Safety Handbook.pdf

VA Defining

HEALTH EXCELl.ENCE CARE in the 21st Century

HAMPTON VA MEDICAL CENTER

Construction Safety Office

• This handbook is a summary of the more common VA policies and

OSHA regulations impacting construction policies and regulations. It is your responsibility as a contractor to be knowledgeable and compliant with all policies and regulations’ applying to the work being performed.

• Miscellaneous permits/forms are attached to this pamphlet and are to be used by the contractor. Requirements are subject to change, under those circumstances permits/forms with new requirements will be supplied by the COR.

Contract workers are an important part of our Medical Center. They provide services in virtually all areas of the Medical Center from time to time. Some contract workers work in direct contact with patients; others work in office areas without direct contact. Regardless of where they work, their activities support the health care and environment of our patients.

It is critically important, therefore, that you, the contract worker, know about the

Medical Center, its patients, its rules and regulations, and ways in which your safety and that of our valuable patients and employees can be insured.

The management, patients, and employees of this health care system appreciate your efforts to help us improve our facility and service to our veterans; however, safety must be stressed at all times.

Please take a moment to review this handbook with all of your employees and make sure everyone is familiar with the safety and infection control requirements. If you have any questions, please feel free to contact the VA COR that is overseeing your project or the Construction Safety Manager.

Thank you.

Hampton VA Medical Center

HAMPTON VA MEDICAL CENTER IS NOW SMOKE FREE!

As part of VHA’s commitment to a smoke-free health care environment for Veterans, the Hampton

VA Medical Center is now smoke free.

No smoking policies apply to cigarettes, cigars, pipes, any other combustion of tobacco and non-

Federal Drug Administration (FDA) approved electronic nicotine delivery systems (ENDS), including but not limited to electronic or e-cigarettes, vape pens or e-cigars.

https://www.flickr.com/photos/chrisinplymouth/34419596012 https://creativecommons.org/licenses/by-nc-sa/3.0/

Security is a cooperative effort. VA Police enforce federal and local regulations to protect patients, contract workers, volunteers, staff, and visitors. They also protect government and private property and preserve a peaceful and secure environment at the Medical Center 24 hours a day.

All contract workers are required to obey traffic, parking, and security regulations. It is also necessary for everyone to use common sense, cooperate with the police and, of course, keep personal possessions in a safe and secure place. Please report all suspicious or criminal activity, vehicle accidents, and personal property losses to the VA Police while on the facility grounds as soon as possible. If you see a suspicious person or any act that may be suspicious and/or criminal, notify the Police by calling (757)722-9961 ext.6911,or 6911 from a VA Land Line, and/or report your suspicion to a VA employee or your COR. Please report all suspicious or criminal activity, vehicle accidents, and personal property losses to the VA

Police while on the facility grounds as soon as possible.

All contractors are required to obtain and wear an identification badge. The identification badge must be visibly displayed on a shirt or jacket at all times while working at this Medical Center.

The Medical Center and its surrounding grounds are Federal property.

Because the VA Medical Center is federal property, all persons and bags are subject to search. In addition, no weapons, alcohol, or illegal drugs are permitted.

The following items are forbidden in the Medical Center buildings or on the grounds:

Alcoholic Beverages

Firearms

Knives with blades over 3 inches*

Fireworks

* excludes any tools of the trade

Information concerning patients and their records should be considered

CONFIDENTIAL.

Speak softly while on the wards, in the library, in the hospital corridors, and in any other areas where people are working or patients are resting.

If patients ask you for help or advice, refer them to a VA employee for assistance.

Do not sit on any patient beds or handle any medical or patient equipment unless you are specifically assigned to do so as a contract worker. Also, do not use the nursing counters.

Do not leave any (energized or de-energized) tools or electrical cords unattended.

Contract workers should not enter a room that is posted “ISOLATION” or “NO

VISITORS,” the Intensive Care Unit, or the Life Support Area, unless approved by the COR. The COR shall confer with the nurse manager in charge of the floor or area before entering. She/he will give you instructions to protect yourself and our patients.

For all “CODES” or emergencies, stand clear of the hallways so that emergency personnel and equipment can move freely.

Do not move or touch a patient. Inform the nursing staff of all patient requests.

Infection Control is critical in all medical center facilities. Interior construction activities causing disturbance of existing dust, or creating new dust, must be conducted within ventilation-controlled areas that minimize the flow of airborne particles into patient areas. Exterior construction activities causing disturbance of soil or creates dust in some other manner must be controlled. An AHA associated with infection control will be performed by VA personnel in accordance with FGI Guidelines (i.e. Infection Control Risk Assessment (ICRA)). The ICRA procedure found on the American Society for Healthcare Engineering (ASHE) website will be utilized. (See Specification Section 01 35 26 Safety Requirements, 1.12 Infection Control)

• Appropriate barrier systems for dust control must be in place before any construction starts. Installation and removal of construction barriers must be done outside of normal work hours. Do so carefully to minimize the spreading of dirt and debris. A job in patient areas or hospital hallways taking 1 0

Minutes or longer to complete requires dust barriers and/or barricades / warning systems.

• Walk-off mats must be placed at any entry/exit and must be changed frequently (checked at least twice daily) to prevent tracking of dust/debris into clean areas.

• Most Construction will require the utilization of HEPA equipped filtration units (furnished by the Contractor) to maintain negative air pressure within the worksite.

• Hampton Veterans Affairs Medical Center has the right to reassess and reclassify Infection

Control Risk Assessment and Interim Life Safety Measures at any time throughout construction. Contractor Shall update and or modify all ILSM/ICRA measures to accommodate such changes.

• Construction personnel will use a designated entry and exit site.

• Only authorized personnel should enter the construction area.

• Doorways and walkways must be kept free of debris.

• Appropriate personal protective equipment (PPE), such as goggles for eye protection, face mask or shield, (Possibly shoe covers, and clean gown or TyVek™ suit), will be worn upon entering the site.

• All PPE must be removed at the site of exit to prevent carrying dust to other areas within the facility. Clothes and shoes should be free of loose sand or debris once PPE has been removed.

• Contractors are responsible for keeping the construction entrance/exit zones clean. This may include wet mopping and/or vacuuming with HEPA filtered vacuum at the end of each work day.

• The Infection Control Practitioner will make periodic unannounced compliance rounds.

Issues needing attention will be discussed and corrected as soon as possible.

• No food or beverages should be taken into the construction area.

• If transporting construction waste through occupied areas is required, p roper containment of construction waste using a tightly covered container, is mandatory. The shortest exit route to the outside should be taken when construction waste is being transported, unless otherwise approved by the facility.

• Remove or Isolate HVAC system in area where work is being done to prevent contamination to the duct system and other areas that may share the same system.

• Upon Completion, the area must be thoroughly cleaned using HEPA filtered Vacuums, cleaners/disinfectant before barriers are removed. The area may require additional cleaning/disinfecting by HVAMC staff. Coordinate through COR.

• Once the project has been completed and the area has been thoroughly cleaned, Infection

Control must be notified to do a walk-thru inspection to ensure cleanliness in the area.

Site/ Laydown area Care and maintenance

• Vegetation on Construction site and laydown areas shall be maintained by

Contractor at all times, until Final Payment or termination of contract.

• Vegetation to not exceed 4” above ground level.

• Issues that are found to be a hazard to patients or staff on the Contractor’s site or laydown area are expected to be addressed Immediately.

• Sites/Laydown areas (including rear “waterfront”) in violation will be treated as a safety offense, and be treated with disciplinary policy procedures.

• Materials/equipment stored on site are subject to mandatory removal if deemed a possible hazard during forecasted severe weather events.

Severe Weather Events

During Forecasted Severe Weather Events, Contractors will be expected to take all precautions necessary, and are required to secure or remove any loose items that may become projectiles, especially any material or equipment stored on elevated levels.

Contractors will be required to perform the following when requested by the VA (as needed according to the type of severe weather event)-

• A survey of your areas to determine the potential exposure to high winds and flooding. Identify areas in need of protection, material removal, etc.

• Examine structures or materials covered with tarps to ensure they will remain standing in a storm. The wind can fill a tarp and cause it to pull down materials or structures.

• Examine any materials stored in your laydown area and secure as needed. The

Laydown area located at the rear of the facility is prone to flooding, recommend anything of value to be removed.

• Dumpster removal.

• Porta-John removal.

• Scaffolding removal.

• Removal of any ladders, trailers, temporary structures, or other items that could become a projectile.

• Removal of any materials, supplies, or tools that are stored on rooftops.

• Removal of any materials identified by the VA that could become a hazard during severe weather.

Our facility is prone to strong winds and flooding due to our waterfront location.

When working from elevated areas, please anticipate strong winds. Use extreme caution when picking up materials with a large surface area as these can act as a sail, and take caution when transitioning off of ladders. Ensure that tools are packed away safely and that materials, cones, signage and other loose materials are safely secured.

Wear eye protection to keep dust, debris and other foreign particles from blowing into the eyes, and ensure hard hats are securely fastened and cannot be blown off your head.

PERMIT / NON-PERMIT CONFINED SPACE ENTRY

• Contractors are responsible for designating roles and responsibilities for members of their Confined Space Teams and providing appropriate Rescue

Teams for their employees.

• For Permit Required Confined Spaces, contractors are required to provide their own entry supervisor, safety equipment, including detection devices for their personnel, as well as rescue equipment and personnel. The initial testing of the atmosphere will be performed by the contractor prior to entry into a confined space, with the documentation provided to the Safety Office prior to issuance of the permit and entry.

• No entry into permit required confined spaces can be made without a permit issued by the Program Coordinator or designee. This is accomplished through the COR.

• All authorized entrants must know the emergency action plan and receive training covering hazard recognition, use of personal protective equipment, and self -rescue.

Training shall be done in accordance with OSHA 1910.146.

• Contractors will notify the Safety Department (#2085 or #2143) indicating employees who are working in crawl spaces, providing information as to entry time and man hours employees are expected to be in those spaces. *NOTE: Work in crawl spaces will require approval of the Safety Department prior to entry.

See Confined Space Entry Permit and Location Definitions attached.

The VA complies with all local, state, and federal environmental regulations. All contractors working on VA property are expected to comply with all applicable environmental regulations and Hampton VAMC environmental permits. Some key areas of environmental regulations are:

1. Erosion and Sediment Control (ESC)/ Stormwater Management (SWM)

a. The contractor is responsible for implementing ESC/ SWM measures even if the site isn’t permitted

b. Refer to the VA ESC Handbook for guidance:

https://www.deq.virginia.gov/Programs/Water/StormwaterManagement/Publications/

ESCHandbook.aspx

c. Prevent illicit discharges from the construction activity. If an illicit discharge occurs, report these immediately to the COR.

d. If you are applying fertilizer, you must comply with the facility Nutrient Management

Plan. This sets time constraints and nutrient limits for the fertilizer. All fertilizer applied must be recorded and reported to the COR. (see attached Fertilizer

Application Record)

e. Once done with construction, the contractor is responsible for returning the site back to grade and establishing permanent uniform grass (Tall Fescue or Virginia native equivalent)

2. Waste Disposal

a. It is the contractors’ responsibility to ensure that all wastes are disposed of according to all applicable regulations.

b. Examples of Hazardous Waste: solvents like paint thinner and aerosols

c. Examples of Universal Waste: fluorescent lightbulbs and batteries

d. All waste tickets and manifests must be given to the COR.

3. Petroleum, Oil, and Lubricant Storage

a. If the contractor stores more than 55 gallons of petroleum product or oil, then the contractor must abide by the facility Spill Prevention, Control, and

Countermeasures Plan. This includes but is not limited to: secondary containment and monthly inspections.

4. Spills

a. Any spills must be immediately cleaned up by the contractor in a manner appropriate for the nature of the chemical spilled.

b. All environmental incidents must be reported immediately to the COR who will notify the GEMS Coordinator.

c. It is the contractor’s responsibility to dispose of any waste resulting from a spill according to state and federal regulations.

Questions regarding environmental issues are to be directed to the COR. The GEMS

Coordinator will make periodic unannounced compliance rounds. Issues needing attention will be discussed and corrected as soon as possible.

https://www.deq.virginia.gov/Programs/Water/StormwaterManagement/Publications/ESCHandbook.aspx https://www.deq.virginia.gov/Programs/Water/StormwaterManagement/Publications/ESCHandbook.aspx

Contractor Parking Policy

a. Parking for vehicles and contractor employee's vehicles will be restricted to the Laydown area west of building 27.

b. Temporary parking at any place other that the Laydown area (including grassy areas) will be allowed only during loading or unloading of tools or material and shall be coordinated with the COR. The contractor must exercise care to not damage government property and must maintain pedestrian access. Once loading/unloading operations are complete, the vehicle must immediately be moved to an authorized area. Any damage to government property during these operations must be repaired at the expense of the contractor. See construction specifications for more specific requirements.

c. All traffic regulations will be er-iforced. This includes unauthorized parking in restricted spaces, parking at yellow curbs, parking in the grass, on walks, etc.

d. Access to the buildings by cranes, oversize trucks or other special equipment must be approved by the Project Engineer and/or COR.

• Do not block hallways, passageways, or exits.

• Do not leave any tools or equipment unattended.

• Be careful and observe your surroundings while walking and working.

• All supplies and other deliveries must be stored in a predetermined location, not left on the floor, and not left unattended.

• Use only grounded UL-listed extension/flexible cords. Do not allow extension cords to cross a walkway or corridor, creating a trip hazard. Cords shall not be run through doorways, or concealed behind ceilings, walls or floors. Cords should be used in continuous lengths without splicing or tape and be visually checked prior to each use.

• All cord and plug connect equipment, e.g., sump pumps, hand- held motor operated tools, and appliances used outside that operate on greater than or equal to 120 volts, or likely to be used in a wet environment, shall be grounded and equipped with a

Ground Fault Circuit Interrupter(GFCI). A l l p o r t a b l e t o o l s a n d a p p l i a n c e s m u s t b e Listed or labeled and protected by an approved UL system of double insulation or its equivalent. GFCI protection must be used at all times.

• All energized parts of more than 24 volts must be guarded against accidental exposure.

• All energized circuits, hazardous energy, or machinery MUST be de-energized or shut off prior to work being performed on or in the near vicinity of such hazardous energy.

Lockout/Tagout as listed in OSHA regulation 29 CFR 1910.147 “Control of

Hazardous Energy”, MUST be followed.

• Fall protection threshold height requirement is 6 ft. for all work, unless specified differently in OSHA regulation 29 CFR 1926.500 subpart M, “Fall

Protection”.

• Scaffolding shall be erected in accordance with 29 CFR 1926 Subpart L

“Scaffolds”. Ladder jacks, lean-to, and prop-scaffolds are prohibited.

Employers who erect, disassemble, move, operate, repair, maintain or inspect a scaffold shall be trained by a competent person. Each employee who performs work on a scaffold shall be trained by a person qualified to recognize the hazards associated with the type of scaffold used and to understand the procedures to control or minimize these hazards. Contractors shall use a scaffold tagging system in which all scaffolds are tagged by the Competent

Person. Tags shall be color-coded: green indicates the scaffold has been inspected and is safe to use; red indicates the scaffold is unsafe to use. Tags shall be readily visible, made of materials that will withstand the environment in which they are used, be legible and shall include:

1.The Competent Person’s name and signature.

2.Dates of initial and last inspections.

• Be careful and observe your surroundings while walking and working.

• If you see a “Wet Floor” sign, do not walk in the area until the sign is removed.

• Safety Data Sheets (SDS) must be provided to the assigned COR and made available on project sites for every, or any chemical product to be used during contracted work.

• If you spill something, clean it up immediately. Caution others to stay clear of the area until it is cleaned up. Notify the COR.

• If you see a spill and you do not know what it is, notify your COR or a VA employee nearby. Do not clean it up yourself.

• If you see any safety hazards, report them to the COR overseeing your project or construction safety manager.

• Be aware of patient and wheelchair traffic. Use caution and pull carts, as opposed to pushing carts, around a blind corner.

• Do not open any window without approval from the COR.

• Prior to entry into any confined space, and upon completion of the entry, the

COR shall be notified. (See HVAMC Procedures/Permits for Permit required

Confined Space)

HVAMC CONTRACTOR SAFETY DISCIPLINARY POLICY PROCEDURES

All contractor and sub-contractor employees are expected to comply with HVAMC policies, OSHA regulations, and to follow established operating procedures set forth by the HVAMC. Violations, and repeated violations will not be tolerated and the superintendent/foreman will be held accountable for the conduct of contractor and sub-contractor employees.

Superintendents and foremen are required to take action when a violation is observed or brought to their attention. Immediate action to control or eliminate a hazard is required.

In the event of a violation/repeat or serious violation is observed, the following procedures have been established to place an employee and the contractor on notice.

Notice Action

First Offense A written warning from the Contracting Officer (CO) to the contractor (Copy to the

Contracting Officer Representative (COR) will address the violation of the employee and the contractor. A copy will be provided to the superintendent and one placed in the contract file and the HVAMC construction safety office file, referencing the violation and warning, including date and time.

Repeated Offense A written letter of reprimand from the Contracting Officer addressed to the contractor with reference to the violation. A request for replacement of Project Superintendent, Site

Safety and Health Officer(SSHO) or removal of contractor employees from the facility.

A copy of this letter will be given to the Contractor’s main office, and HVAMC

Construction Safety Office.

Third Offense OR Serious Violation A “Stop Work” at no-cost to the government will take place immediately and will not be removed until a safety stand-down (SSD) is completed by the contractor and its employees, and monitored by the HVAMC Construction Safety Manager. Requirement for immediate replacement of Superintendent. Documentation of the offense will be filed at the HVAMC Construction Safety Office.

The above procedure has been prepared so that there is no question about how violations of rules, regulations, and procedures will be handled by HVAMC and so that contractor, sub-contractors and their employees will know what to expect if they do not comply with the established rules, regulations, and procedures.

Project: ________________________________Contractor: ___________________________

Superintendent: ______________________________________ Day: _________________

1st Violation

Description: _____________________________________________________________________________________________

Superintendent Signature: Date:

2nd Violation (Repeated Violation: Y N)

Description: _____________________________________________________________________________________________

Superintendent Signature: Date:

Third Offense OR Serious Violation (Repeated Violation: Y N)

Description: _____________________________________________________________________________________________

Superintendent Signature: Date:

VA Construction Safety Manager: Date:

(Third Offense OR Serious violation that has a potential to cause a loss of life, limb or medical center equipment)

ABOVE CEILING PERMIT POLICY AND PROCESS

• All contractors who work above ceiling will read, familiarize themselves with and follow

HVAMC above ceiling policies and processes. Contractors who fail to follow the Above

Ceiling Policy and Process will be immediately directed to leave the facility and will need approval from the Facility Fire Safety Specialist, Engineering Chief or Chief of Safety in order to return to the job.

• All contractors will be properly identified by a badge and have an above ceiling permit issued by the Facility Fire Safety Office, or designee, for work above ceiling.

• The above ceiling permit will be displayed in the transparent ticket holder in full view on the contractor’s ladder in the work area.

• Contractor’s ladders used in above ceiling work will not be made of any type of conductive material to protect the technician from electrical shock and will have the required OSHA and safety labeling. All contractor’s ladders will be clearly marked for ease of identification.

• During periods of above ceiling work the contractor will ensure that no wires are hanging down in a loop or loose that could cause injury to another person.

• Ceiling tiles shall be inspected along the intended route of work for damage and if there are any, shall be reported to the Facility Fire Safety Office designee located in Building 35, or call 757-

722-9961, extension 2123, prior to starting work. It is the contractor’s responsibility to replace any damaged or broken ceiling tiles not identified and reported. Ceiling tiles must be same type and pattern as damaged tiles.

• One ceiling tile per every 50 square feet is the maximum number of ceiling tiles to be removed at one time.

• When contractors need to leave the above ceiling work area for more than 30-minutes, the ceiling tiles will be reinstalled.

• During periods of meals and breaks, all ceiling tiles will be reinstalled.

• No materials – e.g., tools, ladders, etc. shall be left unattended in public areas at any time.

• Any penetration through a non-rated or rated barrier, floor or ceiling assembly will require proper fire stopping. CORs will ensure contractors use Hilti FS Firestop Sealant 259579 and/or Hilti

Firestop Sealant (Product Code: CP6015) fire stopping materials approved by the Fire Safety

Office, or designee.

• Any and all wires, cables, Community Antenna Television (CATV), telephone, data, etc. that penetrate a non-rated or rated barrier, floor or ceiling assembly will be placed in a conduit sleeve and sealed with proper approved 3M fire stop.

• Conduit sleeves shall not be filled with more than 60 percent with wires/cabling.

• All wiring, cabling, CATV, telephone, data, etc. are to be suspended with the proper hangers.

They are NOT to be hung or tied in any form or fashion to piping, ducting, ceiling hanger, pipe hanger, etc. or laid directly on top of the ceilings or grid.

• All piping, ducting, seismic supports, piping hangers, duct hangers, etc. are to be suspended in accordance with the latest codes and standards.

• All miscellaneous materials (trash, wall pieces, etc.) are to be removed from above the ceiling.

• When all work is completed and approved, the permit will be kept on file in the Facility Fire

Safety Office for one year from the last day of work.

HVAMC Procedures/Permits

Permits are required for the following activities and require advanced notification to the COR. Some of these polices are, but not limited to the following-

Daily Log-Safety/ILSM Checklist- The SSHO shall conduct frequent and regular safety inspections (daily) of the site and each of the subcontractors CPs shall conduct frequent and regular safety inspections (daily) of their work operations as required by 29 CFR

1926.20(b)(2). Daily Reports to be documented with provided HVAMC Safety/ILSM

Checklist (See attached Daily Log- Safety/ILSM Checklist)

Utility Outages- Contractor must submit a Utility Outage Request Form to the COR 14 days prior to the requested outage date . For outages affecting the Fire Alarm and Sprinkler Systems, the requestor must also submit a “Disabling a Fire Protection System Permit” with this request.

(Utility Outage Request Form and Disabling a Fire Protection System permit attached)

Ground breaking -All requests should be made as soon as possible in order to maximize planning and notification time frames. A minimum of 5 days’ notice shall be given for all groundbreaking permits except in cases of emergencies. (Ground Breaking Permit attached)

Trenching & Excavating- All excavation work must comply with 29 CFR 1926 subpart P-

EXCAVATIONS. (Excavation checklist attached)

Non-Critical and Critical Lifts- Lift permits, including all supporting documents, must be completed by a qualified person and submitted to and approved by the Safety Section 14 days prior to the planned lift. All lifts must follow 29 CFR 1926 Subpart CC. (See Attached Standard Lift Permit and

Critical Lift Permit)

Working above the ceiling- All contractors who work above ceiling will read, familiarize themselves with and follow HVAMC above ceiling policies and processes. The above ceiling permit will be displayed in the transparent ticket holder in full view on the contractor’s ladder in the work area. All rated and non-rated fire and smoke barriers at Hampton VA

Medical Center (HVAMC) shall be maintained, and/or improved, to a condition equal to or better than original construction and shall comply with NFPA 101, Life Safety Code . (See

ABOVE CEILING PERMIT POLICY AND PROCESS , and attached ABOVE CEILING WORK

PERMIT)

Firewall Penetrations – Contractors must secure a Fire Wall Penetration Permit from the

Fire Inspectors Prior to penetrating and Fire or Smoke Barrier, or Partition. All Fire/Smoke wall penetrations are to be sealed daily. (See attached Fire and Smoke Wall Penetration /

Fire Stop Installation Permit)

Permit/Non-Permit Confined Space Entry- Contractors shall follow the Occupational

Safety and Health Administration (OSHA) 1910.146. Contractors are required to provide their own entry supervisor, safety equipment, PPE, calibrated testing equipment, including detection devices for their personnel, as well as rescue equipment and personnel. Attendant duties shall be the responsibility of the contractor . Entry Supervisor must notify Hampton

City Fire Department prior to a confined space entry. The initial testing of the atmosphere will be performed by the contractor prior to entry into a confined space, with the documentation provided to the Safety Off ice prior to issuance of the permit and entry. No entry into permit required confined spaces can be made without a permit issued by The

Industrial Hygienist. (See attached Confined Space Entry Permit - Hampton VA Medical

Center and CONFINED SPACE ASSESSMENTS/DESIGNATIONS)

Hot Work- A HOT WORK PERMIT is required for all Burning, Cutting, Grinding, Soldering, Welding, Heat applied roofing, Tile Work, Brazing, use of Heat Gun, or any other activity that may produce a spark or flame. Contractors must obtain the permit from the VA

FIRE INSPECTORS OFFICE (Bldg. #35 Rm101F) , Prior to any Hot work activities. Permit must be posted at work site and visible at all times. Failure to do so will prevent work from continuing until posted. A minimum 2 HR fire watch provided by the Contractor is mandatory.

Fertilizer Application Record- All fertilizer applied must be recorded and reported to the COR.

DAILY LOG - Safety/ILSM Checklist STATION: 590 - Hampton, Virginia 23667

PROJECT TITLE: NAME OF CONTRACTOR:

DATE: CONTRACT NUMBER:

DAY OF WEEK: PROJECT NUMBER:

Items for daily review: YES NO N/A

Means of egress is clear in construction and adjacent areas. ___ ___ ___

Access for the fire department and emergency services is clear. ___ ___ ___

Status of the fire detection/sprinkler system: ___ ___ ___

Fire sprinkler system is active. ___ ___ ___

If no, was Fire Watch Conducted ___ ___ ___

Fire alarm system is active. ___ ___ ___

If no, was Fire Watch Conducted ___ ___ ___

Smoke detectors are active. ___ ___ ___

Temporary systems are in place. ___ ___ ___

Construction partitions are being maintained and are smoke tight. ___ ___ ___

Good housekeeping practices are being maintained. ___ ___ ___

Exterior balconies, corridors and stairways are clear of storage. ___ ___ ___

Flammables and combustibles kept to a minimum and in proper containers. ___ ___ ___

Buildings, grounds and equipment are maintained in a safe manner. ___ ___ ___

Smoking regulations are being followed. ___ ___ ___

Fire extinguishers are readily available in construction area. ___ ___ ___

Hot work permit issued. ___ ___ ___

Fire Watch Conducted ___ ___ ___

Work site inspected after hot work. ___ ___ ___

Caution/danger signs and barricades in place where needed. ___ ___ ___

Lock out/tag out in place. ___ ___ ___

Extension cords protected/disconnected at end of day. ___ ___ ___

Dust barriers maintained and walk off mats provided. ___ ___ ___

MSDS maintained on site and products labeled. ___ ___ ___

Asbestos is properly controlled and interstitial doors are closed and locked. ___ ___ ___

Area is secured from public and at the end of the day. ___ ___ ___

Odors from construction operations are cleared. ___ ___ ___

Safety and temporary signage is in place. ___ ___ ___

Emergency recall numbers left at work site. ___ ___ ___

Utility systems returned to operation in occupied areas. ___ ___ ___

Construction storage/field offices maintained and secured. ___ ___ ___

Excavations properly barricaded. ___ ___ ___

All external openings in walls/roof are sealed from inclement weather. ___ ___ ___

Exterior storm drains flushed and cleared of debris. ___ ___ ___

Subcontractors aware/trained in safety/environmental issues. ___ ___ ___

Barrier installed. ___ ___ ___

Wet mop, HEPA vac and inspect prior to barrier removal. ___ ___ ___

Remove construction barrier. ___ ___ ___

Reinstate HVAC. ___ ___ ___

Wipe work surfaces with disinfectant. ___ ___ ___

Dumpster covered and 25' from building. ___ ___ ___

ICRA Required Activities:

Block and seal air vents. ___ ___ ___

Isolate HVAC. ___ ___ ___

Seal Doors. ___ ___ ___

Maintain negative pressure. ___ ___ ___

Dust mat at entrance to work area. ___ ___ ___

Cover construction waste for transport. ___ ___ ___

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

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

Anteroom installed and used appropriately. ___ ___ ___

All personnel wear shoe covers. ___ ___ ___

Contractors signature:

COTR: Concurr or Discrepancies noted Initials __________

Discrepancies/Comments:

If any items have an indication of “No” the COTR is to be notified immediately.

UTILITY OUTAGE REQUEST FORM

Date Requested Requestor (COR) _ ______

Requestor’s Title Requestor’s Phone Number ____

Date Outage Needed Duration of Outage Requested _

Utility Outage Requested: .

Fire Sprinkler* __ Electrical __ Domestic Water __ Chilled Water

__ Steam __ Oxygen __ Medical Air __ Medical Vacuum

__ Natural Gas __ Fire Alarm* Other (Specify) _Fire Protection

Reason Outage is Requested: .

Building Number and Location Affected __ _____________________

Supervisor Approval of Request (Signature) _________________________ _______________

* Fire alarm components disabled for more than 10 hours must be conveyed to the Facility Safety Manager for notification to the VISN. It is the Fire Inspectors responsibility to notify the Facility Safety Manager.

However for outages affecting the Fire Alarm and Sprinkler Systems, the requestor must also submit a

“Disabling a Fire Protection System Permit” with this request.

THIS SECTION FOR MAINTENANCE AND OPERATIONS USE ONLY

Date Request Received__________ Outage Number__________ Shop Assigned ___________________

Special Concerns or Comments: __________________________________________________________

Contacts to Notify of Outage Date Contacted Contact Made By:

UTILITY OUTAGE RETURN NOTICE

Work Order # NR_______________________________

To: __________________________________________ (Requestor) Project # ____________________

Your outage request for the following utility _____________________ was approved and scheduled for

______________ (Date) at __________________ (Time) as requested.

To: __________________________________________ (Requestor) Project

We were unable to schedule your outage request for the following utility ___________________ on the date and time you requested. It has been scheduled for ______________ (Date) at ____________ (Time).

Please notify the Maintenance Program Manager immediately if this will not work for you at ext 2090.

Program Manager/Designee, Maintenance & Operations_____________________________________________

DISABLING A FIRE PROTECTION SYSTEM

PERMIT

DATE:___________________________TIME:___________________

Building Number, floor, fire/smoke zone:

Name of person requesting outage:

COMPANY

TELEPHONE:_____________________NEXTEL:________________

SIGNATURE:_____________________________F.I. Initials________

REASON FOR DEACTIVATION:

REACTIVATED TIME:_________________DATE:_________________

COMMENTS:______________________________________________________

F.I. INITIALS:_____________

RETAIN FOR FILE

GROUND BREAKING PERMIT

This Section shall be completed by Contractor

Requestor________________________________ Requestor Phone Number ______________

Date Request Submitted________________ Date Required________________

Request clearance of contractor marked utilities at the following location:

Type of work to be performed in the area (why clearance is needed):

COR Signature ______________________________________ Date _________________

Project Section Supervisor Signature _________________________ Date _________________

Note: It is the COR’s responsibility to coordinate with Safety and the Police on issues relating to traffic control or items not specific to Maintenance or Utilities.

This Section shall be completed by Maintenance & Operations

Utilities Marked:

Utility Validation Date Comments

Electric

Steam

Water

Sewer / Storm

Fire Components

Other: Specify

Program Manager/Designee, Maintenance & Operations________________________________

Date Returned to Requestor___________________

Marking of utilities is solely the Contractor’s responsibility and shall be performed by a qualified private utility locating company. Contractor excavating within 10 feet of property line will contact

Miss Utility of Virginia for their clearance.

Standard Lift Permit

Rev. 2/20/19

This standard lift permit, including all supporting documents, must be completed by a qualified person and submitted to and approved by the Safety Section 14 days prior to the planned lift. Permits must be at the lift site until the lift is complete. Permits must be reissued if conditions (equipment, weather, and/or ground) or scope of work has changed. All lifts must follow 29 CFR 1926 Subpart CC.

NOTE: If any of the following conditions will be involved with the lift operation, a critical lift permit must be completed:

Lifts involving hazardous materials Lifts with a center of gravity that could change Lifts made with more than one crane or hoist The crane will "walk" with load Hoisting Personnel Loads =/> 75% of rated capacity of the load chart Lifts involving submerged loads Lifts without the use of outriggers using rubber tire load charts Lifts involving multiple or difficult rigging Lifts outside the crane operator’s view

A. GENERAL

Project Name & Number: Contracting Officer’s Representative: Start Date/Time: Finish Date/Time:

Crane Owner: Crane Lift Location (Area/Building): Qualified Person completing permit:

Phone:

Crane Operator:

Phone:

Rigger:

Phone:

B. LIFT DATA

1. Load Weight:

1a. Describe Load and Enter Total Load Weight:

Estimated Weight: Lbs. Actual Weight: Lbs.

1b. Total load weight (block, rigging, jib, etc.) as a percentage of rated load capacity of crane from load chart: %

2. Lifting Height:

Height of Load to be not greater than Feet Maximum Height of Crane Boom / Extension Tip Feet

3. Operating Radius:

Maximum Radius of Load to be not greater than Feet

C. CRANE DATA & LIFT SET UP

1. Crane Manufacturer:

Crane Manufacturer: Size: Model Number:

Date of Last Annual Inspection: Inspected by:

2. Verify manufacturer's load chart indicates lifting capacity at stipulated load radius and boom lengths.

Note: If boom length and/or radius is between the stipulated or posted value on the load chart select the next lesser rating capacity. The next lesser rating capacity may be the next longer or shorter boom length.

D. SPECIAL PRECAUTIONS

Lift will not be conducted over an occupied section of a building Blocked exits and building evacuations require an Interim Life Safety Measure (ILSM) Request ILSM from Safety Section minimum of 14 days prior to planned lift

Coordinate road blocks or closures with the police and fire services prior to the lift Signal Person required when swing path takes load out of crane operator’s view

E. SUBMITTALS

Crane operator license Annual crane inspection Crane lift/load chart showing weight lifted, angle and main boom length Plan view of load location and crane orientation to building(s), swing radius, road closure & barricades.

F. APPROVALS

I certify the information contained on this standard lift permit is correct.

Qualified Person:

Name: ______________________ Signature: _______________________________ Date: ________

Safety Specialist:

Name: ______________________ Signature: _______________________________ Date: _________

G. LIFT OPERATIONS

Execution of the lift shall be in accordance with OSHA 29 CFR 1926 Subpart CC.

LIFT SUPERVISOR TO COMPLETE THIS CHECKLIST ON THE DAY OF THE LIFT

Interim Life Safety Measure (ILSM) obtained from Safety Section as necessary (blocked exits, evacuation, etc.)

Lift will not be conducted over an occupied section of a building

Crane lift site has traffic and pedestrian controls in place

An individual has been designated to observe for obstructions and unauthorized personnel

Confirm swing radius has been barricaded and access is limited to authorized personnel

Confirm load weight

Ensure load hook is directly over the load center of gravity

Confirm boom angle, boom length, lift radius, and the crane capacity

Ensure outrigger pads are fully extended and blocking is sufficient for the load

Ensure tires are clear of the ground and the crane is level

Confirm all obstacles and obstructions have been identified

Ensure lifts in proximity to power transmission lines comply with OSHA 29 CFR 1926.1407 through 1411

Verify a signal method has been determined between the crane operator and the signalman

Verify the crane operator meets OSHA qualifications requirements to operate the crane

Verify the crane boom is equipped with a safety flag and/or beacon light

Verify a "competent person" has inspected all slings, fastenings, and attachments for damage or defects.

Verify a "competent person" has inspected all crane safety devices and operational controls prior to and during use to ensure safe operating condition. Any deficiencies shall be repaired prior to continued use

Ensure damaged or defective equipment is immediately removed from service

Verify all required crane manufacturer operational control procedures are available in the crane cab

Verify the all required inspections have been completed.

Wind Speed: Crane is equipped with anemometer: Yes No Lifts when wind speed > 20 mph require reassessment.

Lifts are not allowed when wind speed exceeds 30 mph

Wind Speed at time of lift: mph.

An on-site meeting on the day of and prior to the planned lift was conducted with the undersigned.

Lift Supervisor:

Name: ______________________ Signature: _______________________________ Date: ________

Contracting Officer’s Representative:

Name: ______________________ Signature: _______________________________ Date: _________

Licensed Crane Operator:

Name: ______________________ Signature: _______________________________ Date: ________

Qualified Rigger:

Name: ______________________ Signature: _______________________________ Date: ________

H. PERMIT DURATION

Start Date/Time: Finish Date/Time: Safety Specialist:

Name: ____________________ Signature: _______________________

Date: _________

HVAMC EXCAVATIONCHECKLIST MCM 138-25 Attachment A

(To be completed by a Competent Person)

SITE LOCATION:

DATE: TIME: COMPETENT PERSON:

SOIL CLASSIFICATION: EXCAVATIO N DEPTH: EXCAVATION WID TH:

TYPE OF PROTECTIVE SYSTEM USED:

Indicate for each item: YES - NO - o r N/A f o r not applicable

1. General Inspection of Jobsite:

A. Excavations, adjacent areas, and protective systems inspected by a competent person daily before the start of work.

B. Competent person has the authority to remove employees from the excavation immediately.

C. Surface encumbrances removed or supported.

D. Employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation.

E. Hard hats worn by all employees.

F. Spoils, materials, and equipment set back at least two feet from the edge of the excavation.

G. Barriers provided at all remotely located excavations, wells, pits, shafts, etc.

H. Walkways and bridges over excavations four feet or more in depth are equipped with standard guardrails and toe boards.

I. Warning vests or other highly visible clothing provided and worn by all employees exposed to public vehicular traffic.

J. Employees required to stand away from vehicles being loaded or unloaded.

K. Warning system established and utilized when mobile equipment is operating near the edge of the excavation.

L. Employees prohibited from going under suspended loads.

M. Employees prohibited from working on the faces of slopes or benched excavations above other employees.

2. Utilities:

A. Utility companies contacted and/or utilities located.

B. Exact location of utilities marked.

C. Underground installations protected, supported, or removed when excavation is open.

3. Means of Access and Egress:

A. Lateral travel to means of egress no greater than 25 feet in excavations four feet or more in depth.

B. Ladders used in excavations secured and extended three feet above the edge of the trench.

C. Structural ramps used by employees designed by a competent person.

D. Structural ramps used for equipment designed by a registered professional engineer (RPE)

E. Ramps constructed of materials of uniform thickness, cleated together on the bottom, equipped with no-slip surface.

F. Employees protected from cave-ins when entering or exiting the excavation.

4. Wet Conditions:

A. Precautions take to protect employees from the accumulation of water.

B. Water removal equipment monitored by a competent person.

C. Surface water or runoff diverted or controlled to prevent accumulation in the excavation.

D. Inspections made after every rainstorm or other hazard-increasing occurrence.

5. Hazardous Atmosphere:

A. Atmosphere within the excavation tested where there is a reasonable possibility of an oxygen deficiency, combustible or other harmful contaminant exposing employees to a hazard.

B. Adequate precautions taken to protect employees from exposure to an atmosphere containing less than 19.5% oxygen and/or to other hazardous atmospheres

C. Ventilation provided to prevent employee exposure to an atmosphere containing flammable gas in excess of 10% of the lower explosive limit of the gas.

D. Testing conducted often to ensure that the atmosphere remains safe.

E. Emergency equipment, such as breathing apparatus, safety harness and lifeline, and/or basket stretcher readily available where hazardous atmospheres could or do exist.

F. Employees trained to use personal protective and other rescue equipment.

G. Safety harness and lifeline used and individually attended when entering bell bottom or other deep confined excavations.

6. Support Systems:

A. Materials and/or equipment for support systems selected based on soil analysis, trench depth, and expected loads.

B. Materials and equipment used for protective systems inspected and in good condition.

C. Materials and equipment not in good condition have been removed from service.

D. Damaged materials and equipment used for protective systems inspected by a registered professional engineer (RPE) after repairs and before being placed back into service.

E. Protective systems installed without exposing employees to the hazards of cave-ins, collapses, or threat of being struck by materials or equipment.

F. Members of support system securely fastened to prevent failure.

G. Support systems provided in ensure stability of adjacent structures, buildings, roadways, sidewalks, walls, etc.

H. Excavations below the level of the base or footing supported, approved by an RPE.

I. Removal of support systems progresses from the bottom and members are released lowly as to note any indication of possible failure.

J. Backfilling progresses with removal of support system.

K. Excavation of material to a level no greater than two feet below the bottom of the support system and only if the system is designed to support the loads calculated for the full depth.

L. Shield system placed to prevent lateral movement.

M. Employees are prohibited from remaining in shield system during vertical movement.

DAILY TRENCHING LOG

DATE: SIGNATURE:

WEATHER: PROJECT:

Was Missed Utilities (811) contacted: Yes No

Protective system: Trench shield (box) Wood shoring Sloping Other

Purpose of trenching: Drainage Water Sewer Gas Other

Were visual soil tests made: Yes No If yes, what type?

Type of Soil: Stable Rock Type A Type B Type C

Surface encumbrances: Yes No If yes, what type?

Water conditions: Wet Dry Submerged

Hazardous atmosphere exists: Yes No (If yes, follow confined space entry procedures policy; complete confined Space Entry Permit; monitor for toxic gas(es))

Is trenching or excavation exposed to public vehicular traffic (exhaust emission): Yes No (If yes, refer to confined space entry procedures; complete Confined Space Entry Permit; monitor for toxic gas(es))

Measurements of trench: Depth Length Width

Is ladder within 25 feet of all workers: Yes No

Is excavated material stored two feet or more from edge of excavation: Yes No

Are employees exposed to public vehicular traffic: Yes No (If yes, warning vests required)

Are other utilities protected: Yes No (Water, sewer, gas or other structures)

Are sewer or natural gas lines exposed: Yes No

Periodic Inspection: Yes No

Did employees receive training in excavating: Yes No

Corrective Actions and Remarks:

Hampton VA Medical Center Lift Plan Permit

A Critical Lift Permit, including all supporting documents, must be submitted to and approved by the Safety Section 14 days prior to the planned lift. Permits must be at the lift site until the lift is complete. Permits must be reissued if conditions (equipment, weather, and/or ground) or scope of work has changed. All lifts must follow 29 CFR 1926 Subpart CC.

A critical lift is defined as any one or more of the following conditions:

Lifts involving hazardous materials Lifts with a center of gravity that could change Lifts made with more than one crane or hoist The crane will "walk" with load Hoisting Personnel Loads =/> 75% of rated capacity of the load chart Lifts involving submerged loads Lifts without the use of outriggers using rubber tire load charts Lifts involving multiple or difficult rigging Lifts outside the crane operator’s view

A. GENERAL

Project Name & Number: Contracting Officer’s…