Risk Assessment.pdf

Training/ Review Date

Project Start Date: Estimated Duration:

Safety Representative

Life Safety/Safety Additional Requirements:

Does the project warrant additional fire drills?

Safety Department will evaluate effects of work on life safety and determine if there is a need to increase frequency of drills.

Conduct a minimum of two fire drills per shift per quarter. (EP 11)

Will smoking be permitted in construction areas?

Smoking is prohibited on VA property. This includes, but is not limited to, cigarettes, cigars, pipes, chew, e-cigarettes/cigars, and vape pens

Refer to NWI Smoking Policy

Will the project require the storage of flammable or combustible materials?

*Increased trash due to debris removal?

*Will construction debris need to be stored in the area as timely removal would be impossible (e.g. freight elevator not working)

*Control combustible load

* Implement housekeeping protocols. (EP9) *Enforce Housekeeping and debris removal practices.

*Fire Watch *Increase surveillance (EP8)

Will the project require a temporary barrier (e.g. fire-resistant poly or 1 hour rated wall)?

*Barrier required by Infection Control?

*Demolition, renovation, or construction activities require a barrier between construction and occupied areas to limit access, noise, dust, and spread of fire/smoke.

* Erect temporary construction barriers that won’t allow smoke into the area and that are made of fire-resistant materials (EP7) Increase surveillance (EP8)

Will fire hazard be higher? *Will hot work ( e.g. burning, welding, cutting, brazing, soldering, grinding) be required?

*Will project require the use of flammable materials?

*Provide additional fire fighting equipment (EP6) and train staff in its use (EP10) *Obtain Hot Work Permit, if required.

*Increase surveillance (EP8)

Will access to emergency services (fire, police, ambulance, etc.) be impacted?

*Will access to fire hydrants, Fire Department connections (interior/ exterior) be blocked?

*Any road closures?

Construction plans will be reviewed to ensure proper access will be maintained.

Will any fire detection or suppression system be impaired ?

*Will alarms and/or sprinklers be out of service 4 or more hours in a 24 hour period? (EP2)

*Fire watch/Fire Department Notification (EP8) *A temporary system must be provided when any fire system is impaired. (EP5). Temporary systems must be inspected and tested monthly (EP 12).

*Addt'l fire extinguishers shall be brought to area (EP6)

Pre-Construction Risk Assessment (PCRA)

Contractor(s)Performing Work:

Supervisor: Telephone:

Safety/Life Safety Risk Assessment (LS.01.02.01) Safety officer should be involved in the design/planning of all projects

VA Project Coordinator: Telephone:

Project Description:

Project Name: Location (Site, Bldg., Room/Area) :

Engineering Representative

Engineering Additional Requirements:

Yes No Evaluated Item Mark "Yes, if any apply (Mark "Yes" if unsure) If answer is “Yes” see potential actions to be taken

Will required exit(s) or other means of egress be effected?

*Will pathways or exits be blocked? *Personnel in the building will receive training on alternate routes and exits. (EP13) *Construction areas will have designated and marked exits to be clear at all times. (EP4) *Exit signage will be updated to direct occupants to nearest exit. (EP3)

*Are you working on a fire/smoke wall, hazardous area, on a floor/ceiling slab , suite doors? Verify area on LS Drawings.

*Contact Safety if questions.

*Train staff to compensate for impaired structural or compartmentalization features of fire safety, such as doors and walls. (EP14)

* Increase surveillance (EP8)

Were any questions answered "Yes"? Conducting education programs to promote awareness of LSC building deficiencies, construction hazards, and ILSMs.

Will any smoke/firewalls, doors, assemblies and/or other structural features be impaired?

Will any additional training be required?

Other Life Safety Code considerations?

24/7 Contracting Contact: Gregg Sutcliffe 402-996-3536

Revision 5 11.21.19

Y

Y N

Will there be any anticipated utility disruptions? (e.g. communications, electrical, HVAC, medical gases, vacuum, water, server)

CLASS

III

I II III

HIGHEST Risk II III/IV III/IV IV

CLASS

I

I II III/IV IV

CLASS

IV

Will vibration levels be excessive for hospital machinery to operate properly?

Will the construction compromise security?

CLASS

II

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW Risk I II II III/IV

MEDIUM Risk

Hazardous Areas/ Materials

Critical Alarms Critical clinical alarms should be functional and audible within and adjacent to the construction zone? Including but not limited

a. Emergency Code Systems

b. Medical Gas alarms (Oxygen, Air, Suction)

c. Wander guard technology

d. Cardiac and other vital sign Monitoring Systems

e. Medication/Nutrition Delivery Systems

f. Nurse Call Systems

1. Hazardous areas should not be accessible by patients/visitors.

2. Signage for hazardous areas should be visually adequate (see above).

3. Hazardous chemicals and tools should be stored appropriately to preclude patient/visitor access?

If any are YES, involve of the patient safety manager in design/planning , especially with regards to the following items:

Access/ Egress

1. The new/temporary access/egress path should be intuitive, i.e. easy to follow.

2. Signage should be adequate for decreased visual acuity and at appropriate viewing levels for both ambulating and w/c bound patients/visitors.

3. The access/egress path should be smooth, without tripping hazards.

4. The access/egress path should be handicap accessible.

5. For applicable clinical areas, the construction barriers prevent unauthorized patient egress.

Will the work be likely to generate any noxious/unusual odors (e.g. paint or glue fumes) or known contaminates (e.g. asbestos, lead, mold)?

Patient Safety Risk Assessment

Will the project involve a patient care area?

CONSTRUCTION ACTIVITYN

Will the project be adjacent (beside, above and/or below) to a patient care area?

Will there be unusual noise levels for adjacent areas?

Will this project alter patient access/egress to/from the building/patient care area, either temporarily or permanently?

1. Wipe surfaces with disinfectant.

2. Contain construction waste before transport in tightly covered containers.

3. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.

4. Remove isolation of HVAC system in areas where work is being performed.

1. Include all items from Class I/II above

2. Do not remove barriers from work area until completed project is thoroughly cleaned as required by the owner’s Safety Department and/or Infection Control Department.

3. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

4. Vacuum work area with HEPA filtered vacuums.

5. Wet mop area with disinfectant

1. Include all items from Class I/II/III above

Infection Control Risk Assessment (match construction activity to patient risk group to determine project class)

Patient Safety Representative

Patient Safety Additional Requirements:

YN

IV

HIGH Risk

Infection Control Representative

Infection Control Additional Requirements:

During Construction Project Upon Completion of Project

CONSTRUCTION ACTIVITY TYPE

A: Inspection, non-invasive activity-includes, not limited to removal of ceiling tiles for inspection (1/50 sq ft or a 2x4 section), painting (not sanding), wall covering, electrical trim work, minor plumbing, activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

B: Small scale, short duration, moderate to high levels-includes but not limited to installation of telephone/computer cabling, access to chase spaces, cutting of walls or ceiling where dust migration can be controlled.

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 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 the ceilings; major cabling activity; any activity which cannot be completed in a single work shift.

D: Major duration and construction activities-Includes, but not limited to: activities that require consecutive work shifts; requires heavy demolition or removal of a complete cabling system; new construction.

PATIENT RISK GROUP (may modify as appropriate)

Low Risk

Medium Risk-

High Risk

Highest Risk-

1. Clean work area upon completion of task

Project Class

1. Execute work by methods to minimize raising dust from construction operations.

2. Immediately replace any ceiling tile displaced for visual inspection.

1. Include all items from Class I above

2. Provides active means to prevent air-borne dust from dispersing into atmosphere

3. Water mist work surfaces to control dust while cutting.

4. Seal unused doors with duct tape.

5. Block off and seal air vents.

6. Place dust mat at access points of work area.

7. Contain construction waste before transport in tightly covered containers.

8. Isolate HVAC system in areas where work is being performed to prevent contamination of duct system.

1. Include all items from Class I/II above

2. Involve infection control in design/planning before construction begins.

3. 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.

4. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

5. Cover transport receptacles or carts. Tape covering unless solid lid.

1. Include all items from Class I/II/III above

2. Involve infection control in design/planning before construction begins.

3. Seal holes, pipes, conduits, and punctures appropriately.

4. If exiting to a patient care area, 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 they leave the work site.

5. Walk-off mats are recommended to minimize tracking of heavy dirt and dust from construction areas. Shoe covers may be considered in certain areas.

A TB pre-construction risk assessment has been performed. Workers on this job are not at risk and do not require pre-construction screening. YES NO NA

Examples: Cardiology, Echocardiography, Endoscopy, Nuclear Medicine, Physical Therapy, Radiology/MRI, Respiratory Therapy

Examples: CCU (Coronary Care Units), Emergency Department, Laboratories (specimen), Medical Units (CLC & Med/Surg), Outpatient Surgery, Pharmacy, Post Anesthesia Care Unit, Surgical Units

Examples: Office Areas, Outpatient, Primary Care

Examples: Any area caring for immunocompromised patients, Burn Unit, Cardiac Cath Lab, Central Sterile Supply, Intensive Care Units, Negative Pressure Isolation Rooms, Oncology, Operating Rooms

Revision 5 11.21.19

VHAOMAPeterC Oval

Text13: inner vestibule doors to remain locked, exit signs will be covered up and corridors will meet dead-end corridor requirements for length of travel for occupants to nearest exit (verified by VA safety). contractor to include signage for directing patients per ER direction NOTE: Verify "exit signage" is in place and appropriate for alternate exit before blocking /closing the exit.