S02 - Att9 Final SOW REV1 05182022.pdf

05/18/2022

Tomah VA Medical Center Project Engineering

SCOPE OF WORK MEMORANDUM

1. Project Data:

A. Title: Repair Campus Fire Dampers B. Location: VA Medical Center, Tomah, Wisconsin Campus Wide C. Project #: 676-22-120 D. COR: James Conn E. Time requirement: 60 days from Notice to Proceed

Provide work in accordance with federal, state, and local authorities.

Project conditions:

The intent of this project is to repair existing dampers, test, label and document smoke and fire dampers and install access panels for ease of access for future inspection.

SCOPE OF WORK

676-22-120

Repair Campus Fire Dampers Tomah VAMC, Tomah WI 54660

A. INSPECTION OF SITE OF PROPOSED WORK:

Before submitting a proposal on the work specified herein, the bidder shall examine the site and familiarize themselves with all existing conditions and limitations. Permission for inspection may be obtained from James Conn, COR at (608) 790-6302.

B. FACILITY STATUS:

The VA Tomah Campus is occupied and operated on a 24-hour basis and shall remain in this status throughout the performance of all assigned work. All construction barriers, infection control barriers, construction signs, and project identification signs shall be the responsibility of the contractor to furnish and install as necessary throughout the various phases of this project.

C. DESCRIPTION OF WORK:

1. The Contractor shall furnish all labor, equipment, tools, materials, and supervision necessary to perform all work repairs in strict accordance with this Statement of Work.

2. All work shall be performed in accordance with all current NFPA, Local, State, and Federal building codes and all stated specific requirements.

D. TIME REQUIREMENTS:

1. Time requirement: Length of Repair time frame is – 60 calendar days from signed Notice to

Proceed.

E. PRINCIPAL FEATURES:

1. Any changes to this SOW shall be authorized and approved only through written modification of this contract from the CO in coordination with the COR. Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor.

2. Notwithstanding, the Contractor shall perform no additional work without the prior written authorization of the Contracting Officer. Any additional work, which may be performed by the Contractor without this approval, will be performed by the Contractor at no additional cost to the Government.

F. SERVICE HOURS AND FEDERAL HOLIDAYS

1. Normal hours of coverage are Monday through Friday from 7:30 am to 4:30 pm, excluding holidays. All work shall be performed during normal hours of coverage unless otherwise requested or approved by the COR or their designee.

2. All contract work shall be on a date and time mutually agreed upon between the Contractor and the COR.

3. Federal Holidays observed by the VAMC are:

New Years’ Day Labor Day Martin Luther King Day Columbus Day Presidents’ Day Veterans’ Day Memorial Day Thanksgiving Day

Independence Day Christmas Day

G. GENERAL INFORMATION

1. Compliance with General Safety Regulations:

2. The Contractor shall coordinate all dates for service and testing with contract COR.

3. Contractor is responsible to replace any items damaged by the contractor, sub-contractor, their employees, or equipment at no extra charge to the Government.

4. Contractor personnel must conduct their work in a manner that does not interfere with the normal functions of the facility and will stop work if asked by the CO/COR as required if interruptions do occur.

H. Work to be performed

1. Repair Fire Dampers: SERVICES TO BE PROVIDED: Based on current campus facility drawings, failure report, and other information provided to contractor, Contractor agrees to provide the following services with respect to building’s dampers:

a. See Attachment ~A Fire Damper Failure Report for details of work to be accomplished for each location.

a. Use all commercially reasonable efforts to locate and, once located and accessed, operate (i.e., actuate) identified dampers in the facilities and repair/replace as noted.

b. Remove and reset fusible links on fire dampers, to verify such Fire Damper fully closes and if necessary, replace any fusible link that is compromised (per National Fire Protection Association Code

b. Lubricate all moving parts on each Damper.

c. Clear each damper of any debris that would impede such damper’s normal operation.

d. Coordinate with COR and local fire department to place facility fire alarm system in “test mode”, if necessary, to conduct inspection of the smoke and/or combination Dampers.

e. Manually activate actuators on electric and pneumatic smoke and/or combination Dampers to verify proper operation of such damper.

f. Identify on VA provided spreadsheet and drawings for the locations of each damper and place identification stickers/labels on ceilings or other location to assist in locating such dampers following inspection.

3. Report of Fire Dampers. On conclusion of the performance of the Repair Services, Fire and Smoke Damper Inspection Contractor will provide Customer with an updated report, which is intended to provide evidence of damper inspection for submission to applicable agencies, such as

A. A listing of the location of each Damper, such Damper’s number (if no number is assigned, work with COR to assign a number. Joint Commission and other Fire Protection Agencies and comply with NFPA 105 and NFPA 80 requirements. The report format will be provided and will be updated to match existing report format.

4. Install Access Panels/Doors A. Not used… B. Installation of access panels as noted in Attachment A.

C. This portion of work requires diligent prior coordination and planning of demolition and installation.

D. Supplied Interim Life Safety Management (ILSM) forms will be completed and forwarded to the

COR/CCR for all work locations 1 week prior to start of work.

E. ICRA barriers will be required for all construction work. Although not required, the use of a

“shark tank” style ICRA barrier system is recommended due to the number of locations.

F. Access panels will match existing surface G. A stamped metal tag will be affixed to each damper with report cross-reference number.

H. A tag will be affixed to Ceiling grid or wall to identify Damper location for ease of inspection.

I. Digital photographs of each damper before and after performance of the inspection services

(showing each Damper opened and, where operable, closed).

J. CONTRACTING OFFICER’S REPRESENTATIVE (COR)

a. Scheduling of work shall be arranged with the Point of Contacts below and in the following order: contract COR (Contracting Officers Representative), CCR (Construction Control Representative).

i. See Table 1 below for Point of Contact information.

Table 1:

NAME POSITION PHONE EMAIL

James Conn COR 608-790-6302 James.conn@va.gov

Jeff Kundert CCR 608-377-0632 Jeffrey.kundert@va.gov

K. COMPETENCIES AND QUALIFICATIONS OF PERSONNEL SERVICING EQUIPMENT:

i. All work shall be by personnel with American Society of Sanitary Engineering

(ASSE) -6000 Certifications.

L. ORIENTATION FOR CONTRACTOR EMPLOYEES:

i. Contractor will attend an orientation meeting as arranged by the Contracting

Officer's Representative (COR). The VA will schedule this meeting and it will include discussion of the following topics: (VA will provide information to the contractor regarding these topics and will document the meeting)

• Fire and Safety

• Infection control

• Disaster procedures - Other

ii. The Contractor will be responsible to ensure that Contractor employees coming to the work site will receive the information required above.

M. SECURITY REQUIREMENTS

a. All Contractor FST’s (Field Service Technician(s)) shall obtain contractor ID badges from the

VA Police. Identification shall be worn visible always by the Contractor and all FST’s while on premises. Contractor shall coordinate with COR to acquire said identification badges.

b. During normal working hours of operation, Monday through Friday, the contractor shall check in with the COR/Tomah VAMC (Veterans Affairs Medical Center) POC (Point of Contact), whether in person or with a phone call, when arriving to perform work and check out, in the same manner, with the COR/Tomah VAMC POC when work/workday is complete.

c. During other than normal hours of operation, the contractor shall sign in and out with the Fire Department located on the east end of B36.

d. It is the responsibility of the Contractor to park in the appropriate designated parking areas.

Information on parking is available from the VA Police Section. The VAMC will not invalidate or make reimbursement for parking violations of the Contractor under any conditions.

e. Effective October 1, 2019, smoking is prohibited both inside and outside (entire campus) at the VAMC.

f. Possession of weapons is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court.

N. RISK CONTROL

a. The Contractor shall take all necessary precautions to protect government property and shall repair any damage caused by their efforts.

b. All work affecting patients shall be coordinated in advance by the Government and the

Contractor to have minimal impact on the patients.

O. COVID-19 REQUIREMENTS

a. Tomah VA Medical Center guidelines and policy related to work on a CLC unit or an area where CLC Veterans are cared for.

i. Each contract will require approval of front office and IC prior to contractors entering a CLC

ii. If approval is granted contractors must meet the following criteria

iii. Covid-19 testing withing 72 hours of entry to the CLC

iv. Entrance screening to include symptom questions and temperature, a sticker will be provided after screening occurs

v. Guidance on the appropriate PPE needed for the job being performed will be provided by Infection Control upon approval

vi. Contractors are expected to provide their own PPE. Face masks and face shields are required for all work. Technical description and specifications of PPE must be sent to Project COR for approval prior to start of work. In limited circumstances, the facility may be able to supply PPE.

vii. If a respirator is needed, proof of fit testing is required, contractor must wear the respirator identified on the fit testing form.

viii. Contractors are expected to follow all guidelines established by VHA and Infection Control related to:

ix. Proper social distancing.

x. The cleaning and disinfection of frequently touched objects, including but not limited to, shared tools, machines, vehicles, ladders, portable toilets, etc.

xi. Limiting whenever possible tool sharing.

xii. Proper hand hygiene.

xiii. Encourage sick workers to stay home.

xiv. Encourage workers who are well with sick family members to follow CDC guidance related to quarantine and isolation. More information can be found at:

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are- sick/quarantine.html

b. See below for Tomah VA Medical Center guidelines and policy related to work entrance to the Tomah VA Medical Center for work performance.

i. Vendor staff entering the Tomah VA Medical Center will have to have pass through screening and their temperature shall be taken, daily, along with answering Covid-19 symptom questions. Proof of normal temperature check will be provided to the Vendor each day in the form of a sticker and shall be worn visibly all that day.

ii. Facemasks/face shields shall always be worn while performing work in CLC working environments. See above for all requirements related to work performance in CLC areas.

P. PLACE OF PERFORMANCE

Tomah VA Medical Center, 500 E. Veterans St., Tomah, WI. 54660

Q. GENERAL:

1. Contractor shall be responsible for all temporary marking and construction signage during the demolition and construction phases.

2. Contractor shall submit a construction schedule for approval prior to work start. Work under this contract shall be accomplished during normal Tomah VAMC business working hours. Tomah VAMC business working hours are 7:00am through 4:30pm Monday through Friday, excluding holidays. Construction schedule shall be approved by the COR prior to work start. Contractor may work off hours (evenings and weekends) if desired with prior approval of the COR. Contractor shall have site Superintendence represented during all requested off hour work schedules.

3. Government personnel will be responsible for the moving of any Government equipment and materials in all affected areas.

4. All phasing, scheduling, utility shutdown and coordination of government property needing to be moved/removed or provided shall be done through the COR.

5. Demolition shall be performed with a minimum amount of damage to adjacent property not included in this contract, which is to remain. Any damage to such existing work resulting from demolition work shall be considered a part of work included in this contract and is the responsibility of the contractor and shall be repaired upon completion of project.

6. If removal of materials discloses defective materials, which should be replaced, necessitating work over and above the scope of this contract, Contractor shall immediately contact the Contracting Officer or his/her duly appointed representative in order that corrective action may be taken.

7. Contractor shall take extra measures to ensure any significant amounts of dust and dirt generated from this project are contained within the immediate construction area. Any dirt and debris tracked outside of the immediate working areas will be the responsibility of the contractor for clean up if necessary. Any work being done shall be done in such a manner as to create a minimal amount of disruption to the ongoing work mission on the property and within the remainder of the complex. See attached Pre-Construction Risk Assessment (PCRA) and Infection Control Risk Assessment (ICRA) for details.

8. During the demolition and repair phases contractor shall ensure that all work is accomplished in a safe manner in accordance with OSHA requirements. Contractor shall ensure that all areas where work is to be performed are secured and safe during and at the end of each workday.

9. All non-hazardous excess material and debris generated from this project shall be disposed of off site in a State of Wisconsin licensed landfill upon completion of project. The Contractor shall remove all debris resulting from this contract from the site.

a) With each application for progress payment, Contractor shall submit a summary of construction and demolition debris diversion and disposal including beginning and ending dates of period covered.

b) The Contractor shall quantify all materials diverted from landfill disposal through salvage or recycling during the period with the receiving parties, dates removed, transportation costs, weight tickets, manifests, invoices. Include the net total costs or savings for each salvaged or recycled material. Delivered to COR upon each site removal.

c) The Contractor shall quantify all materials disposed of during the period with the receiving parties, dates removed, transportation costs, weight tickets, tipping fees, manifests, invoices. Include the net total costs for each disposal. Delivered to COR upon each site removal.

10. Public restrooms will be available for use during contract. Contractor shall not wash construction tools and equipment in any facility bathroom sinks/etc. The Tomah VA will provide any water needed for construction purposes. Contractor shall coordinate with COR for locations.

R. PROTECTION:

1. All existing station complex property shall be suitably protected against damage, and it shall be the Contractor’s responsibility to replace any such items as may become damaged as a result of his failure or negligence in fully protecting same. Any damage done to the buildings or grounds by the contractor during the construction period will be the responsibility of the contractor and shall be repaired upon completion of project.

S. STORAGE AREA:

Storage area will be available at the VAMC Campus during construction phases. Contractor shall coordinate with project COR for storage location.

T. SAFETY:

Safety is the responsibility of the Contractor. Contractor shall submit a safety plan for approval prior to work start. Contractor shall assume all liability for damage or injury. Contractor shall cease operations and notify Contracting Officer’s Representative if safety appears to be endangered. Do not resume operations until safety is restored. All work shall be performed in accordance with all applicable VHA/OSHA standards. See Attachment B for PCRA (Pre-Construction Risk Assessment)

U. INFECTION CONTROL:

a. See Attachment C for Infection Control Risk Assessment (ICRA) for details of Contractors responsibility to maintain a clean work environment during construction.

V. INTERIM UTILITY SYSTEM OUTAGE MEASURES:

a. See Attachment E for IUSOM for details of Contractors responsibility to schedule with the COR the utility shutdown ensuring a safe work environment during repairs.

Must submit 14 days in advance of expected date of outage.

W. INTERIM LIFE SAFETY ASSESSMENT:

a. See Attachment D for ILSA/ILSM for details of Contractors responsibility to schedule with the COR the patient/pedestrian traffic zone closure ensuring a safe work environment during repairs.

X. PHYSICAL SECURITY:

a. Contractor Identification

i. On the first day of work, the Contractor shall coordinate with COR/Resident Engineer to acquire the proper security badging. Identification badges shall be worn and visible on your person, at all times while on campus.

ii. Contractor shall keep issued Identification badge on their person when leaving campus. There will be instances that the VA Police will be verifying IDs at the entrance to the campus and identification will be required. Please have IDs with you.

iii. When project is complete each person will be REQUIRED to turn their Identification Badges back into the Tomah VA Police.

b. Contractor Access and Key Requests

i. Contractor shall coordinate with COR to request any required keys needed to gain access into any required non-public spaces. Request shall be made via email to COR. COR will coordinate internal process with Contractor for issuance. Email requests for keys shall have the following information.

1. Name of Contractor

2. Name of Company that Contractor works for

3. Type(s) of key(s) that is/are being requested

4. Quantity of each key needed.

END OF SECTION

VAMC TOMAH

Pre-Construction Risk Assessment (PCRA)

Attachment B (MCM FS – 50)

Project: Location(s): Start Date:

COR: Contractor:

Brief Description of Work:

Category Factors YES N/A Initials Noise *Industrial Hygienist (IH)

Impact, Duration

Vibration *Industrial Hygienist (IH)

Tool use, Demolition, Distance

Infection Control *Infection Control Coordinator

Category of Risk [1] see below Level: I - II - III - IV

Dust *Infection Control Coordinator

Cutting, Grinding, Sanding, etc.

Life Safety Impact *Fire Department

ILSM Issues: [2] – see below

Security *Chief, Police Service

Site Security, Access Control

Disruption of Utilities *COTR - Facilities

Planned Shutdowns, Construction Near Utility System Supplies

[1] Infection Control Risk Assessment (ICRA) is for evaluation of the level of practices necessary to provide appropriate levels of patient safety.

[2] ILSM Risk Assessment is for determining whether ILSM are necessary and which ILSM are to be implemented.

Other Risk Assessments: YES N/A Permit Required Confined Space (PRCS) entry will be necessary. *FD Asbestos/lead or other hazardous abatement will be necessary. *IH Construction debris will be produced. (Recycling Program) *IH Chemicals will be on site. (Hazard Communication/MSDS sheets necessary.) *IH Compressed gas cylinders will be on site. (Appropriate storage) *IH Penetration in floors, walls, ceilings will be necessary. (Permit required) *FD Cutting, burning, or welding will be necessary. (Hot Work Permit) *FD Off tour construction/work will be necessary. (Supervision) *FD Lock-Out/Tag-Out of the following systems be necessary: *Facilities

□ Domestic Water □ Electrical Systems □ HVAC System □ Medical Gas

□ Steam Systems □ Security Alarms □ IT Systems

Safety/FD/designee COR Date

Concerns to address: Measures to take:

Select Control Procedures:

Impact of Building Trades on Healthcare

System Possible Interruption Possible Effect to Patients Electrical - Changing position of switches and breakers

- Cutting or splicing into wires

- Disconnecting wires or terminals

- Disturbing Junction

Boxes/Electrical Panels

- Core Drilling

- Demolition of walls

- Excavation

Electrical Systems provides LIFE SUPPORT (Directly and Indirectly)

- Can cause DEATH to patients

Water Lines - Turning valves

- Cutting into lines

- Demolition & Excavation

HVAC, GPICU, X Ray, etc Can cause DEATH to patients Infection Control issues Major Cleanup issues

Medical Gases:

Oxygen Air Vacuum Nitrous Oxide Nitrogen

- Cutting or disturbing into lines (labeled, unlabeled)

- Changing valve positions

- Deactivating alarms

- Demolition & Excavation

Oxygen, vacuum, air, etc.

GPICU, Med/Surg.

Can cause DEATH to patients

HVAC - Shutting down

- Modifying

- Changing controls

- Cutting into the roof

- Producing foul odors near intakes

- Cutting into chilled water lines

- Obstruct fresh air intake

Temperature is critical in GPICU, etc. Infection Control issues Major Air Quality Issues

Fire Alarm and Sprinklers - ANY modifications

- covering or removing smoke heads

- Demolition & Excavation

- Damage or set off sprinkler heads

- Duct work modifications

- Compromising Fire Safety

- False Alarms

- Floods

- Major disruptions and distractions

ALL THE ABOVE CAN

RESULT IN DEATH

Code Alarms Nurse Call Wander Guards

- Demolition & Excavation

- Unplugging

- Changing position of switches/breakers

Lack of communicating system can result in patient death or injury

Select Control Procedures:

VAMC TOMAH

Infection Control Risk Assessment (ICRA)

Attachment C (MCM FS – 50)

Step 1. - Use the following chart to identify the Type of Construction Project Activity (Type A-D)

Type A

Inspect and Non-invasive Activities: Includes, but not limited to:

Removal of ceiling tiles for visual inspection limited to 1 tile per 50 square feet

Painting (but not sanding) Wallcovering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection

Type B Small scale, short duration activities which create minimal dust: Includes, but not limited to:

Installation of telephone and computer cabling Access to chase spaces Cutting of walls or ceiling where dust migration can be controlled

Type C Work that generates a moderate t 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 floorcovering, ceiling tiles and casework New wall construction Minor duct work or electrical work above ceilings Major cabling activities Any activity which cannot be completed within a single work shift

Type D

Major demolition and construction projects: Includes, but not limited to:

Activities that require consecutive work shifts.

Requires heavy demolition or removal of a complete cabling system.

New construction

Selected Type of Construction:

Step 2. - Using the following table, identify the Patient Risk Group that will be affected. If more than one group is affected, select the higher risk group.

Low Risk Medium Risk High Risk Highest Risk Office areas Cardiology

Echocardiography Endoscopy Nuclear Medicine Physical Therapy Radiology/MRI Respiratory Therapy

CCU

Emergency Room Laboratories Outpatient Surgery Pharmacy Post Anesthesia Care Unit Surgical Units

Any area caring for immunocompromised patients

Cardiac Cath Lab Central Supply Intensive Care Units Medical Units Negative airflow rooms Oncology Operating Rooms

Select Patient Risk Group:

Step 3. - Match the Patient Risk Group with the planned Construction Project Type (A, B, C, D) on the following matrix, to find the Class of Precautions (I, II, III, IV) or level of infection control activities required.

Patient Risk Group

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 II III/IV III/IV IV

Attachment C (MCM FS – 50)

During Construction Project

Upon Completion of Projects

C la ss I

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

2. Immediately replace a ceiling tile displaced for visual inspection

1. Clean work upon completion of task

C la ss

II

1. Provide active means to prevent airborne dust from dispersing into atmosphere.

2. Water mist work surfaces to control dust while cutting

3. Seal unused doors with duct tape

4. Block off and seal air vents.

5. Place dust mat at entrance and exit of work area.

6. Remove or isolate HVAC system in areas where work is being performed

1. Wipe work surfaces with disinfectant.

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

3. Wet mop &/or vacuum before leaving work area.

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

C la ss

II

I

1. Remove or isolate HVAC system in area where work is being done to prevent contamination of duct system.

2. 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 & sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

3. Maintain negative air pressure within worksite utilizing HEPA-equipped air filtration units.

4. Contain construction waste before transportation in tightly covered containers.

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

1. Do not remove barriers from work area until completed project is inspected by Safety Management & Infection Control & thoroughly cleaned by Environmental Management.

2. Remove barrier materials carefully to minimize spreading of dirt & debris associated with construction.

3. Vacuum work area with HEPA-filtered vacuums.

4. Wet mop with disinfectant.

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

C la ss

IV

1. Isolate HVAC system in area where work is being done to prevent contamination of duct system.

2. 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 & sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

3. Maintain negative air pressure within worksite utilizing HEPA-equipped air filtration units.

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

5. 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 the can wear cloth or paper coveralls that are removed each time they leave the work site.

6. All personnel entering the work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area.

7. Do not remove barriers from work area until completed project is inspected by Safety Management & Infection Control & thoroughly cleaned by Environmental Management.

1. Remove barrier materials carefully to minimize spreading of dirt & debris associated with construction.

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

3. Cover transport receptacles or carts.

Tape covering unless solid lid.

4. Vacuum work area with HEPA-filtered vacuums.

5. Wet mop with disinfectant.

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

Note: Infection Control approval will be required when Construction Activity and Risk Level indicate that Class III or Class IV control procedures are necessary.

Project Class Type

VAMC Tomah Interim Life Safety Measures (ILSM)

Attachment D (MCM FS -50)

Project: Location(s): Evaluation Date: Start Date:

COTR: Contractor:

Guidelines Y/N If any answer is no, need ILSM in place:

Will exit egress routes from occupied areas remained unchanged?

Will exit stairs remain unobstructed & fire separated?

Will sprinkler system stay functional?

Will fire and smoke compartments remain intact and unchanged?

Will fire alarm detection systems remain functional & unimpaired?

Will construction area be separated by noncombustible smoke tight partitions?

Will access to emergency access by fire department remain unobstructed?

Will the construction area have two remote exits?

Adequate distance to exit?

Hazardous areas protected?

Interim Life Safety Measures (ILSM) – circle the letters for action required (Refer to Matrix)

a. Ensure Egress h. Prohibit Smoking

b. Ensure Emergency Forces Access i. Conduct 2 Fire Drills per Shift per Quarter

c. Ensure Fire Department Notification j. Increase Hazard Surveillance

d. Ensuring Operational Life Safety Systems k. Compartmentation Training of Personnel

e. Temporary Construction Partitions l. Conduct Organizational Training on Life

Safety

f. Additional Fire Fighting Equipment m. Daily removal of debris and hazardous waste material

g. Control Combustible Loading n. Institute a Fire Watch

Life Safety Narrative:

Assessed by: Fire Department Date

Agreed by: COTR Date

Contractor Date

O

AFFECTED SYSTEMS: STEAM WATER NORMAL POWER EMERGENCY POWER

NURSE CALL MED. GAS

OTHER

FIRE PANEL FIRE SUPPRESSION ELEVATOR

AFFECTED BUILDINGS/LOCATIONS:

INTERIM MEASURES REQUIRED:

AFFECTED STAFF NOTIFIED COMMENTS:

ADDITIONAL EQUIPMENT REQUIRED SPECIFY:

BACK-UP PROCEDURES IN PLACE SPECIFY:

EMERGENCY PROCEDURES REVIEWED COMMENTS:

OTHER:

OTHER:

ADDITIONAL COMMENTS:

REQUEST APPROVED BY: APPROVED DATE:

WORK COMPLETION REVIEW: WORK COMPLETION DATE:

OUTAGE FOLLOW UP:

INTERIM UTILITY SYSTEM OUTAGE MEASURES

REQUESTING SHOP: Project Section NAME OF REQUESTER: David Martin

DATE REQUESTED:

WORK START DATE:

PROJECT NUMBER:

676-19-116

AFFECTED TIMEFRAME:

DESCRIPTION OF W RK/PROJECT: Repair Campus Life Safety Findings