S02 523A5-24-010 PCRA Determination - 523A5-24-010 - Expansion Joint Correction.pdf

VHA-PCRA-2023-1.0

Pre-Construction Risk Assessment (PCRA) Permit

This page must be posted at the entrance to the project area, or other designated area Unique permit number:

Location and brief description of construction/renovation/maintenance

523A5-24-010 – Replace Expansion Joint – Throughout Brockton Tunnel System - The goals of this project are to correct deficient expansion joints in the tunnel area, repair damaged tile at the expansion joints, and complete tile work at the Building entrances.

Project manager Steven Riley Project start date - Contact phone number 774-826-2391 Completion date - Contractor or lead shop TBD Permit expiration date -

Activity Type Inspection/Upkeep, Small-scale, or Large-scale) Large Scale

Activity Type Control measures to be in place for the duration of the activity

(Check the box for the Activity Type to indicate the Control Measures)

Inspection/Upkeep

1. Immediately replace any ceiling tile, close access panels, etc., upon completion of work.

2. Site visits of construction area are required weekly by member of multi-disciplinary team. Site visits will be documented on standard checklist.

3. Site specific safety plan, task hazard analysis, and hazard communication required to be provided by the contractor and approved.

4. Must address identified hazards and controls that will be implemented to ensure minimal impact patients, employees, contractors and facility.

5. Communication and coordination plan for all affected areas

Small-scale

All control measures in the row above and the following:

1. Hazard communication chemical inventory required to be provided by the contractor and approved.

2. ILSMs in place and staff trained on situation

3. Hot Work or burn permits in place and staff trained

4. LOTO procedures in place and staff trained on their use

5. Site visits will be reviewed using the criteria in standardized guide.

6. Daily inspections of the site are to be conducted by the General Contractor and documented on their daily log.

Large-scale

All control measures in both rows above and the following Activity Hazard Analyses and Control Plans as applicable (check all that apply):

1. Excavation safety plan in place

2. Dust control plan in place

3. Pollution prevention plan in place

4. Dig safe paperwork in place

5. Crane lift plan in place

a. Crane placement

b. Crane swing

c. Crane load evaluation

6. Fall protection plan in place and staff trained

7. Confined entry plan in place and staff trained

*The location of all Activity Hazard Analyses and Control Plans (excavation, dust, pollution, etc.) as applicable shall be identified on this permit and shall be made available to all workers on the job.

Additional requirements:

Is an Infection Control Risk Assessment (ICRA) required for the Activity? Yes No

Infection Prevention and Control signature:

Date:

Project Manager signature Date

Safety Officer signature Date

Chair, Construction Safety Committee signature

Date

STEVEN M RILEY 3353810 Digitally signed by STEVEN M RILEY 3353810 Date: 2023.09.08 11:15:37 -04'00'

Alice F. Skolnik 367514 Digitally signed by Alice F. Skolnik 367514 Date: 2023.09.08 12:41:29 -04'00'

CHARLES PERENICK Digitally signed by CHARLES PERENICK Date: 2023.09.20 08:15:08 -04'00'