J01g - ICRA Template.docx
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- Solicitation number
- 75H701-23-R-00048
About this file
This document contains a risk assessment template and federal contract opportunity notice. The risk assessment template is to be completed for construction and renovation projects at the Peach Springs Health Center in Arizona. It addresses infection control, indoor air quality, noise and vibration, utility requirements, and emergency procedures.
The federal contract opportunity is a solicitation notice for a construction project at the Peach Springs Health Center. The purpose of the project is to replace an existing failed dry-pipe sprinkler system with a new wet-pipe system, replace HVAC units beyond their useful lives, and replace outdated communication cabling. The construction magnitude is estimated between $1 million to $5 million. The period of performance is 365 calendar days from the notice to proceed. The contract type will be firm fixed price. The solicitation will use lowest price technically acceptable evaluation criteria and will be set aside for small businesses with average annual revenue less than $45 million.
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Attachment J01g – ICRA Template Peach Springs Replace Sprinkler System, HVAC, and Communication Cabling
HEALTH CARE FACILITY
CONSTRUCTION AND/OR RENOVATION RISK ASSESSMENT
PROJECT NAME: Peach Springs Replace Sprinkler System, HVAC, and Communication Cabling
DESCRIPTION:
UNUSUAL FEATURES:
| IN HOUSE CONSTRUCTION: | Yes | No | |
| OUTSIDE CONTRACTOR: | Yes | No | |
| PERMIT REQUIRED: | Yes | No |
PREPARED BY:
SIGNATURE:
DATE:
This risk assessment addresses Infection Control, Indoor Air Quality, Noise and Vibration, Utility requirements and Emergency Procedures.
To be completed for all renovation and new construction at Peach Springs Health Center.
Patient, staff or visitor risk group.
| Low Risk |
| Medium Risk |
| High Risk |
| Highest Risk |
| Office Areas |
| Clinical Areas |
| Laboratories |
| Sterile Areas |
| Maintenance |
| Radiology (X-ray) |
| Pediatrics |
| Med. Prep |
| Housekeeping |
| Physical Therapy |
| Pharmacy |
| Isolation Rooms |
| Storage Areas |
| Dental |
| Occupied Patient Rooms |
| Sterile Supply |
| Administration |
| Patient Corridors |
| Meeting Rooms |
| Mental Health |
Nurse Lounge
Non-patient corridors
Empty Patient Rooms
Exterior
Type of Construction for each of the five risk areas.
1. INFECTION CONTROL
TYPE A
Inspections - Removal of ceiling tiles, limited to 1 tile per 50 square feet.
Structural - Small-scale repairs, not generating dust.
Plumbing - Minor activities not generating dust or debris.
Electrical - Routine in nature, not generating dust.
Architectural – Minor activities not generating dust or debris.
TYPE B
Cabling - Installation of computer or telephone cables above ceiling or in walls.
Electrical - Installation of wiring not required to be in conduit.
Structural - Repairs where dust can be controlled.
Plumbing - Activities limited to an isolated location.
Architectural – Activities that generate minor amounts of dust, removal/cutting of less than one panel of gypsum wall up to one room.
TYPE C
Structural - Renovation that generates a moderate to high level of dust.
Plumbing - Renovation or construction that requires a minimal amount of removal or replacement of sewer lines, water lines or medical gas lines.
Electrical - Extensive installation of electrical components in a controlled area.
HVAC - Small-scale removal of ducts or HVAC accessory components.
Cabling - Large-scale cabling that requires wall and ceiling penetrations.
Sanding/Painting - Any activity that creates dust.
Floor Covering - Removal of existing floor covering in controlled areas.
Architectural – Activities that generate considerable amounts of dust, removal of one or more gypsum wall panels.
TYPE D
Structural - Major renovation that requires consecutive work shifts.
Plumbing - Major renovation or construction that requires removal or replacement of sewer lines, water lines or medical gas lines.
Electrical - Extensive installation of electrical components.
HVAC - Removal of ducts or HVAC accessory components.
Cabling - Major cabling that requires extensive removal or installation of a total cabling system.
Floor Covering - Removal of existing floor covering in corridors or patient areas.
Architectural – Major architectural work, more than one room in scope.
2. INDOOR AIR QUALITY
TYPE A
Painting - Touch-up only, less than 100 sq. ft., brush or roller.
Chemical Usage - Spray lubricants, cleaners in small amounts.
Adhesives - Wood glue, floor tile adhesive in small amounts, less than 100 sq. ft.
TYPE B
Painting - Areas larger than 100 sq. ft. and up to a single room size, brush or roller.
Varnish - Touch-up only, less than 50 sq. ft.
Grinding - A minimum amount, isolated areas, less than two minutes of continuous use.
Chemical Usage - Extended use of lubricants or cleaners.
Adhesives - Areas larger than 100 sq. feet and up to a single room size.
TYPE C
Painting - One to three rooms, brush or roller.
Varnish - Between 50 and 100 sq. ft.
Grinding - Extensive grinding, Greater than two minutes of continuous use in a 1 hour period.
Welding - Any.
Brazing - Any.
Soldering - Any.
Chemical Usage - Extensive use not allowed in hospital.
TYPE D
Painting - Major renovation, brush or roller. Spray-painting not allowed in hospital.
Varnish - Areas greater than 100 sq. ft.
Grinding - Major renovations that require the use of large mechanical grinding equipment.
Welding, Brazing, Soldering - Associated with major renovation.
Adhesives - Extensive use for floor removal not allowed in hospital.
Asbestos Containing Material - Removal of floor covering and mastic.
Asbestos Containing Material - Removal of pipe insulation.
Lead-based Material - Removal, grinding, sanding, cutting.
3. NOISE AND VIBRATION
TYPE A
Pounding - Minimum amount, less than 20 minutes of intermittent noise, no vibration, nothing on the concrete deck or exterior walls.
Drilling - Minimum amount, less than 20 minutes of intermittent use, with little noise, no hammer drilling, nothing on the concrete deck or exterior walls.
Miscellaneous Power Tools - Minimum noise, short-term repairs, less than 20 minutes of intermittent use.
TYPE B
Pounding - 20 minutes to 2 hours of intermittent noise associated with small renovations, nothing on the concrete deck or exterior walls.
Drilling - 20 minutes to 2 hours of intermittent noise associated with small renovations, nothing on the concrete deck or exterior walls.
Miscellaneous Power Tools - 20 minutes to 2 hours of intermittent noise associated with small renovations, nothing on the concrete deck or exterior walls.
TYPE C
Pounding - Greater than 2 hours of noise, intermittent to continuous, less than 20 minutes involving the concrete deck or exterior walls.
Drilling - Greater than 2 hours of noise, intermittent to continuous, less than 20 minutes involving the concrete deck or exterior walls.
Grinding/Scraping - Associated with floor covering removal, minimal amounts, less than 25 sq. ft.
Miscellaneous Power Tools - Repeated use, greater than 2 hours of intermittent to continuous noise, less than 20 minutes involving the concrete deck or exterior walls.
TYPE D
Pounding - Major renovation, continuous noise and vibration on a daily basis, substantial involvement of the concrete deck or exterior walls.
Drilling - Major renovation, continuous noise and vibration (hammer drilling), substantial involvement of the concrete deck or exterior walls.
Grinding/Scraping - Associated with floor covering removal, extensive amounts, greater than 25 sq. ft.
Miscellaneous Power Tools - Use of power tools associated with major renovation, continuous noise and vibration on a daily basis, substantial involvement of the concrete deck or exterior walls.
4. UTILITY REQUIREMENTS
TYPE A
Routine Maintenance - Isolated areas, less than 4 hours.
Interruption of domestic water, sewer, HVAC or electrical systems.
TYPE B
Routine Maintenance - Controlled area, 4 to 8 hours.
Interruption of domestic water, sewer, HVAC or electrical systems.
TYPE C
Maintenance or testing requiring temporary interruption of the fire alarm system for less than 4 hours.
Maintenance or testing requiring temporary interruption of the domestic water, sewer or HVAC for more than 8 hours.
Maintenance or testing of the oxygen, medical gas or vacuum lines for less than 2 hours.
Construction or maintenance requiring partial blockage of corridors, egress pathways, exits or stairways for less than 4 hours.
Construction, maintenance or testing requiring the interruption of the sprinkler system for less than 4 hours.
TYPE D
Construction or maintenance requiring long-term interruption of the fire alarm system, more than 4 hours.
Construction or maintenance requiring long-term interruption of the domestic, water, sewer, HVAC or electrical systems for more than one day.
Construction or maintenance requiring any shut down of the emergency generator or emergency electrical system.
Construction, maintenance or testing of the medical gases for greater than 2 hours.
Construction or maintenance requiring the blockage of corridors, egress pathways, exits or stairways for more than 4 hours.
Construction, maintenance or testing requiring the interruption of the sprinkler system for more than 4 hours.
5. EMERGENCY PROCEDURES
TYPE A
Routine Maintenance - Isolated areas, less than 4 hours.
Interruption of fire alarm, sprinkler system, or other life safety condition.
TYPE B
Routine Maintenance - Controlled area, 4 to 8 hours.
Interruption of fire alarm, sprinkler system, or other life safety condition.
TYPE C
Maintenance or testing that requires temporary interruption of the fire alarm, sprinkler system or other life safety condition for more than 8 hours.
Maintenance or testing of the oxygen, medical gas or vacuum lines for less than 2 hours.
Construction or maintenance that requires partial blockage of corridors, egress pathways, exits or stairways for less than 4 hours.
TYPE D
Construction or maintenance that requires long-term interruption of the fire alarm system, for an extended period of time. Construction of a new fire alarm system.
Construction or maintenance that requires long-term interruption of the domestic, water, sewer, HVAC or electrical systems for more than one day.
Construction or maintenance that requires any shut down of the emergency generator or emergency electrical system.
Construction, maintenance or testing of the medical gases for greater than 2 hours.
Construction or maintenance that requires the blockage of corridors, egress pathways, exits or stairways for more than 4 hours.
Construction, maintenance or testing that requires the interruption of the sprinkler system for more than 4 hours.
Type of Construction with the risk group for each of the five areas.
1. INFECTION CONTROL
TYPE
A
TYPE
B
TYPE
C
TYPE
D
| Low Risk |
| I |
| II |
| II |
| III / IV |
| Medium Risk |
| I |
| II |
| III |
| IV |
| High Risk |
| I |
| II |
| III / IV |
| IV |
| Highest Risk |
| I |
| III / IV |
| IV |
| IV |
2. INDOOR AIR QUALITY
TYPE
A
TYPE
B
TYPE
C
TYPE
D
| Low Risk |
| I |
| II |
| II |
| III / IV |
| Medium Risk |
| I |
| II |
| III |
| IV |
| High Risk |
| I |
| II |
| III / IV |
| IV |
| Highest Risk |
| I |
| III / IV |
| IV |
| IV |
3. NOISE AND VIBRATION
TYPE
A
TYPE
B
TYPE
C
TYPE
D
| Low Risk |
| I |
| II |
| II |
| III / IV |
| Medium Risk |
| I |
| II |
| III |
| IV |
| High Risk |
| I |
| II |
| III / IV |
| IV |
| Highest Risk |
| I |
| III / IV |
| IV |
| IV |
4. UTILITY REQUIREMENTS
TYPE
A
TYPE
B
TYPE
C
TYPE
D
| Low Risk |
| I |
| II |
| II |
| III / IV |
| Medium Risk |
| I |
| II |
| III |
| IV |
| High Risk |
| I |
| II |
| III / IV |
| IV |
| Highest Risk |
| I |
| III / IV |
| IV |
| IV |
5. EMERGENCY PROCEDURES
TYPE
A
TYPE
B
TYPE
C
TYPE
D
| Low Risk |
| I |
| II |
| II |
| III / IV |
| Medium Risk |
| I |
| II |
| III |
| IV |
| High Risk |
| I |
| II |
| III / IV |
| IV |
| Highest Risk |
| I |
| III / IV |
| IV |
| IV |
DESCRIPTION OF REQUIRED PRECAUTIONS BY CLASS.
1. INFECTION CONTROL
CLASS I
During Construction
1. Minimize dust during construction activities.
2. Replace ceiling tiles immediately after inspections.
After Construction
1. Remove debris and clean area.
CLASS II
During Construction
1. Provide active means to prevent airborne dust.
2. Water mist work surfaces to control dust while cutting or drilling.
3. Seal unused doors with duct tape.
4. Seal air returns.
5. Seal air supplies, if necessary.
6. Place dust mats at the work area egresses.
After Construction
1. Wipe work surfaces with disinfectant.
2. Bag or otherwise contain construction debris.
3. Wet mop and/or vacuum work area.
4. Remove seals from doors and HVAC system.
CLASS III
During Construction
1. Seal, supply and return registers as needed to prevent the spread of airborne dust.
2. Maintain negative airflow in the construction area.
3. Provide a construction barrier. (Sheetrock, plastic, etc., to seal the construction area from non-work areas.)
4. Bag or otherwise contain construction debris for transport out of the construction area.
5. Place dust mats at the work area egresses.
After Construction
1. Remove seals from supply and return registers.
2. Remove construction barrier only after approval from the EOC Committee. Care should be taken to remove the barrier to minimize dust and debris.
3. Vacuum work area with HEPA filtered vacuums.
4. Wet mop area with disinfectant.
CLASS IV
During Construction
1. Isolate HVAC system in the construction area to prevent the spread of airborne dust.
2. Maintain negative airflow in the construction area.
3. Provide a construction barrier. (Sheetrock, plastic, etc., to seal the construction area from non-work areas.) Provide a HEPA vacuum for vacuuming prior to exiting from the construction area.
4. Seal holes, pipes, conduits and punctures to prevent dust from leaving the construction area.
5. Where practical, provide an anteroom and require all personnel to pass through this room so they can be vacuumed before leaving the construction area.
After Construction
1. Remove seals from supply and return registers.
2. Remove construction barrier only after approval from the EOC Committee. Care should be taken to remove the barrier to minimize dust and debris.
3. Vacuum work area with HEPA filtered vacuums.
4. Wet mop area with disinfectant.
2. INDOOR AIR QUALITY
CLASS I
During Construction
1. Seal paint cans immediately after use.
2. Seal adhesives immediately after use.
3. Choose "low odor paint" where practical.
4. Utilize water-based paint and sealant.
After Construction Nothing additional required.
CLASS II
During Construction
1. Keep exhaust vents open.
2. Keep supply vents open.
3. Seal return air ducts.
After Construction Reopen return air ducts.
CLASS III
1. Keep exhaust vents open.
2. Keep supply ducts open.
3. Seal return air ducts.
4. Open windows, if available.
5. Provide construction barrier.
6. Ensure chemicals are approved for use in healthcare environments.
After Construction
1. Reopen return ducts.
2. Close windows.
3. Remove barriers.
CLASS IV
During Construction
1. Seal supply return vents.
2. Provide impermeable barrier.
3. Provide external mechanical exhaust.
4. Provide filtered exhaust where required.
5. Ensure chemicals are approved for use in healthcare environments.
6. Asbestos/Lead removal: follow EPA/OSHA requirements for removal, disposal and air monitoring.
After Construction
1. Certify clean ducts.
2. Remove barriers.
3. NOISE AND VIBRATION
CLASS I
During Construction
1. Ensure patient privacy.
2. Check the area to alleviate patient disturbance. Move patients when possible.
3. Utilize hand tools to minimize noise.
4. Power tools can be used on a small scale.
After Construction Nothing additional required.
CLASS II
During Construction
1. Schedule construction during low use hours.
2. Check the area to alleviate patient disturbance. Move patients when possible.
3. Notify staff prior to start of construction.
4. No construction during nighttime hours.
After Construction Nothing additional required.
CLASS III
During Construction
1. Remove patients and staff from the immediate area.
2. Ensure construction barriers are as tight as possible.
3. Move construction to non-business hours as much as feasible.
4. Make personal ear protective equipment available to persons in adjoining areas.
After Construction Nothing additional required.
CLASS IV
During Construction
1. Remove patients and staff from immediate area.
2. Remove patients and staff from adjoining areas when possible.
3. Ensure construction barriers are tight.
4. Provide personal ear protective equipment to all persons in adjoining areas.
5. Schedule construction activities to have the least impact on patients and staff.
After Construction Notify staff when construction is completed.
4. UTILITY REQUIREMENTS
CLASS I
During Construction Inform staff in areas of impact.
After Construction Inform staff after completion.
CLASS II
During Construction
1. Inform staff in areas of impact.
2. Inform Operations Manager and/or Facility Manager.
After Construction Inform staff, Operations Manager and Facility Manager after completion.
1. Notify Facility Manager, Safety Officer, local Fire Department, and monitoring company when construction causes an interruption of the fire alarm or fire protection systems.
2. Implement Fire Watch with Safety Officer and Security.
3. Notify department head.
After Construction Clear notifications.
CLASS IV
During Construction
1. Notify Facility Manager, Safety Officer, local Fire Department, and monitoring company when construction causes an interruption of the fire alarm or fire protection systems.
2. Initiate Interim Life Safety measures.
3. Notify department head.
4. Notify all other affected departments.
After Construction
1. Clear notifications.
2. Cancel Interim Life Safety measures.
5. EMERGENCY PROCEDURES
CLASS I
During Construction Inform staff in areas of impact.
After Construction Inform staff when construction is completed.
CLASS II
During Construction
1. Inform staff in areas of impact.
2. Inform Operations Manager and/or Facility Manager.
After Construction
1. Inform staff after completion.
2. Inform Operations Manager and Facility Manager after construction completion.
1. Notify Facility Manager and Safety Officer when any Life Safety systems are affected.
2. Implement Fire Watch with the Safety Officer and Security.
3. Notify department head.
After Construction
1. Inform staff after completion.
2. Inform Operations Manager and Facility Manager after construction completion.
CLASS IV
During Construction
1. Notify Facility Manager and Safety Officer.
2. Initiate Interim Life Safety measures.
3. Notify department head.
4. Notify other affected departments.
After Construction
1. Notify Facility Manager and Safety Officer when construction is completed.
2. Clear Interim Life Safety Measures.
For Class I and Class II construction or demolition, the Engineering Department will provide information to the Safety Officer and Infection Control Department.
A permit is required for all Class III and Class IV construction or demolition.
Original to remain in the Engineering Office.
Copies to:
Infection Control Safety Officer Facility Manager
CONSTRUCTION PERMIT.
The attached Risk Assessments for Infection Control, Indoor Air Quality, Noise and Vibration, Utility Requirements and Emergency Procedures have determined this project must follow the requirements for:
Class III
Class IV Based on the Risk Assessments performed and the precautions that will be taken, the construction may proceed.
| __________________________________ | _____________ | |
| Facility Manager | Date | |
| __________________________________ | _____________ | |
| Safety Officer | Date | |
| __________________________________ | _____________ | |
| Infection Control Director | Date | |
| __________________________________ | _____________ | |
| Project Officer or Project Foreman | Date |
File details come from the government source that posted it. Updated .