J.09 Form_3900-18.pdf

Pre-Construction/Installation Environmental and Occupational Safety and Health Checklist

INSTRUCTIONS FOR COMPLETING FAA FORM 3900-18

FAA Form 3900-18 (03/15) Electronic Version (PDF) Page i of iii

Section A. Purpose. FAA Form 3900-18, Pre-Construction/Installation Environmental and Occupational Safety and Health (EOSH) Checklist, must be used to review construction, installation and non-routine maintenance activities involving construction prior to commencement of work that potentially has EOSH impacts on NAS operations and employees. The organization that directly manages the construction project is responsible for completing the checklist. They must coordinate with the appropriate District Office prior to commencement of work. Construction must not be initiated prior to completion and review of the checklist. This form must be used at the pre-construction meeting and similar meetings. Emphasis should be placed on using this checklist as a tool to assess as well as reassess hazards as the work progresses.

Responsibilities: Responsibility for completing the checklist may vary depending on the work being performed.

a. The District Office Manager will be responsible for District Office projects.

b. The Project Engineer for Engineering Services projects.

c. The Facilities Maintenance Program (FMP) Manager for FMP projects.

d. For turnkey projects managed by Headquarters organizations, the Headquarters program office will be responsible for completing the checklist.

Section B. Work Summary Information. The individual/organization initiating the checklist will complete this portion of the checklist.

1. District Office: Name of the District Office.

2. Work Location: City, State, Airport, building, room within building.

3. Facility: Facility type, associated runway, facility LOC ID.

4. Work Description: Provide a concise statement as to the nature of the work to be accomplished. Example: Asbestos abatement of the control room attic.

5. Project Number/JCN: Provide the Project Number and or Job Control Number (JCN).

6. Planned Start Date: Provide the expected start date of the work.

7. Expected Completion Date: Provide the expected completion date of the work.

8. Contractor Contact: Provide the name and telephone number for a contractor representative who has the authority to make decisions and implement stop work/change orders. If the work is being accomplished by an FAA employee(s) or FAA contract employee(s), provide the name, organization, and telephone number of the on-site lead.

9. Project/Design Representative: Provide the name for the designer of the work (e.g., Engineering Services project engineer, District Office engineer, Headquarters program manager for turnkey projects).

10. COR/Specialist: Provide the name, organization, and telephone number of the on-site lead (e.g., Contracting Officer’s Representative, Resident Engineer).

11. District Office EOSH Contact: Provide the name and telephone number of the person responsible for the occupational safety and health/environmental program for the District Office (e.g., SECM, District Office EOSH Professional).

12. Facility Representative: Provide the name and telephone number for an ATO representative at the facility who has the authority to make decisions for facility management.

Section C. Evaluation: The District Office Manager or designee may evaluate whether the remainder of the checklist needs to be completed. If necessary, the District Office Manager or designee will be provided any additional information regarding the project that will facilitate their determination on whether the remainder of the checklist should be completed.

If there is an impact (yes), forward the checklist to the organization directing the construction project for completion of the remainder of the checklist. If there is no impact, provide a justification, sign and date the form, and then proceed to Section I, Distribution List, for distribution only. The designee may be the COR, SSC Manager, or other party.

Section D. Facility Procedures: The individuals/organization performing the work, and their contractors, along with the facility POC, must review all applicable facility specific procedures and plans. The intent of this section is to review applicable facility procedures and plans for the project and that it may be necessary to supplement this form.

1. Asbestos Contingency Plan: Determine the responsibilities of the personnel performing the work in the event of an incident requiring implementation of the asbestos contingency plan.

2. Hazard Communication: The personnel performing the work must be made familiar with the facility Hazard Communication program. Information such as safety data sheets (SDS) must be shared between the facility and the personnel performing the work.

3. Lockout/Tagout (LOTO): The work must be performed in accordance with the facility LOTO program. Determine if the facility LOTO procedures require equipment to be locked out/tagged out by an FAA technician, or if the personnel performing the work will be allowed to LOTO the equipment.

FAA Form 3900-18 (03/15) Electronic Version (PDF) Page ii of iii

4. Work Permits: Applicable FAA facility, District Office, or Service Area work permits must be submitted by the individuals/organization performing the work, signed and posted at the work site. General note: All work permits should be included in this document (e.g., asbestos, lead, hot work, welding, cutting, brazing).

5. Emergency Plans: Describe the responsibilities, including the points of contact, in the event of an incident that requires implementation of the facility Occupant Emergency Plan or Fire Prevention Plan

6. Impacts to Fire Protection Systems (e.g., fire alarm, fire suppression, smoke control, fire rated doors): Identify the Fire Alarm and Suppression System and instructions to avoid unintentional impact to it. If the work involves intentional impact to the Fire Alarm and Suppression System, determine what coordination has to be done to ensure no disruption of the NAS. Determine what interim life safety measures (i.e., egress pathways, occupant emergency notification & fire alarm impairments) will be required during the project.

7. Confined Space Entry: Describe the facility procedures used in and around confined spaces. In addition, describe specific procedures for permit-required confined space in and around where the work will take place.

8. Work at Heights: Describe procedures for working at elevated surfaces (e.g., catwalks, towers, roofs) that may require fall protection procedures or equipment. Review rescue procedures and ensure awareness of responsibilities.

9. Restricted Areas due to EOSH Concerns: Describe those areas of the facility that have restricted access due to safety and health hazards (e.g., asbestos regulated areas, radiation, noise).

10. First Aid/Bloodborne Pathogens: Describe the facility procedures for dealing with emergency first aid situations and other trauma situations.

11. Other: The personnel performing the work should be made familiar with other facility programs, procedures, and requirements.

Section E. Activity Hazard: The individuals/organization performing the work, and their contractors, along with the facility POC, must identify potential EOSH hazards that may be encountered during the accomplishment of the work. Determine the possibility of causing disruption of NAS operations.

1. Asbestos: Determine if known or assumed asbestos containing material will be impacted by this work.

2. Chemical, Gases, Fumes, Vapors, Mist, Dust, Radiation: Determine if any products or methods will be used that may cause odors or vapors (from chemicals volatizing or biological agents), fumes (from welding or burning), excessive dust (e.g., sanding, grinding), or radiation (e.g., heat sources, light sources such as lasers, ionizing radiation sources such as X-ray equipment).

3. Use and Storage of Hazardous Materials: Determine if substances that exist at the facility may be impacted and what substances may be brought into the facility, which may have an impact on the facility and/or occupants.

4. Waste Management: Determine if work activities will generate wastes (e.g., construction waste, hazardous waste) and what procedures will be used for waste management (e.g., accumulation area, training).

5. Impact on HVAC System: Determine whether the environmental control elements of the facility may be impacted by the accomplishment of the work.

6. Equipment Removal/Installations: Determine if work activities will cause disturbance of excessive dust (e.g., disturbance of equipment which has been in place for a long time).

7. Fire Protection: Determine if work activities will impact fire protection systems and procedures at the facility (e.g., blocking egress, removing fire stopping, impacting fire rated barriers).

8. Impact to Integrity of Fire Alarm/Suppression System: Identify impacts to the fire alarm and suppression system. If the work involves intentional impact to the fire alarm and suppression system, determine what coordination has to be done to ensure no disruption of the NAS. Determine what interim life safety measures will be required during the project.

9. Lead Exposure: Determine if activities will expose FAA employees to lead dust, lead fumes, or other exposure to lead from known or assumed lead-containing material during the construction project.

10. Electrical Safety: Determine if work activities will expose FAA employees to electrical safety hazards (e.g., open electrical panel doors, exposed energized conductors, energized work).

11. Excessive Noise Exposure: Determine if work activities will expose FAA employees to excessive noise.

12. Walking Working Surfaces: Determine if work activities will expose FAA employees to tripping, slip and fall hazards (e.g., open panels in a raised floor, uneven floors, raised or loose carpeting, stairs, wet floors, etc.).

13. Work above Equipment/People: Determine if work activities will expose FAA employees to objects dropped from above.

14. Water Quality/Sanitation: Determine if work activities may cut off or contaminate the facility’s potable water system.

15. Cranes/Rigging/Hoisting: Determine if work activities will expose FAA employees to hazards associated with rigging, hoisting and cranes.

FAA Form 3900-18 (03/15) Electronic Version (PDF) Page iii of iii

16. Lighting: Determine if work activities will create insufficient lighting for FAA employees.

17. Machinery and Mechanized Equipment: Determine if work activities may expose FAA employees to hazards such as being struck by, caught in, or injured by machinery and mechanized equipment.

18. Excavation: Determine if work activities performed near facilities may cause catastrophic failure of a NAS facility.

19. Other: Other work activities that may impact NAS operations and employees.

Section F. Site Safety and Health – Controls. Ensure that measures and controls to address applicable site safety and health risks (e.g., through discussions, available site safety plans, or other applicable documents) have been identified. If a hazard has been identified in Section E, Activity Hazard, briefly describe the controls to be used.

1. Identify issues/hazards in Section E, Activity Hazard.

2. “Description of Controls” – The purpose of this column is to very briefly describe the controls in place for addressing each hazard.

Section G. Site Walk-Through: Following review of all applicable facility procedures, activity hazards and applicable control measures, the personnel performing the work must participate in a walk-through of the area of the facility where the work will be accomplished, led by a facility representative. The purpose of the walk-through is to allow the personnel performing the work to be introduced to the facility and the potential hazards as referenced in Sections E and F. It also allows the personnel performing the work to become familiar with the facility with respect to the work being done and awareness of the method of implementation of the various emergency plans. If the project is located at a staffed Air Traffic facility, inclusion of the Air Traffic Manager is warranted. The time, date, and personnel present for the walk-through must be recorded in Section G.

Section H. Review Information. This form must be reviewed by those individuals identified below, as appropriate, during design of the project, during pre-bid conferences, prior to the beginning of work (preferably at or prior to the pre-construction conference) and periodically throughout the completion of the project.

1. Originator: This is the individual/organization responsible for initiating the work (e.g., project engineer, senior engineer, technical support office) or the organization directly managing the day-to-day activities in the construction project.

2. Contractor/Installation Crew Lead/Specialist: These are the individuals performing the work who have the authority to make decisions and implement stop work/change orders. If the work is being accomplished by an FAA employee or an FAA contract employee, the employee should sign the form and provide a routing symbol and platform title.

3. District Office Manager or designee: This person must be the District Office Manager or designee. The designee may be the COR, SSC Manager, or other party.

Section I. Distribution List: This form must be forwarded to the following as applicable:

1. District Office Manager.

2. Safety and Environmental Compliance Manager (SECM) or District Office EOSH Professional.

3. Engineering Services EOSH Coordinator.

4. Engineering Services Manager.

5. Engineering Services Project Engineer.

6. Contracting Officer’s Representative.

7. Facility Air Traffic Manager.

FAA Form 3900-18 (03/15) Electronic Version (PDF) Page 1 of 5

Section A. Purpose

This checklist is intended to review construction, installation and non-routine maintenance activities, prior to commencement, that potentially have occupational safety and health related impacts on NAS operations and employees. This tool must be used, as appropriate, during critical phases of the work (e.g., the pre-construction meeting, prior to commencement of work, etc.). Emphasis should be placed on using this checklist as a tool to assess as well as reassess hazards as the work progresses. This form is required to be completed as per FAA Order JO 3900.57A.

Section B. Work Summary Information The purpose of this section is to provide a brief description of the construction project and/or specific maintenance tasks, and identify key personnel responsible for project completion. Fill in the requested site-specific information. Indicate if this work will occur in or adjacent to an occupied space (e.g., equipment room, ATCT cab, etc.). Note: Provide further explanation of activities on additional sheets if necessary.

1. District Office: 2. Work Location: 3. Facility:

4. Work Description:

5. Project Number/JCN: 6. Planned Start Date: 7. Expected Completion Date:

8. Contractor Contact Name: Phone:

9. Project/Design Representative Name: Phone:

10. COR/Specialist Name: Phone:

11. District Office EOSH Contact Name: Phone:

12. Facility Representative Name: Phone:

Section C. Evaluation

The purpose of this section is to allow the District Office Manager or designee to determine whether the remainder of the checklist needs to be completed. If there is a potential EOSH hazard, then no signature is required in Section C and subsequent sections of the form are to be completed by the organization managing the construction project or maintenance task. If there is no potential hazard, the District Office Manager or designee must sign below and provide an explanation, then proceed to Section I.

Yes

Is there a potential EOSH hazard?

(Explanation) No (if no, explain)

Name: (print)

(Title)

Signature:

(Date)

FAA Form 3900-18 (03/15) Electronic Version (PDF) Page 2 of 5

Section D. Facility Procedures

Review site-specific FAA procedures and considerations with the contractor/installer/specialist. For example, discuss when or how during the work, emergency plans will be required and/or used.

Facility Procedures Reviewed?

[Yes/No/N/A] Notes

1. Asbestos Contingency Plan

2. Hazard Communication (e.g. SDSs)

3. Lockout/Tagout

4. Work Permits (e.g., asbestos, lead, hot work)

5. Emergency Plans (e.g., Occupant Emergency Plan)

6. Impacts to Fire Protection Systems

7. Confined Space Entry

8. Work at Heights

9. Restricted Areas due to EOSH Concerns

10. First Aid/Bloodborne Pathogens

11. Other

NOTE: Think about your work and its potential hazards. Consider sensitive NAS operations and all facility personnel that may be impacted by your work. As an example, construction activities with potential for impacting asbestos materials in or near sensitive operations could result in incidents that may disrupt NAS operations.

Section E. Activity Hazard Note: Provide further explanation of potential hazards, locations, etc. below and attach additional sheets if necessary.

Potential Hazardous Exposures and/or Activities Consider Sensitive NAS Operations

Potential for Exposure/Release

/ Incident [Yes/No/N/A]

Description of Hazard

1. Asbestos (e.g., tiles & insulation)

2. Chemical, Gases, Fumes, Vapors, Mist, Dust, Radiation

a. Painting/Solvent/Adhesive/Sealant

b. Grinding/Sanding/Cutting/Welding/Soldering

c. Indoor Air Quality (e.g., biological agents, mold, odors, CO2)

3. Use and Storage of Hazardous Materials (e.g., flammables, compressed gas)

4. Waste Management

5. Impact on HVAC System

6. Equipment Removal/Installation (e.g., dust disturbance)

7. Fire Protection (e.g. blocked egress, fire barrier penetration)

FAA Form 3900-18 (03/15) Electronic Version (PDF) Page 3 of 5

Potential Hazardous Exposures and/or Activities Consider Sensitive NAS Operations

Potential for Exposure/Release

/ Incident [Yes/No/N/A]

Description of Hazard

8. Impact to Integrity of Fire Alarm/Suppression System(s)

9. Lead Exposure (e.g., lead-based paint)

10. Electrical Safety

a. Work on Live Electrical Systems

b. Temporary Wiring

11. Excessive Noise Exposure

12. Walking/Working Surfaces (e.g., tripping hazards, work at heights)

13. Work above Equipment/People

14. Water Quality/Sanitation

15. Cranes/Rigging/Hoisting

16. Lighting

17. Machinery and Mechanized Equipment (e.g., operator training and certification and equipment certification)

18. Excavation

19. Other

Section F. Site Safety and Health – Controls After reviewing the potential hazards in Section E, ensure that measures and controls to address applicable site safety and health risks (e.g., through discussions, available site safety plans, or other applicable documents) have been identified. If a hazard has been identified in Section E, briefly describe the controls to be used.

Note: Provide further explanation of controls below and attach additional sheets if necessary.

Potential Hazardous Exposures and/or Activities Identified as a hazard in Section E? [Yes/No/N/A]

Description of Controls (e.g., addressed in Accident Prevention Plan or Site Safety

Plan)

1. Asbestos (e.g. tiles & insulation)

2. Chemical, Gases, Fumes, Vapors, Mist, Dust, Radiation

a. Painting/Solvent/Adhesive/Sealant

b. Grinding/Sanding/Cutting/Welding/Soldering

c. Indoor Air Quality (e.g., biological agents, mold, odors, CO2)

3. Use and Storage of Hazardous Materials (e.g., flammables, compressed gas)

4. Waste Management

5. Impact on HVAC System

FAA Form 3900-18 (03/15) Electronic Version (PDF) Page 4 of 5

Potential Hazardous Exposures and/or Activities Identified as a hazard in Section E? [Yes/No/N/A]

Description of Controls (e.g., addressed in Accident Prevention Plan or Site Safety

Plan)

6. Equipment Removal/Installation (e.g., dust disturbance)

17. Machinery and Mechanized Equipment (e.g., operator training and certification and equipment certification)

18. Excavation

19. Other

10. Electrical Safety

a. Work on Live Electrical Systems

b. Temporary Wiring

11. Excessive Noise Exposure

12. Walking/Working Surfaces (e.g., tripping hazards, work at heights)

13. Work Above Equipment/People

14. Water Quality/Sanitation

15. Cranes/Rigging/Hoisting

16. Lighting

7. Fire Protection (e.g., blocked egress, fire barrier penetration)

8. Impact to Integrity of Fire Alarm/Suppression System(s)

9. Lead Exposure (e.g., lead-based paint)

Section G. Site Walk-Through Time/date of site walk-through with appropriate personnel (e.g., District Office representative, SSC Manager, SECM, Air Traffic Manager, Resident Engineer, COR, Contractor).

Site Walk Through:

(Date) (Time)

Appropriate Personnel:

(Name) (Organization)

(Name) (Organization)

(Name) (Organization)

FAA Form 3900-18 (03/15) Electronic Version (PDF) Page 5 of 5

Section H. Review Information The appropriate FAA point-of-contact and the contractor/installation crew lead/specialist print and sign below to document discussion of the items on this form.

Completed By:

FAA Originator of Work (e.g., Project Engineer, Resident Engineer):

(Print or Type Name) (Signature ) (Title) (Date)

Contractor Name:

(Print or Type Name) (Signature ) (Title) (Date)

Reviewed By:

District Office Manager or Designee:

(Print or Type Name) (Signature ) (Title) (Date)

Section I. Distribution List

This form must be forwarded to the following as applicable: Name/Routing Symbol

1. District Office Manager

2. SECM/District Office EOSH Professional

3. Engineering Services EOSH Coordinator

4. Engineering Services Manager

5. Engineering Services Project Engineer

6. Contracting Officer (if contractor resources perform the construction work)

7. Facility Air Traffic Manager

Site Safety and Health Controls question 5- Description of Controls: