J-1502000-02(DHA)-04_ISLM Assessment Form.pdf
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- Attached to
- DRAFT Solicitation, Base Operations Support (BOS) Services at Naval Station Guantanamo Bay, Cuba
- Solicitation number
- N6945022R0032
About this file
This document contains an Interim Life Safety Measure (ILSM) Assessment Form for the USN Naval Guantanamo Bay Hospital project. The form requires identification of code deficiencies at the site such as patient room door latching problems, lack of smoke barriers, improper fire exit discharge, excessive travel distances to exits, lack of two remote exits for large rooms or suites, non-conforming building construction types, improperly protected vertical openings, large penetrations in fire barriers, unprotected hazardous areas, inaccessible or inoperable fire/smoke dampers, blocked exits, rerouting of traffic to the emergency room, major renovations of occupied floors, significant modifications to smoke or fire barrier walls, and fire alarm or sprinkler systems out of service for over four hours. For any deficiencies identified, the form requires selection of applicable interim life safety measures and signatures of approval. Related details involve scope of work, comments, and safety concerns.
A separate document provides details for a Draft Solicitation for Base Operations Support (BOS) Services at Naval Station Guantanamo Bay, Cuba to be issued by the Department of the Navy Naval Facilities Engineering Command. The BOS services include labor, supervision, management, tools, materials, equipment, facilities, transportation, incidental engineering and other items necessary for family housing, facility management, facility investment, custodial services, pest control, integrated solid waste management, grounds maintenance and landscaping, utilities including electrical, wastewater and water, and base support vehicles and equipment.
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Text version
USN Naval Guantanamo Bay Hospital Interim Life Safety Measure (ILSM) Assessment Form
Project Name or Deficiency:
Estimated Start Date:
Estimated End Date:
Location:
1) In sp ec ts e xi ts in a ffe ct ed ar ea s on a d ai ly b as is
2) Pr ov id es te m po ra ry fi re al ar m /d et ec tio n sy st em s
3) Pr ov id es a dd iti on al fi re fig ht in g eq ui pm en t
4) U se s te m po ra ry co ns tru ct io n pa rti tio ns
5) In cr ea se d ha za rd su rv ei lla nc e
6) En fo rc in g st or ag e, ho us ek ee pi ng re m ov al
7) Pr ov id es a dd iti on al tr ai ni ng on fi re -fi gh tin g eq ui pm en t
8) C on du ct s ad di tio na l f ire dr ill pe r s hi ft pe r q ua rte r, if >4 da ys
9) In sp ec ts te st s te m po ra ry sy st em s m on th ly
)E du ca tio n/ no tif ic at io n of de fic ie nc y/ ha za rd /m ea su re
)T ra in s to c om pe ns at e fo r im pa ire d fir e sa fe ty fe at ur es
)E m er ge nc y Fo rc es n ot ifi ed
)F ire W at ch in iti at ed
)A lte rn at e ex its d es ig na te d an d si gn ag e po st ed
LIFE SAFETY CODE DEFICIENCY YES NO
a. Patient room door latching problem X X
b. Lacking a code complying smoke barrier X X X
c. Fire exit stairs discharge improperly X X X X
d. Excessive travel distance to an approved exit (>150 ft/>200 ft)* X X
e. Lack of two remote exits (Rooms/Suites > 2,500sqft) X X X
f. Non-conforming building construction type X X
g. Improperly protected vertical openings X X
h. Large penetrations in fire barriers X X
i. Hazardous areas not properly protected X
j. Inaccessible fire/smoke damper X
k. Inoperable fire/smoke damper X X
l. Blocking off an approved exit X X X X X X
m. Re-routing of traffic to the emergency room X
n. Major renov. of an occupied floor ** X X X X X X X X X
o. Significantly modifying smoke or fire barrier walls X X X X X X
p. Fire alarm system out of service for more than four hours*** X X X X X X X X X
q. Sprinkler system out of service for more than four hours*** X X X X X X X X X
r. Vibration/ Noise
s. Specify, if not listed above:
REQUIRED SIGNATURES FOR APPROVAL:
Facilities Dept/Date: ______________________________________ Department Leadership/Date: ______________________________ Project Manager/Date: ____________________________________ Contractor/Date:_________________________________________
Indicate if ILSM is required for each code deficiency
OTHER SAFETY CONCERNS
SUPERVISORY FIRE ALARM AND SUPPRESSION SYSTEM
COMMENTS:
SCOPE OF WORK:
ILSM
| LIFE SAFETY CODE DEFICIENCY: |
| YESa Patient room door latching problem: |
| NOa Patient room door latching problem: |
| YESb Lacking a code complying smoke barrier: |
| NOb Lacking a code complying smoke barrier: |
| YESc Fire exit stairs discharge improperly: |
| NOc Fire exit stairs discharge improperly: |
| YESd Excessive travel distance to an approved exit 150 ft200 ft: |
| NOd Excessive travel distance to an approved exit 150 ft200 ft: |
| YESe Lack of two remote exits RoomsSuites 2500sqft: |
| NOe Lack of two remote exits RoomsSuites 2500sqft: |
| YESf Nonconforming building construction type: |
| NOf Nonconforming building construction type: |
| YESg Improperly protected vertical openings: |
| NOg Improperly protected vertical openings: |
| YESh Large penetrations in fire barriers: |
| NOh Large penetrations in fire barriers: |
| YESi Hazardous areas not properly protected: |
| NOi Hazardous areas not properly protected: |
| YESj Inaccessible firesmoke damper: |
| NOj Inaccessible firesmoke damper: |
| YESk Inoperable firesmoke damper: |
| NOk Inoperable firesmoke damper: |
| YESl Blocking off an approved exit: |
| NOl Blocking off an approved exit: |
| YESm Rerouting of traffic to the emergency room: |
| NOm Rerouting of traffic to the emergency room: |
| YESn Major renov of an occupied floor: |
| NOn Major renov of an occupied floor: |
| YESo Significantly modifying smoke or fire barrier walls: |
| NOo Significantly modifying smoke or fire barrier walls: |
| Facilities DeptDate: |
| Department LeadershipDate: |
| Project ManagerDate: |
| ContractorDate: |
| Text57: |
| Text58: |
| Text59: |
| Text60: |
| Text61: |
| Text62: |
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