VA 01 00 00 General Requirements - Appendix C.pdf

Appendix C

Facilities Management Service‐Alerts

SECTION 01 00 00

GENERAL REQUIREMENTS

Appendix C

Proper Procedures and Forms for all Access Closures, Utility Shutdowns and Live Electrical Work Request

GENERAL NARRATIVE OF DOCUMENTATION REQUIREMENTS FOR

PLANNED UTILITY SHUTDOWNS

General: All of the following types of work will be documented by the requesting party (contractor or in-house maintenance person) in a file folder fitted with two-hole prong paper fasteners.

Fasteners will be attached to the tops of each cover of the file folder. This narrative should be used in conjunction with the Utility Shutdown Flow Chart for a clear understanding of the shutdown process.

1. Planned Utility Shutdown:

In accordance with Hospital Policy Memorandum (HPM) 138-23, June 2007, a request for utility shutdown must be presented to the Chief, Facilities Management Service (FMS), for evaluation and action to determine whether the shutdown will be classified as routine or major.

A. A Draft Utility Shutdown Notice is initiated by the requesting party and upon completion will be stapled to the outside front-cover of the file folder.

B. The Planned Utility Interruption/ Checklist will be attached to the inside front-cover using the two-hole prong fastener.

C. The Work Plan / Peer Review form (attachment #5) is initiated and attached to the inside back-cover using the two-hole prong fastener.

D. All Supporting Documents will be attached to the inside back-cover of the file folder in reverse chronological order (most recent on top). These documents include, but are not limited to, (1) any required permits (enclosed space, above ceiling, etc.) and approvals, (2) drawings / sketches of work, (3) meeting minutes, (4) coordination with affected services, (5) Mitigation

Plan, (6) Contingency Plan, (7) shutdown procedures, and (8) start-up procedures, or as required by the Approving Official (Chief, FMS).

2. Live Electrical Work:

In accordance with VHA Directive 2006–056, any energized electrical work plan must have the prior knowledge and approval of the Medical Center Director (Exception – The Chief, FMS may approve energized electrical work plans for Branch Circuits, from the final overcurrent protecting devices to the outlets, that do not serve the critical patient care areas, such as Operating Rooms, Critical Care, Intensive Care, Dialysis Units, Isolation Rooms, Catheterization Laboratories, Emergency Rooms, or

Supply, Processing, and Distribution (SPD) rooms).

Section 01 00 00, Revised May 2015 General Requirements – Appendix C Page 1

A. The Request to Perform Live Electrical Work (memo to the Hospital Director) is initiated and upon approval will be attached to the inside back-cover using the two-hole prong fastener.

B. The Work Plan / Peer Review form (attachment #5) is initiated and attached to the inside back-cover using the two-hole prong fastener.

C. All Supporting Documents will be attached to the inside back-cover of the file folder in reverse chronological order (most recent on top). These documents include, but are not limited to, (1) any required permits (enclosed space, above ceiling, etc.) and approvals, (2) drawings / sketches of work, (3) meeting minutes, and (4) coordination with affected services.

3. Hot Work (Burn):

Facilities Management Service Standard Operating Procedures No. 138-05, August 2009, defines Hot

Work as operations which include “… cutting, welding, brazing, silver soldering and other processes that utilize an open flame or arc.” Please note that although Live Electrical Work is sometimes referred to in the trade as Hot Work, it is not (within the context of this document) since under normal working conditions it will not result in an open flame or arc.

A. The Hot Work (Burn) Permit is initiated and consists of two documents – the Notification of

Hot Work Operations by Contractor Personnel (Burn Permit) and the Hot Work Fire Safety

Check List for Operations Area Inspection (Attachments 2 & 3). Upon approval it will be posted at the job site until all work has been completed. After completion of work, the documents will be attached to the inside back-cover of the file folder.

B. The Work Plan / Peer Review form (attachment #5) is initiated and attached to the inside back-cover using the two-hole prong fastener.

C. All Supporting Documents will be attached to the inside back-cover of the file folder in reverse chronological order (most recent on top). These documents include, but are not limited to, (1) any required permits (enclosed space, above ceiling, etc.) and approvals, (2) drawings / sketches of work, (3) meeting minutes, and (4) coordination with affected services. The following flowchart is based on the Planned Utility Interruption Checklist included within

Appendix C.

4. Planned Access Closure Request:

A. A request for an access closure must be presented to the Chief, Facilities Management Service

(FMS), for evaluation and action to determine whether the closure will be classified as routine or major.

B. A Draft Closure Notice is initiated by the requesting party and upon completion will be stapled to the outside front-cover of the file folder.

C. The Planned Utility Interruption/Closure Checklist will be attached to the inside front-cover using the two-hole prong fastener.

General Requirements – Appendix C Page 2

D. The Work Plan and Peer Review form (attachment #5) is initiated and attached to the inside back-cover using the two-hole prong fastener.

E. All Supporting Documents will be attached to the inside back-cover of the file folder in reverse chronological order (most recent on top). These documents include, but are not limited to, (1) any required permits (enclosed space, above ceiling, etc.) and approvals, (2) drawings / sketches of work, (3) meeting minutes, (4) coordination with affected services, (5) Mitigation

Plan, (6) Contingency Plan, (7) shutdown procedures, and (8) start-up procedures, or as required by the Approving Official (Chief, FMS).

General Requirements – Appendix C Page 3

PLANNED UTILITY INTERRUPTION CHECKLIST

Project Name: Project #

COTR Name: Phone #:

1. Utility Shutdown Request

# Item POC Comments 1.a. Draft Utility Shutdown Notice COTR 1.b Work Plan, draft Timeline & Peer review Contractor /

COTR

1.c Other Work Plans (Piggyback work) M&O /

1.d Utility prints marked with isolation points for valves, equipment

COTR /

M&O

1.e Identify affected areas / services COTR /

1.f Identify duration of shutdown Contractor /

1.g Draft mitigation plan COTR /

2. Planning the Shutdown

2.a. Peer Review complete COTR 2.b Chief FMS determines “Routine” or “Major” shutdown Chief FMS

2.c Coordination meetings as applicable 2.d Coordinate with affected areas & services* COTR /

2.e Prepare utility shutdown and start-up procedures

M&O Shops

2.f Verify & update prints COTR 2.g Finalize Utility Mitigation Plan M&O 2.h Identify Contingency Plan COTR /

2.i Publish Utility Shutdown Notice COTR

*Include respiratory therapy on all AOV-related system modifications.

3. Preparation

3.a. Tag and mark field verified equipment and locations of valves / breakers, switches, etc that disrupt utilities & hospital services*

M&O

3.b Stage work materials, pre-fabricated parts, etc.

24 hours before work is to begin. The COTR is to verify that all materials and tools are present.

Contractor

General Requirements – Appendix C Page 4

3.c Stage mitigation supplies & services M&O 3.d Shutdown folder to CEP, contents include (as applicable):

• Final Shutdown Notice

• Work Plan with Peer review & Timeline

• Mitigation Plan

• POC Lists with contact information

• Shutdown and Start up procedures

CEP

Supervisor

*Includes all sources of stored energy and services such as medical gasses.

4. Execution

4.a. COTR informs CEP to initiate shutdown COTR 4.b CEP initiates shutdown*; equipment is LOTO as planned

CEP

4.c Monitor shutdown and informs all parties when utility / service is secure

CEP

4.d Tracks progress via the Work Plan Timeline CEP / COTR 4.e Notifies CEP when work is complete COTR 4.f Initiates start up procedures to return the utility to service

CEP

4.g Notifies AOD when facility returns to safe state CEP

*Contact Respiratory Therapy POC whenever AOV-related items are affected.

5. Recovery

5.a Mitigation measures removed; report completion to CEP CEP / Shops

5.b Update Drawings COTR 5.c File Shutdown Folder Chief, FMS

Note: Be sure to include the following on this side of 2-Prong Folder. Some elements may be omitted.

1. Notes from Shutdown Meetings / Coordination

2. Mitigation Plan

3. Contingency Plan

4. Shutdown procedures

5. Work Plan / Peer Review

6. Start-up procedures

General Requirements – Appendix C Page 5

Distributed:

AREA(S)

AFFECTED:

TIME /

DURATION:

DATE:

ESTIMATED TIME FRAME:

HOW THIS AFFECTS YOU:

REASON FOR SHUTDOWN:

FMS CONTACT PERSON: , COTR

@ ext. , or Cell

If you have any questions or problems with this date, please notify the contact person(s) above by the close of business one day from the date of this publication. After that date, the closure will proceed as described above. Supervisors, please share with all staff.

Chief, Facilities Management Service

PLEASE SHARE WITH ALL STAFF

General Requirements – Appendix C Page 6

ENERGIZED (LIVE) ELECTRICAL WORK DIRECTOR MEMO

Date:

From: Facilities Management Service (138)

Subject: Request to Perform Live Electrical Work for the Project

To: Director (00)

1. In accordance with VHA Directive 2006-056 an energized electrical work plan must have the prior knowledge, and approval of the Medical Center Director.

Description of the work being performed, and the circuits impacted by this work:

2. The start date for this work is . The estimated duration for this work is hours.

3. Any questions or concerns please call , Project Engineer / COTR, at extension , VA Cell Phone , or e-mail:

Chief, Facilities Management Service

Approve Disapprove

, Director (00) Date:

Enclosure:

General Requirements – Appendix C Page 7

HOT TAP WORK PERMIT - EQUIPMENT IN SERVICE (Page 1 of 3) Note: Separate request required for each individual hot tap.

Part I: TO BE COMPLETED BY THE REQUESTER:

Job/Work Order Number:

(1) Description of piping/equipment/job location:

(2) Description of work to be done:

(3) Justification of why the piping/equipment cannot be de-energized through explanation of continuity of service is essential & shutdown impractical (Note: Inconvenience is not a factor):

Requester/Title: Date:

Part II: TO BE COMPLETED BY THE QUALIFIED PERSONS DOING THE WORK:

YES NO

(1) Have personnel executing the “Hot Tap” procedure provided documentation of the necessary level of training to meet responsibilities associated with the procedure.

(2) Competent Person oversight is available and will be present during the hot tapping.

(3) Welding Required

(4) Hot Work permit was obtained and includes a specific Hot Tapping Welding Safety

Task Review (API-2201, Appendix C)

(5) Emergency Action Plan developed (i.e.API-2201, Appendix D)

(6) Necessary personal protective equipment to safely perform the assigned task (FR Clothing, Welding

Helmet, Gloves, etc…)

(7) Means employed to restrict the access of unqualified persons from the work area:

(8) Evidence of completion of a Job Briefing including discussion of any job-related hazards:

(9) Multi-Gas Meter is available, calibrated, and will be used for monitoring

(10) Do you agree the described work can be done safely? (If no return to requester)

Contractor/ VA Operation Supervisor(s):

Date:

COTR/VA Project Engineer:

Date:

General Requirements – Appendix C Page 8

HOT TAP WORK PERMIT - EQUIPMENT IN SERVICE (Page 2 of 3) Part III: RECOMMENDATION(S) TO PERFORM THE WORK WHILE EQUIPMENT IS IN

SERVICE:

Facility Safety Officer:

Chief, Facilities Management Service:

Part IV: APPROVAL TO PERFORM THE WORK WHILE EQUIPMENT IS IN SERVICE:

Medical Center Director:

TO BE FILLED OUT BY THE REQUESTER

TYPE OF PROPOSED INSTALLATION:

HEADER OR VESSEL INFORMATION

LINE SIZE (in.): METALLURGY:

OPERATING PRESSURE: PSIG TEMPERATURE:

PROCESS DESCRIPTION:

BRANCH CONNECTION INFORMATION

LINE SIZE (in.): FLANGE RATING: PSI

OPERATING PRESSURE: PSIG METALLURGY:

INITIATOR:

Provide location sketch of the proposed hot tap. The hot tap location must have scaffolding (where required for access), insulation must be removed and the equipment must be marked for the exact hot tap location prior to notifying Pressure Equipment Inspection.

General Requirements – Appendix C Page 9

HOT TAP WORK PERMIT - EQUIPMENT IN SERVICE (Page 3 of 3) TO BE FILLED OUT BY THE CONTRACTOR (COMPETENT PERSON) or VA PROJECT ENGINEER

AND PRESSURE EQUIPMENT ENGINEER (QUALIFIED PERSON)

WALL THICKNESS AT HOT TAP LOCATION: (in.)

DETERMINED BY:

DATE:

WELD DETAIL NUMBER:

1. PROCEDURE: X-RAY:

2. PROCEDURE: X-RAY:

3. PROCEDURE: X-RAY:

INSPECTOR:

TESTS REQUIRED:

(A) NOZZLE: PSIG MEDIUM:

(B) REINFORCING PAD: PSIG MEDIUM:

(C) BLOCK VALVE: HYDROSTATIC SEAT EACH SIDE AT: PSIG

AREA INSPECTOR:

PRESSURE EQUIPMENT ENGINEER:

TO BE FILLED OUT BY THE CONTRACTOR PERFORMING THE HOT TAP

HOT TAP MACHINE:

MAKE:

MACHINE RATING: PSIG @: F

MODEL:

PRESSURE TESTED @ PSIG

SERIAL NO.:

BY: DATE:

CONTRACTOR REPRESENTATIVE:

General Requirements – Appendix C Page 10

Distributed:

AREA(S)

AFFECTED:

TIME /

DURATION:

DATE: ESTIMATED TIME FRAME:

HOW THIS AFFECTS YOU:

REASON FOR SHUTDOWN:

FMS CONTACT PERSON: , COTR

@ ext. , or Cell

If you have any questions or problems with this date, please notify the contact person(s) above by the close of business one day from the date of this publication. After that date, the closure will proceed as described above. Supervisors, please share with all staff.

Chief, Facilities Management Service

PLEASE SHARE WITH ALL STAFF

General Requirements – Appendix C Page 6

Distributed: