SOW Attachment 01 - VA PCRA.pdf

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PRE-CONSTRUCTION RISK ASSESSMENT CHECKLIST – Page 1/2

Project: 402-23-003S Install Security Upgrades and PACS Devices Project Location: Bldg 257 (Radio Repeater) Bldg 200 (Starbucks) and Bldg 209 (PIV Office)

Assessment Date: 01/05/2022 Project Manager: Mickey O’Brion

Evaluation Factor Status Condition

Yes No N/A If "Yes", Action Plan to be implemented

CONSTRUCTION SAFETY AND SECURITY

1 Will construction safety signs and/or barricades be required?

X Assure that appropriate construction barriers are built and construction signage is posted.

2 Will secured access to the construction site be required?

X Assure that access to construction site is secured to prevent the entrance of unauthorized persons.

3 Construction work will primarily be outside. X Place appropriate barricades and signage.

Notify hospital staff and security, and arrange appropriate detours for patients, visitors and staff.

4 Construction work will primarily be inside. X Place appropriate barricades and signage.

Notify hospital staff and Police, and arrange appropriate detours for patients, visitors and staff.

5 Will hot work operations be performed? X Issue "Hot Work Permit" in accordance with VACHS policy.

LIFE SAFETY/ INTERIM LIFE SAFETY

1 Will construction obstruct any means of egress?

i.e., corridors, stairwells, exits?

X Implement ILSM to include adjusting "EXIT" signage to compensate for temporary changes to egress path.

2 Will construction restrict access to other departments/services?

X Provide temporary signage directing patients and staff.

3 Will construction affect the fire alarm or the fire sprinkler system?

X Implement ILSM for areas impacted by shutdown of the system. Notify the Safety Office if an extended shutdown is required.

4 Will construction compromise smoke barriers and/or fire barriers?

X Implement ILSM Assure that additional fire extinguishers are available within the affected area.

5 Will construction impact exterior fire service systems, i.e., siamese connections, fire hydrants?

X Implement ILSM to include notifying the West Haven Fire Department of impact to exterior fire service systems.

6 Will construction impact interior fire service systems, I.e., fire sprinkler and/or standpipes?

X Implement ILSM for areas impacted by shutdown of the system. Notify the Safety Office if an extended shutdown is required.

Comment You will need above ceiling permit in Building 200 because of penetrations.

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PRE-CONSTRUCTION RISK ASSESSMENT CHECKLIST – Page 2/2

Project: 402-22-758 Design Build Garage Floor Repair Project Location: : Building 201 Grounds Garage

Evaluation Factor Status Condition

Yes No N/A If "Yes", Action Plan to be implemented

LIFE SAFETY/ INTERIM LIFE SAFETY cont…

7 Will asbestos containing materials be disturbed during construction?

X Assure that appropriate procedures are being followed in accordance with EPA and CT- DPH regulations and VA Specification requirements for the proper containment and removal of the asbestos containing material.

8 Will any hazardous materials be used on the project?

X Contractor should have SDSs available on site with proof of training for review upon request.

9 Will hazardous materials emit odors that need to be contained to the construction area?

X Follow FMS Policy 39 for dust control procedures during construction.

AIR QUALITY & INFECTION CONTROL

1 Will construction consist of demolition of walls and/or ceilings?

X Follow infection prevention procedures during construction. Verify item 7 above.

2 Has COR obtained Infection Control Construction Permit?

X Follow Infection Control Risk Assessment

UTILITY/ COMMUNICATION SYSTEMS

1 Will construction disrupt any utilities, i.e., electrical, water, etc. supporting patient care operations?

X Coordinate utility shutdowns in accordance with FMS Policy 33.

2 Will construction disrupt nurse call/code blue system?

X Coordinate utility shutdowns in accordance with FMS Policy 33.

3 Will construction disrupt communication systems, i.e., telephone, computer, overhead paging, pocket pager, two-way radio system(s), alarms, door locks, cameras, security systems?

X Coordinate utility shutdowns in accordance with FMS Policy 33. Coordinate interruption of communications system(s) with Biomed, IRM and VA Police.

4 Will temporary electrical service be required to be installed?

X Provide in accordance with the NEC and OSHA standards.

5 Will construction affect Air/Oxygen/Vacuum system?

X Coordinate utility shutdowns in accordance with FMS Policy 33. Coordinate with SPD and Nursing Service. Perform recertification of modified medical gas and oxygen in accordance with NFPA 99.

NOISE & VIBRATION

1 Will construction cause noise and vibration in-patient care areas?

X Coordinate phasing of demolition and new construction work with affected Services to minimize impact to patient care operations.

Follow VA specifications on maximum noise level tolerances allowed.

EMERGENCY PROCEDURES

1 Will construction affect emergency access of local Police or Fire Departments to the facility?

X Notify the local authorities of construction activities and alternate access to the facility.

George O Porter 647722

Digitally signed by George O Porter 647722 Date: 2023.02.21 10:12:35 -05'00'

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Attachment D

Signature of Construction Superintendent _________________________________________

Signature of Contracting Officer Representative (COR): ______________________________________________

Signature of Person completing rounds (if other than above) __________________________________________s

PROJECT TITLE: NAME OF CONTRACTOR:

STATION: CONTRACT NUMBER:

AREA: PROJECT NUMBER:

PROJECT COR: WEEK STARTING:

CHECK DAYS WORKED SUN MON TUE WED THU FRI SAT

Check only if problems are noted. If issues found, write on back of this form & note remediation on back

Safety/ ILSM/ IC issues S M T W Th F S Comments

Subcontractors are trained in safety/environmental issues

Means of egress is clear in construction and adjacent areas

Construction exits designated during construction?

Doors are closed to construction site and proper signage is in place

Did personnel receive training for alternative exits and/or ILSM?

Access for the fire department and emergency services is clear

Fire sprinkler / fire alarm systems and smoke detectors are active. Temporary systems are in place. Fire extinguishers readily available in construction area

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

NO Smoking Policies are being followed

Exterior balconies, corridors and stairways are clear of storage

Flammables and combustibles kept to a minimum and in proper containers. SDS are maintained on site and all products are labeled

Utility systems returned to operation in occupied areas

Lock out/ tag out in place

Buildings, grounds and equipment are maintained in a safe manner

Hard hats are used regularly per protocols

CONSTRUCTION SAFETY ROUNDS LOG - Safety/ILSM /Infection Control

Checklist

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Extension cords protected/disconnected at end of day

Exterior storm drains flushed and cleared of debris

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

Construction storage/field offices maintained and secured

Dust barriers are maintained, secured & tested. Barriers are monitored consistently for integrity & NPV airflow (clean to dirty)

Negative air pressure ventilation in work area is maintained utilizing HEPA equipped air filtration units

A log is maintained to document ongoing negative pressure ventilation in area

Compliance with traffic patterns for both construction worker & debris / worker movement (e.g., clean covered cart, dedicated elevator, designated route, etc.

Windows & doors are properly closed & sealed to prevent circulation of dust/debris

Walk off mats are provided & changed when needed. Floors are free of visible dirt outside construction area

All areas are cleaned daily and more often as needed by contractor or FMS

There are no signs of water leakage

There are no signs of pests (i.e., mice, insects, birds, squirrel, etc.)

All construction debris is transported in tightly covered containers

Emergency recall numbers left at work site

COMMENTS FROM ISSUES

NOTED ON DAILY ROUNDS

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