title or Type of Work: | 0 | |
| Project No. | 0 |
| Evaluate the project using the criteria below to determine which ILSM are applicable. | |||||
| Deficiency | Y or N? | Deficiency | Y or N? | ||
| Blocking off an approved exit | Installing sprinkler system (out of service) | Y | |||
| Rerouting of primary egress path | Significantly modifying smoke or fire barrier walls | N | |||
| Rerouting of secondary egress path | Adding an addition to an existing structure | ||||
| Rerouting of traffic to emergency care center | Taking fire alarm / sprinkler system out of service >4 hours | ||||
| Major renovation of an occupied floor | Disconnecting 4 or more alarm devices >4 hours | ||||
| Replacing the fire alarm system (out of service) | All / part of medical gas alarm panels out of service |
| 1 | Notify the fire department and initiate a fire watch. |
| 2 | Post signage identifying the location of alternative exits to everyone affected. |
| 3 | Inspect exits in affected areas on a daily basis. |
| 4 | Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired. |
| 5 | Provide additional firefighting equipment. |
| 6 | Use temporary construction partitions that are smoke-tight, or made of noncombustible or limited-combustible material that will not contribute to the development or spread of fire. |
| 7 | Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices. |
| 8 | Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level. |
| 9 | Provide additional training to those who work in the hospital on the use of firefighting equipment. |
| 10 | Conduct one additional fire drill per shift per quarter. All areas. |
| 11 | Conduct one additional fire drill per shift per quarter. Local area. |
| 12 | Inspect and test temporary systems monthly. |
| 13 | Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. |
| 14 | Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features. |
5-ILSM Defic
| Interim Life Safety Measures (ILSM) Assessment for Life Safety Code Deficiency | ||
| Deficiency: | 0 |
| Evaluate the deficiency using the criteria below to determine which ILSM are applicable. | ||||||
| Deficiency | Y or N? | Deficiency | Y or N? | |||
| Corridor door latching / gap / rating problems | N | Nonconforming building construction type | N | Y | ||
| Fire door latching / gap / rating problems | N | Improperly protected vertical openings | N | N | ||
| Smoke door latching / gap / rating problems | N | Large penetration in fire / smoke barriers | N | |||
| Lacking a code-compliant barrier | N | Corridor walls do not extend to the structure | N | |||
| Fire exit stairs discharge improperly | N | Fire protection systems* failure <4 hours | N | *alarm, detection or |
suppression
| Excessive travel distance to approved exit | N | Fire protection systems* failure >4 hours | N |
| Lacking two remote exits | N | Hazardous area not properly protected | N |
| 1 | Notify the fire department and initiate a fire watch. |
| 2 | Post signage identifying the location of alternative exits to everyone affected. |
| 3 | Inspect exits in affected areas on a daily basis. |
| 4 | Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired. |
| 5 | Provide additional firefighting equipment. |
| 6 | Use temporary construction partitions that are smoke-tight, or made of noncombustible or limited-combustible material that will not contribute to the development or spread of fire. |
| 7 | Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices. |
| 8 | Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level. |
| 9 | Provide additional training to those who work in the hospital on the use of firefighting equipment. |
| 10 | Conduct one additional fire drill per shift per quarter. All areas. |
| 11 | Conduct one additional fire drill per shift per quarter. Local area. |
| 12 | Inspect and test temporary systems monthly. |
| 13 | Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. |
| 14 | Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features. |
6-ILSM Contract ILSM Formal Contract
| Project Title / Deficiency: | 0 | Project No.: | 0 |
| COTR: | 0 | Contractor: |
Location and Description of Work:
Replace existing patient room sink faucets with auto-operated faucets
| Date of this Formal Contract: | December 31, 1899 | ||||||
| Mandatory ILSM | Yes | No | |||||
| 1 | Notify the fire department and initiate a fire watch. | ||||||
| 2 | Post signage identifying the location of alternative exits to everyone affected. | ||||||
| 3 | Inspect exits in affected areas on a daily basis. | ||||||
| 4 | Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired. | ||||||
| 5 | Provide additional fire-fighting equipment. | ||||||
| 6 | Use temporary construction partitions that are smoke-tight, or made of noncombustible or limited-combustible material that will not contribute to the development or spread of fire. | ||||||
| 7 | Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices. | ||||||
| 8 | Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level. | ||||||
| 9 | Provide additional training to those who work in the hospital on the use of firefighting equipment. | ||||||
| 10 | Conduct one additional fire drill per shift per quarter. All areas. | ||||||
| 11 | Conduct one additional fire drill per shift per quarter. Local area. | ||||||
| 12 | Inspect and test temporary systems monthly. | ||||||
| 13 | Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. | ||||||
| 14 | Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features. | ||||||
| Staff Training | |||||||
| Subject(s) | |||||||
| (use above numbers) | Names/Groups Trained | Date |
| Dates of Fire Drills | |||||
| Area | Date | Time | Area | Date | Time |
7-Inspection
MEDVAMC CONSTRUCTION SAFETY INSPECTION FORM
Project Title: Project Number:
| Inspector: | Inspection Date: | ||||
| Possible ILSMs from the Construction Safety Assessment | Required? | In Place? | Comments | ||
| Yes | No | ||||
| 1 | Notify the fire department and initiate a fire watch. | ||||
| 2 | Post signage identifying the location of alternative exits to everyone affected. | ||||
| 3 | Inspect exits in affected areas on a daily basis. | ||||
| 4 | Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired. | ||||
| 5 | Provide additional firefighting equipment. | ||||
| 6 | Use temporary construction partitions that are smoke-tight, or made of noncombustible or limited-combustible material that will not contribute to the development or spread of fire. | ||||
| 7 | Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices. | ||||
| 8 | Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level. | ||||
| 9 | Provide additional training to those who work in the hospital on the use of firefighting equipment. | ||||
| 10 | Conduct one additional fire drill per shift per quarter. All areas. | ||||
| 11 | Conduct one additional fire drill per shift per quarter. Local area. | ||||
| 12 | Inspect and test temporary systems monthly. | ||||
| 13 | Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. | ||||
| 14 | Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features. |
| Other Construction Issues | ||||||||
| Y | N | N/A | Y | N | N/A | Comments | ||
| Construction area warning sign posted? | Adequate lighting provided in all work areas? | |||||||
| All construction doors (including interstitial) closed and locked? | Hand held and mounted equipment properly guarded? | |||||||
| Evidence of dust and debris tracked to outside of barrier? | Aisles and passageways in good repair, kept clear and properly marked? | |||||||
| Mat/carpet at entrance? | Egress to and from work site unobstructed? | |||||||
| Floor, wall, ceiling penetrations sealed properly? | Fire extinguisher on site? | |||||||
| Ladders in good condition? | ||||||||
| Hot Work or Confined Space Permits posted? | MSDS available on site? | |||||||
| Area free of insects and rodents? | Gas cylinders secured? | |||||||
| Area under negative pressure? | Evidence of smoking? | |||||||
| Ventilation system adequately removes toxic dust and gases from work environment? | Electrical power cords in good condition? | |||||||
| Workers wearing or have available appropriate PPE? | Guardrails and toe boards provided for scaffolding that is open at all sides? | |||||||
| Safety harnesses being worn for work >6’ off the ground? | Additional Comments: |
8-Detailed Description of Work Detailed Description of Work
9- NEPA checklist
9- NEPA
| Project: | Location: | |||||||||
| Project Number: | ||||||||||
| Type of Project: | Project Description: | |||||||||
| Operation and Maintenance Activities | ||||||||||
| Repairs/Renovation Project | ||||||||||
| New Construction Project | ||||||||||
| Lease | ||||||||||
| Other | ||||||||||
| Level of NEPA Analysis: | Other Environmental Permits/Analysis Needed: | |||||||||
| Categorical Exclusion | ||||||||||
| Environmental Assessment Needed | ||||||||||
| Environmental Impact Statement Needed | ||||||||||
| Project Impacts: | ||||||||||
| Would the proposed activity involve or generate any of the following? | ||||||||||
| SOURCE | YES | NO | SOURCE | YES | NO | SOURCE | YES | NO | ||
| Air Emissions | ||||||||||
| including GHGs | Liquid Effluent | RCRA or CERCLA |
Sites
| Asbestos | Petroleum Storage | Wetlands |
| Excess Noise | Solid Waste | Permit |
Modification Utility Modification Hazardous Waste Chemical Use/Storage
| Soil Disturbance | Biological | |||||||
| Resources | Aesthetics | |||||||
| Water Treatment | Radioactive Waste | Water/Well Use | ||||||
| Water Flow | ||||||||
| Modification | Mixed Waste | Other | ||||||
| Determination: | ||||||||
| I find the proposed project qualifies as a CATEGORICAL EXCLUSION with no | ||||||||
| extraordinary circumstances. Specify which CATEX: | ||||||||
| I find that the proposed project MAY have a significant effect on the environment; | ||||||||
| therefore, an ENVIRONMENTAL ASSESSMENT will be prepared. | ||||||||
| EIS | ||||||||
| Recommended by: | Project Manager | Date: | ||||||
| Approved by: | Chief, Eng. Service | Date: | ||||||
| Approved by: | GEMS PM | Date: |
1. Repair, replacement and new installation of primary or secondary electrical distribution systems; 2. Repair, replacement and new installation of components such as windows doors, roofs, and site elements such as sidewalk, patios, fences, retaining walls, curbs, water distribution line and sewer lines which involve work totally within VA property boundaries;
3. Routine VA grounds and facility maintenance activities;
4. Procurement and activities for goods and services for routing facility operations maintenance and support;
5. Interior construction or renovation;
6. New construction of 75,000 gross square feet or less;
7. Development of 20 acres of land or less within an existing cemetery, or development on acquired land of five acres or less.
8. Actions which involve support or ancillary appurtenances for normal operation;
9. Leases, licenses, permits, and easements;
10. Reduction in force resulting from workload adjustments, reduced personnel or funding levels, skill imbalances or other similar causes;
11. VA policies, actions and studies which do not significantly affect the quality of the human environment; 12. Preparation of regulations, directives, manuals, or other guidance that implement, but do not substantially change, the regulations, directives, manuals, or other guidance of higher organizational levels or another Federal agency, and
13. Actions, activities. Or programs that do not require expenditure of Federal funds.
*38CFR Part 26.6(b)(1)
Examples of VA's Extraordinary Circumstances The following examples are illustrative of Extraordinary Circumstances where an action would typically require further NEPA evaluation (an EA or EIS).
These are not intended to be comprehensive, but they will help you to identify extraordinary circumstances when they exist.
1. Greater scope or size than normally experienced for a particular categorical exclusion
2. Actions in highly populated or congested areas
3. Potential for degradation, although slight, or existing poor environmental conditions
4. Use of unproven technology
5. Potential presence of an endangered species, archaeological remains, or other protected resources
6. Potential presence of hazardous or toxic substances
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