PCRA.pdf

402-24-001 Close and Infill Underground Vaults - PCRA

Request #244

Initiated by Abigail CampbellPre-Construction Risk Assessment (PCRA)

Togus Submitted 9/24/2024

Infection Prevention Review: Signed by vhatoghammv 9/30/2024

1: Activity 1.1: Activity Location (Campus- Building-Room/Area) *

Behind Cabin-in-the-Woods

1.2: Activity Name, Number, and/or Brief Description *

402-24-001 Close and Infill Underground Vaults

In the spring of 2023 an underground structure was discovered on Togus campus located behind the Cabin in the Woods grounds, see Structure Location Map. The underground structure is entirely covered in vegetation/hillside and can currently only be accessed by (4) chimney-like structures protruding out of the ground. Size, make and history of the structure are unknown.

Contractor is to perform a full investigation of the underground structure conditions and to provide a final report with findings, including, but not limited to, structure dimensions, potential entry points, and structure materials. Report to also include the feasibility of infilling the underground structure with gravel or an alternative type of fill to prevent structure collapse.

Once the VA has reviewed and approved the proposed solution and materials from the initial report, the second portion of work includes all construction services to infill the structure.

1.3: Statement of Work (SOW): * 1.4: * x Contractor 1.4.1: Submittal Stage * x Pre-Award 1.4.1.1: Responsible COR *

Abigail Campbell 1.4.1.2: Contractor Request # (Project # - XX) *

Pre-Construction Risk Assessment (PCRA) 1Continued on the next page.

1.4.1.3: Contractor * 1.4.2: Service *

1.4.2.1: Responsible Party (Last, First) *

2: Activity Type and Description 2.1: Will work be completed in a single shift, not to exceed 10 hours? * x No 2.1.1: Will work take longer than a single shift but not exceed 6 months? * x Yes 2.1.1.1: Will work exceed 6 months in duration? *

2.1.2: Patients, employees, and/or visitors may be in the area depending the activity. * x No 2.1.2.1: Will work create dust or debris? * x No 2.1.2.1.1: Will work include selective demolition/removal or preexisting floor covering, casework, lay-in ceiling, or other architectural elements that may:disturb asbestos, lead or silicacreate the potential for falling objectscreate vibration and/or noise in excess of 80 dB(A) in surrounding areascause penetrations in fire or smoke barrier *

2.1.2.1.1.1: Will work include demolition of building components and infrastructure including removal of multiple doors, walls, framing, ceilings, flooring, piping, electrical and HVAC that may:require asbestos, lead or silica abatement create the potential for falling objects create vibration and/or noise in excess of 90 dB(A) in surrounding areas. cause breaches to fire or smoke barrier *

2.1.2.1.2: Will excavation or heavy equipment use be taking place?

Dig safe required utility locationTrench safetyDust control planEquipment exhaust, noise, vibration *

2.1.2.2: Will work create vapors or fumes? * x No 2.1.2.2.1: Will it include architectural, structural, or any other work that may cause vapors or fumes such as:

Roofing workFlooring workPainting or other large-scale use of such substances * x No 2.1.2.2.2: Will there be welding, cutting or use of torches requiring burn permits? * x No 2.1.2.3: Will ceiling tiles be removed? * x No 2.1.2.4: Will it include minor interior updates that do not create vibration or noise?replacing floor or ceiling tilescarpentry work - including hanging signage, and painting with hand tools * x No 2.1.2.5: Will it include limited building system maintenance that does not require Lock Out Tag Out (LOTO)?

Such as: plumbing on potable systems limited to faucet replacement steam trap replacement, etc. electrical work such as replacement of bulbs, receptacles, or switches * x No 2.1.2.5.1: Will it include plumbing work (installation of new sinks, showers and toilets and associated plumbing) that requires utility outages or work on the steam system that may require:

LOTOThe use of compressed gas cylinders *

Pre-Construction Risk Assessment (PCRA) 2Continued on the next page.

Will it include plumbing work (installation of new sinks, showers and toilets and associated plumbing) that requires utility outages or work on the steam system that may require:

LOTOThe use of compressed gas cylinders continued * x No 2.1.2.5.1.1: Will there be plumbing work requiring LOTO and system shutdown and startup such as the installation of:new medical gas systems, steam/heating hot water, condensate systemspotable water and sanitary drainage, multiple sinks, showers and toilets including associated plumbing. *

2.1.2.5.2: Will it include electrical work (installation of conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans, etc.)? Electrical work such as installation of cabling/wiring/conduit for a single device, installation of a new device such as a light fixture that require LOTO. * x No 2.1.2.5.2.1: Will there be electrical work requiring LOTO and system isolation, such as:

installation of electrical feedersdistribution panelsconduit and wire for lighting receptacles and switches for an areainstallation of conduit and wire for new devices (terminal units, fans, etc.) *

2.1.2.5.3: Will it include Air Handler and/or fan shutdown/startup and HVAC work such as replacement of a single diffuser, single terminal unit, a single device and the installation of ductwork, diffusers, and terminal units for an area that may require:

Work on laddersRigging, hoisting or lifting of equipment or materials overhead * x No 2.1.2.6: Will work create some noise and vibration due to power tool use? * x No 2.1.2.7: Will modification of existing fire alarm and suppression systems requiring system outages and ILSMs or obstruction of exits and/or impact on corridors be needed? * x No 2.1.2.7.1: Will there be installation of fire alarm and suppression systems requiring outages of those systems and ILSMs or closure of exits/corridors? * x No 2.1.2.7.1.1: Will there be mechanical work requiring lifting and support of equipment and systems, such as:installation of air handling equipment, associated ductwork, diffusers, heat exchangers, terminal units and controls * x No 2.1.2.8: Will work require confined space entry?

(Permit required or not) * x Yes 2.1.2.9: Does the work include elevated work?Roof work, fall protectionWindow work, scaffolding and fall protectionOdor control * x No 2.1.2.10: Will there be installation of building components such as new walls, ceilings and doors including framing, drywall and associated plaster work that requires transport of significant materials through building and up elevators i.e., weight limits of floors and elevators * x No

2.2: Inspection/Upkeep.

2.2.1: Please follow adequate control measures:Immediately replace any ceiling tile, close access panels, etc., upon completion of work.Site visits of construction area are required weekly by member of multi-disciplinary team. Site visits will be documented on standard checklist.Site specific safety plan, task hazard analysis, and hazard communication required to be provided by the contractor and approved where a contact is in place. For internal work the shop involved must work with Safety to ensure proper precautions are in place.Must address identified hazards and controls that will be implemented to ensure minimal impact to patients, employees, contractors and facility.Communication and coordination plan for all affected areas. *

2.2.1.1: Safety plan - briefly describe/explain *

Pre-Construction Risk Assessment (PCRA) 3Continued on the next page.

Safety plan - briefly describe/explain continued *

2.2.1.1.1: Safety plan

2.2.1.2: Task hazard analysis (to include identified hazards/controls implemented) * Task Hazard Controls

2.2.1.3: Communication and coordination (and hazard communication) *

2.2.1.3.1: Communication and coordination (and hazard communication) 2.2.2: The following control measures shall be followed:

2.2.2.1: Supplemental Documents

2.3: Small scale 2.3.1: 6. Hazard communication chemical inventory required to be provided by the contractor and approved.7. Where construction, Renovation and maintenance are done in an accredited facility, and ILSM assessment is required to be done and ILSMs put into place in accordance with TJC LS.01.02.01 and the local facility policy including Fire watch if necessary. Staff is trained and the ILSM is verified regularly8. Hot Work or burn permits in place and staff trained9. LOTO procedures in place and staff trained on their use10. Site visits will be reviewed using the criteria in standardized guide.11. Daily inspections of the site are to be conducted by the General Contractor or shop supervisor and documented on their daily log. *

2.3.1.1: Hazard communication, chemical inventory, SDS *

2.3.1.1.1: Hazard communication, chemical inventory, SDS * 2.3.1.2: ILSM plan *

2.3.1.2.1: ILSM plan 2.3.1.3: LOTO plan *

2.3.1.3.1: LOTO plan 2.3.2: Control measures 1-5 are indicated along with the following:

2.3.2.1: Supplemental documents 2.4: Does work require crane?

General crane workLift over buildings *

Pre-Construction Risk Assessment (PCRA) 4Continued on the next page.

2.5: Large-scale 2.5.1: Ensure control measures 1-11 are in place and the following Activity Hazard Analyses and Control Plans(check all that apply) *

2.5.1.1: Excavation safety plan in place *

2.5.1.2: Dust control plan in place *

2.5.1.3: Pollution prevention plan in place *

2.5.1.4: Dig safe paper work in place *

2.5.1.5: Crane lift plan in place.

Include placement, swing, load evaluation. *

2.5.1.6: Fall protection plan in place. *

2.5.1.6.1: Proof of fall protection staff training. *

2.5.1.7: Confined entry plan in place *

2.5.1.7.1: Proof of confined entry staff training. * 2.5.2: Large-scale activities will require all previous control measures in the sections above (#1-11) and the following Activity Hazard Analyses and Control Plans (check all that apply):

2.5.2.1: Supplemental documentation:

2.6: Based on the answers provided, the following activity types are applicable and should follow the following control measures:

2.7: Submittal stage x Pre-Award

3: Affected Adjacent Area Assessment

3.1: Activity area must be included.

* There may be more than one Service/type of area for each row. List all. The information entered on this table must be used in the ICRA if required.

** List the area(s) in which the construction/renovation/maintenance activity will occur. * Area Service(s)/Type(

s) of Area(s) Point of Contact

(POC)

POC Contact

Email Point of Contact

Phone Construction plan communicated to POC?

Activity Area** FMS Mark Roberts Mark.Roberts6@va .gov

207-623-8411 Yes

3.2: Is adjacent area: * x Vacant (work outside, construction of new building, etc.).

Pre-Construction Risk Assessment (PCRA) 5Continued on the next page.

3.2.1: If adjacent area is vacant (e.g., work outside, construction of new building, etc.): Coordination is typically not necessary other than potentially traffic flow and pedestrian access.

3.2.2: If adjacent area is non-continuously occupied (e.g., areas where outpatient care is provided, employee health, etc.):Develop a list of activities that will potentially impact or disrupt the operation of the area (e.g., work involving noise, vibration or exit obstruction) and meet with POC to coordinate execution of work in a way that mitigates the impact (e.g., conduct work after hours).

3.2.3: If adjacent area is occupied continuously (e.g., areas where inpatient care is provided, residential areas such as Community Living Centers, etc.):Develop a list of activities that will potentially impact or disrupt the operation of the area (e.g., work involving noise, vibration or exit obstruction) and meet with POC to coordinate execution of work in a way that mitigates the impact

(e.g., move affected party temporarily).

4: Infection Control Risk Assessment (ICRA)

4.1: This section acknowledges that the PROJECT LEAD will CONSULT with INFECTION

PREVENTION & CONTROL regarding the assessment of potential infection risks associated with the activity and the need for control measures. Project Lead must submit Infection Control Risk

Assessment (ICRA) for ALL projects. See VHA Directive 7715 and the VHA ICRA Template for more information.

4.2: Coordinate for completion of ICRA - Contact Infection Prevention to assist with ICRA Form completion. * x Will consult with Infection Prevention and Control for ICRA.

5: Attachments

5.1: PCRA permit copy

5.2: Additional attachments

5.3: PCRA permit copy must be posted at the entrance to the project area, or other designated area.

* = required field

Pre-Construction Risk Assessment (PCRA) 6This form was generated by LEAF on 10/3/2024