Attachment_5_-_NMCSD_WPP_8.24._Work_Permit_Application.docx

NAVAL MEDICAL CENTER SAN DIEGO

WORK PERMIT PROGRAM (WPP)

Version 1.1 - (August 24, 2017)

CONTENTS

SECTION 1.0 InITIALIZING/Completing the Risk Assessment Process

section 1.3 instructions (checklist) for completing risk assessment……………………………………………… .5

APPENDIX E ABOVE THE CEILING AND PENETRATION POLICY……………………………………………………….……….70

APPENDIX F Planned Utility System Shutdown Policy 77

APPENDIX G FIRE WATCH POLICY…………………………………………………………………………………………………………. 84

APPENDIX H MEDICAL GAS PROTOCOL………………………………………………………………………………………………….89

APPENDIX I REAL PROPERTY INVENTORY (RIPE) DATA COLLECTION SHEET………………………………………..…. 92

Page | i WPP v AUGUST 24, 2017

SECTION 1.1

GENERAL INSTRUCTIONS

1. Review all sections of this documentation first to get a general overview of the Work Permit Program (WPP), and the necessary documentation.

2. The Work Permit Program is required for ALL construction and renovation projects.

3. All documentation of this packet needs to be filled in by the project team and submitted to the responsible Facility Manager (FM) or Project Manager so the necessary documentation can be uploaded into the Naval Medical Center San Diego (NMCSD) on-line Work Permit Authorization system.

4. Information is submitted into the Work Permit Program system by the Facility Manager (FM) or Project Manager. Information will be reviewed by the Authorizing Stakeholders and will be approved once all WPP has been considered and the information is complete and meets all NMCSD requirements.

5. Work Permit Authorization is printed and permits maintained in accordance with NMCSD posting requirements (Section 2.8).

Note: Definition of critical area versus non-critical area: Critical areas are referenced in the infection control risk assessment (ICRA) RISK GROUP DETERMINATION and are groups 3 and group 4.

*Important* Documentation needs to be completed and submitted into the Work Permit System 30 days prior to requested start date.

SECTION 1.2

DETERMINING THE NEED TO COMPLETE THE RISK ASSESSMENT PROCESS (Maintenance Activities ONLY)

For ALL Facility Management general maintenance activities in buildings with patient care activities, that meet ONE of the following criteria, the Facility Manager must follow the Work Permit Program to obtain a Work Permit Authorization (Section 1.3 of this package).

For maintenance activities where one of the below conditions exist, the components of this package MUST be considered:

· The activity takes longer than one shift (8 hours)

· The activity involves the removal of more than 5 ceiling tiles per 100 tiles

· The activity has a value of more than $50,000

· The activity involves the shutting down of any component of a critical utility system

· The activity involves, sanding, soldering, grinding, welding, brazing or torch cutting

· The activity involves any critical or high risk patient care area listed below (*):

· Other condition: ________________________________________

SECTION 1.3 (INSTRUCTIONS)

(CHECKLIST) FOR COMPLETING THE RISK ASSESSMENT PROCESS

Step 1 Assessment & Notifications. For ALL Projects, and maintenance activities that meet the criteria, the Project Manager or Facility Manager shall submit the “Construction Authorization Form” (Section 1-4 of this package) with all project information filled out, and e-mail to the appropriate members of the risk assessment team listed below.

Authorizing Stakeholders Facility Management

Facilities Management usn.san-diego.navmedcensanca.list.nmcsd-wpafacilities@mail.mil

Safety & Industrial Hygiene usn.san-diego.navmedcensanca.list.nmcsd-wpasafety_IH@mail.mil

Life Safety usn.san-diego.navmedcensanca.list.nmcsd-lifesafety@mail.mil

Infection Prevention usn.san-diego.navmedcensanca.list.nmcsd-wpaic@mail.mil

Patient Safety usn.san-diego.navmedcensanca.list.nmcsd-patientsafety@mail.mil

Step 2 Walkthrough & Assessment. The Project Manager or Facility Manager will schedule a time to meet with the members of the risk assessment team either in whole or individually. The risk assessment team will use this time to ask questions to help clarify the intent of the project.

|_| Coordinate the Work Permit Process walkthrough and evaluation process.

Step 3 Review. Upon receipt and review of all of the necessary components of the on-line work permit application system, the Risk Assessment team will advise and direct the Project Manager (PM) or Facility Manager (FM) on Interim Life Safety requirement, Infection Control requirements, and Patient safety requirements of the project.

|_| Collect all documentation required by the Work Permit Process evaluation.

Step 4 Work Permit Authorization. After all documentation is received and approved by the risk management team, a work permit will be generated.

Step 5 Postings. Following the Naval Medical Center San Diego posting requirements, the FM or PM will ensure that all of the required components of this package (including past inspections and permit documents) are available on the jobsite at all times and that the following items are posted according to the chart in Section 2 – 8 Postings & Documentation

|_| Post permits and authorizations required by the Work Permit Process evaluation

|_| Place documents and related polices in the jobsite audit binder according to Section 2 - 8

Page | 5 WPP v AUGUST 24, 2017

SECTION 1.4

WORK AUTHORIZATION

SECTION 1.4 INSTRUCTIONS

❶ Naval Medical Center San Diego’s Risk Assessment Team Members sign off on Work Permit Assessment. Any referenced documents are attached to work permit and comments and feedback are also part of the approval documents.

❷ The PM or FM reviews all of the submitted documents and verifies that all approvals have been received. Approved Work Permit Assessment and attached documents are forwarded to construction team for processing and jobsite posting per NMCSD‘s posting requirements.

AUTHORIZATION #:________________________

Location-Building(s):

Project Description:

PROJECT CONTACT INFORMATION

General Contractor/CM/Prime:

Superintendent or Foreman:

Contractor After Hours Telephone Number: (After 4:00 PM)

The above to be completed by the Project Manager or Facility Manager (for Maintenance Activities) Components Included in this Authorization (Selected at Walkthrough or Project Meeting)

Facilities Maintenance/Engineering

Infection Prevention

Fire & Life Safety

Safety

Patient Safety

Project Manager Sign-Off Project manager has agreed to implement all of the requirements noted above and in the supporting documents.

Project Manager Signature: Date:

NEXT STEP: Please e mail this form to the following as identified in Section 1-3 of this package – (Safety, Infection Prevention, Facility Management, Fire Safety & Patient Safety

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SECTION 2.0

WORK PERMIT PROGRAM (WPP) MODULES

Page | 8 WPP v AUGUST 24, 2017

SECTION 2.1

INFECTION CONTROL RISK ASSESSMENT (ICRA)

SECTION 2.1 INSTRUCTIONS

❶ If required, Infection Prevention will complete and submit ICRA to the Naval Medical Center San Diego Project Manager or Facility Manager. In most cases this documentation will be uploaded by infection control to the on-line Naval Medical Center Work Permit Application system

❷ The form “Infection Control Construction Permit” will be posted at/near the entrance to the jobsite

❸ The NMCSD Project Manager, Construction Team and the Infection Control Department will ensure compliance to the ICRA requirements at all times (24/7)

Page | 9 WPP v AUGUST 24, 2017

INFECTION CONTROL RISK ASSESSMENT (ICRA) CLASS DETERMINATION

ICRA TYPE DETERMINATION

Using the following table, identify the Type of construction project activity (check one)

Includes, but is not limited to:

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

· painting (but not sanding)

· wall covering, 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.

Includes, but is not limed to:

· installation of telephone and computer cabling

· access to chase spaces

· cutting of walls or ceilings where dust migration can be controlled.

Includes, but is not limed to:

· sanding of walls for painting or wall covering

· removal of floor coverings, 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.

Includes, but is not limed to:

· activities which require consecutive work shifts

· requires heavy demolition or removal of a complete cabling system

· new construction.

ICRA RISK GROUP DETERMINATION

Using the following table, identify the Patient Risk Groups that will be affected. If more than one risk group will be affected, select the higher risk group.

Group1 Low Risk Group 2 Medium Risk Group 3 High Risk Group 4 Highest Risk

· Office areas

· Common Areas

· Cardiology

· Echocardiography

· Endoscopy

· Physical Therapy

· Radiology/MRI

· Respiratory Therapy

· Rehabilitation

· Outpatient Services

· Nuclear Medicine

· Emergency Room

· Laboratories (Specimen)

· Pediatrics

· Pharmacy

· Post Anesthesia Care Unit

· Medical Unit

· Endoscopy

· Echocardiography

· Any area caring for immunocompromised patients

· Cardiac Cath. Lab

· Labor & Delivery

· Negative pressure - Isolation rooms

· Intensive Care Units

· Surgical Units

· Newborn Nursery

· Outpatient Surgery

· Oncology

· Operating rooms

· C-section rooms

· Dialysis

· Anesthesia

· Central Sterile Supply

ICRA RISK GROUP DETEMINATION (check one):

☐ Group 1 ☐ Group 2 ☐ Group 3 ☐ Group 4

Cross Reference the ICRA Type (A, B, C, D) with the ICRA Risk Group (Low, Medium, High, Highest) using the following matrix to find the class of precautions (I, II, III, IV, or V) or Class of infection control activities required.

IC MATRIX – CLASS OF PRECAUTIONS

* Signifies it is the discretion of the Infection Prevention Officer to decide whether the project is to be classified a Class III or Class IV.

NOTE: Infection Prevention approval will be required when the ICRA Type and ICRA Risk Group indicate that Class III or Class IV control procedures are necessary.

DETERMINATION:

☐Class I ☐ Class II ☐ Class III ☐ Class IV ☐ Class V (Special Risk Group)

SPECIAL NOTES:

Page | 11 WPP v AUGUST 24, 2017

INFECTION CONTROL CONSTRUCTION PERMIT

ICRA Permit No.:

CONSTRUCTION ACTIVITY

INFECTION CONTROL RISK GROUP

GROUP 3: Medium/High Risk

GROUP 4: Highest Risk

☐Complete final ceiling assembly.

☐Wipe down all horizontal surfaces (except floor and ceiling).

☐Clean HVAC system as closure being removed, and operate system for 24 hrs prior to final cleaning of job.

☐Maintain all barriers (envelope) until post-job cleaning complete. Use vacuum with HEPA filters during removal of barriers.

☐Damp-wipe all horizontal surfaces with disinfectants approved by Infection Prevention before being occupied.

☐Air pressure should be maintained negative to patient care areas during final cleanup.

CLASS I

☐Public Areas - Use portable control unit with negative pressure and HEPA technology.

☐Removing debris - Cover all carts with tight-fitting cover. Remove via designated path and elevators only.

☐Use 3 industrial mats or tacky mats at every entry. Mats must be kept visibly clean. Cart wheels should also be cleaned, and run over a tacky mat or industrial mat. All persons must walk across the industrial mats or tacky mats.

CLASS II

☐Continue Class I requirement ☐Cover all supply and exhaust vents with plastic or equivalent.

☐Use HEPA Vacuums to keep the site clean.

☐Seal all holes, penetrations, and openings in the construction barriers and walls which are part of the construction separation with appropriate fire rated materials. Other holes, door seams must be sealed with tape and plastic. Seal door gaps with tape or equivalent.

CLASS III

☐Continue Class I & II requirements ☐Maintain Negative Pressure between the project and adjacent space with constant monitoring at the entrance.

☐Exhaust of project space - PRIORITY: 1) exhaust HEPA filtered air directly to outside 2) use existing isolated duct or shaft 3) Last resort – recirculate in space. Negative pressure must be constantly monitored.

☐The debris removal containers should be vacuumed or wet-wiped prior to removal from the site. Remove via designated path and elevators only.

CLASS IV

☐Continue Class I, II & III requirements ☐Create a construction ante-room where all clothing, tools, equipment, and other materials being removed are HEPA vacuumed or wet-wiped prior to transition to active hospital. Any person who has dust, dirt, or materials on their clothing must vacuum it prior to leaving the ante-room areas. The ante room is HEPA vacuumed several times a day to ensure no buildup of dust/dirt on any surface.

☐The ante-room will be wet mopped frequently (several times a day in usual construction activity), or similar methods will be used to satisfy the Infection Prevention staff.

☐Either change clothing prior to leaving the job site, or use shoe covers, and cover clothing prior to leaving the area. If work shoes are worn off-site, they must be covered by shoe covers. Dirty work clothing must be removed in sealed containers for laundering.

☐Security is required.

CLASS V

☐Continue Class I, II III, & IV requirements ☐Use a two chamber “air-lock” or similar method to assure no open path from project to active hospital.

☐The clean lock must be mopped frequently and not allowed to become visibly soiled. Tacky mats be used in the clean chamber.

Date:

Initial:

Additional Requirements: (If scope of project changes IC needs to be notified)

Exceptions/Additions to this permit are noted by attached memoranda: Date Initials

Page | 12 WPP v AUGUST 24, 2017

SECTION 2.2

PATIENT IMPACT RISK ASSESSMENT

SECTION 2.2 INSTRUCTIONS

❶ Environmental Health and Safety (EH&S) will complete and submit form “Patient Impact Risk Assessment” to the NMCSD Project Manager

❷ The form “Patient Impact Risk Assessment Permit” will be posted at/near the entrance to the jobsite

❸ The NMCSD Project Manager and Construction Team will ensure compliance to the Patient Impact Risk Assessment requirements at all times (24/7)

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Page | 13 WPP v AUGUST 24, 2017

PATIENT IMPACT RISK ASSESSMENT PERMIT

Permit No.:

UTILITIES IMPACT

☐One or more utility systems will be shut down or impaired.

☐No Utility Impacts ☐Only Engineering staff may shut down systems ☐Five (5) day notice to Engineering and affected department(s) prior to shutdown ☐24 Hr notice to Engineering and affected department(s) prior to shutdown ☐15 min notice to Engineering and affected department(s) prior to shutdown ☐Signed shutdown permit must be issued and posted ☐An Engineering/Facilities office telephone line is available to affected departments and will be promoted to all affected departments 24 hours/15min in advance, and by postings.

☐No Patient Care Activities to be Impacted ☐Communication to the affected staff on daily basis, as applicable.

☐In case of issues affecting patient care delivery, the on-call Nursing Supervisor’s Office line is set up for all affected departments.

☐The construction site manager responds and to project-related patient care concerns.

HAZARDOUS MATERIALS &

VAPOR CONTROL

☐No Hazardous chemicals to be used.

☐ Hazardous chemicals (liquids or gases) will be used onsite:

☐ Flammables ☐ Corrosive ☐ Toxic ☐ Reactive ☐ Compressed Gases (e.g. welding tanks) ☐ Odorous Products (e.g. tar, mastic, paints, etc.)

☐Asbestos ☐ Lead ☐ Mercury Lamps ☐ Other: __________________________ ☐ALL chemical’s SDS must be available and reviewed against the prohibited and controlled chemical list. SDS must be available ☐Ventilation to the outside will be required ☐Compressed gases will meet storage requirements ☐All flammable gases will be removed from the building at the end of day. No storage permitted.

☐ACM/Lead will be abated as per applicable code ☐Mercury lamps will be collected and recycled.

☐Other Counter Measures:_______________________

☐N/A - No noise impacts expected.

☐Activities which may increase the normal vibration level will be conducted during the project (including jackhammering, cement cutting, sawing, heavy equipment use, coring, pumping, high velocity fan use, excavation, blasting, demolition, powered actuated gun use).

☐N/A - No Vibration impacts expected ☐Work will be scheduled to minimize noise/vibration impacts.

☐ 24-hour notice prior to noise or vibration production phase ☐ 15-minute notice prior noise or vibration production phase (critical care areas) ☐Noise/Vibration levels impact assessments to be conducted during the active phases of the project.

☐ An Engineering/Facilities office telephone line is available to affected departments and will be promoted to all affected departments 24 hours in advance, 15 minutes in advance, and by postings.

☐Unit fully restricted (closed off)/No access to construction site by non-authorized personnel.

☐Restricted access/barriers to construction site ☐All contractor’s staff to wear ID while on site.

☐ COMMENTS: ___________________________________

Additional Requirements: (If scope of project changes Safety/Patient Safety needs to be notified)

Exceptions/Additions to this permit are noted by attached memoranda: Date Initials

EMERGENCY HOTLINE 1-800-555-1212

PRE-CONSTRUCTION RISK ASSESSMENT

WPP

AUTHORIZATION PERMIT

Infection Control Risk Assessment

ICRA PERMIT

Patient Impact Risk Assessment

PIRA PERMIT

Interim Life Safety Permit

ILSM PERMIT

FIRE WATCH INSPECTION

ABOVE CEILING PERMIT

SECTION 2.3

INTERIM LIFE SAFETY MEASURES (ILSM)

SECTION 2.3 INSTRUCTIONS

❶ Fire Safety (FS) will execute and document the implementation

❷ Fire Safety will identify which administrative actions are to be completed.

❸ The form “Fire Safety ILSM Permit” will be posted at/near the entrance to the jobsite

Page | 15 WPP v AUGUST 24, 2017

INTERIM LIFE SAFETY MEASURES (ILSM) ASSESSMENT

ILSM INCLUSION CRITERIA

These criteria are used to evaluate areas in which construction renovation is planned or in which a Life Safety Code® deficiency has been identified. Consideration should be given to the scope of operations in the area, the Class of staff activity, and the acuity of patient treatment in the area.

☐Patient Care ☐ Non-Patient Care

Scope of Work:

If ANY of the following conditions are answered “SIGNIFICANT”, ILSM will be applied.

6. Justification Comments (mandatory):

Findings: ☐ILSM are required ☐ILSM are not necessary

Initial Assessment: _____________________________ Date: _______________________

Re-Assessment: _______________________________ Date: _______________________

Page | 16 WPP v AUGUST 24, 2017

FIRE SAFETY ILSM ADMINISTRATIVE ACTIONS SELECTION PERMIT

Selection of Interim Life Safety Measures – (14 Administrative Actions) Check the Administrative Action(s) that apply to compensate for the Deficiency(s)

NFPA (I-XI) &

JC LS. Std. (LS.01.02.01

EP 4-14)

CHECK

ACTIONS

ILSM ADMINISTRATIVE ACTION

DOCUMENTATION TO VALIDATE ILSM

I.

II.

III.

IV.

V.

VI.

VII.

VIII.

IX.

XI.

Additional Requirements: (If scope of project changes FS needs to be notified)

Exceptions/Additions to this permit are noted by attached memoranda: Date Initials

WPP

Page 17 Reviewed/Revised: AUGUST 24, 2017

INTERIM LIFE SAFETY MEASURES INSPECTION FORM

DATE PROJECT STARTED: _________________________ DATE PROJECT COMPLETED: _____________________

PROJECT CE #:___________________________ GENERAL CONTRACTOR: _____________________

AREAS(S) OF PROJECT/JOB INSPECTED: ___________________________________________________________________

Inspection Frequency (Based On Risk):

☐ Daily ☐ Weekly ☐ Every Other Weekday ☐ Twice Per Week ☐ Other:________

WHERE APPLICABLE, NOTE EXCEPTIONS OF AREA IDENTIFIED AS BEING DEFICIENT DURING INSPECTION, AND EXPLAIN IN SUFFICIENT DETAIL IN THE COMMENTS SECTION OF THIS FORM. TURN COMPLETED FORMS INTO THE PROJECT MANAGER.

If emergency egress has the potential to be obstructed, daily inspections must occur of all emergency egress of the affected area (refer to Daily Emergency Egress Exit Inspection Form).

DATE:

1. Exits are readily accessible and provide unobstructed egress at all times.

2. If required, due to inaccessibility of existing exits, alternate exits have been established

3. If alternate exists have been established, Personnel in the area are aware of their relocation and existence

4. Exits are clearly identified and able to be seen in the event of an emergency or fire

5. Fire evacuation routes are posted, and reflect up-to-date changes and alternate escape routes due to construction deficiencies

6. Written procedures and guidelines are posted in the immediate and adjacent areas for what to do and who to call in the event of fire or emergency

7. Personnel in the immediate and adjacent areas are aware and informed regarding procedures and guidelines to follow in the event of fire or emergency

8. Fire alarm and detection equipment appear to be operational

9. There is no evidence of smoking in the construction area and “No Smoking” is enforced in the construction area

10. Construction/remodel area storage, waste and debris are being maintained to minimize potential for fire or safety hazards during daily operations (if applicable)

11. Temporary partitions are built to be smoke tight and of noncombustible/fire retardant materials, to minimize spread of smoke or fire within the building (if applicable)

12. Electrical panels, temporary wiring, extension cords, tools and equipment appear to be installed, utilized, and functioning in a safe manner

13. In general, the exterior construction areas, buildings, grounds, and equipment, giving special attention to excavation, field offices, emergency accessibility) are free of hazard and potential safety violations (if applicable)

14. If there is any gas/arc welding or cutting being performed within the building or on site, additional fire safety precautions have been taken and the necessary equipment has been provided and is being utilized

15. If there is any gas/arc welding or cutting being performed within the building or on site, Facilities Department has been notified

16. If hand and safety rails are required, they are in place and maintained in good condition

17 Extension cords that are being used are 3 wire grounded type

18. If there are temporary electrical outlets provided, they have ground fault protection at the receptacle or at the panel

19. If hazardous chemicals are present and/or being used, they are being limited to the amount needed and used daily

20. SDS sheets are readily available for any hazardous chemicals that are present or being used

21. Ladders and scaffolds appear to be in satisfactory condition and used in a safe manner

22. Personal protective equipment, such as safety glasses, hard hats and etc. are being used

23. Infection control procedures are known and being followed (as applicable)

24. Electrical equipment “Lockout/Tagout” procedures are being followed

25. Site is provided with at least two fire extinguishers at each entrance and exit to the construction/renovation site and every 75 feet.

26. Fire extinguishers are clearly visible and easily accessible (not obstructed).

27. Fire extinguishers are properly charged with pins in place.

28. Fire extinguisher tags are up to date (inspected monthly and annually certified).

29.

30.

31.

32.

PLACE INITIALS OF PERSON PERFORMING INSPECTION TO THE RIGHT.

INSPECTION COMMENTS/FINDINGS:

WPP

Page 19 Reviewed/Revised: AUGUST 24, 2017

DAILY EMERGENCY EGRESS EXIT INSPECTION FORM

Are exits readily accessible and do they provide unobstructed egress at all times? Indicate with a check below and time of inspection in space provided below. (ONLY if Administrative Action #3 is selected)

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SECTION 2.4

FIRE WATCH

SECTION 2.4 INSTRUCTIONS

❶ Based upon the Fire Safety Shutdown submittal, Fire Safety will implement the Fire Watch if required.

Page | 21 WPP v AUGUST 24, 2017

FIRE WATCH INSPECTION FORM - HOURLY

Fire Dept Notification: Start Date:__________Time:________Fax:___________ Fed Fire Contact:_______________________________________ Notified by:_________________________________________Area Covered by Fire Watch:_________________________________________

NOTIFICATION FOR FIRE OR OTHER EMERGENCY: CALL FIRE DEPT USING A CELL PHONE: CALL 911 & PULL ALARM, OR CALL FIRE DEPT USING A LAND LINE PHONE: CALL 9-911 & PULL ALARM

ANY OF THE FOLLOWING CONDITIONS BELOW MUST BE REPORTED IMMEDIATELY AND CORRECTED

FIRE WATCH INSPECTION FORM - Every 30 Minutes CONTRACTOR/DEPT _______________________ PROJECT _________________Initials of Fire Dept. Notification___________ Area To Be Covered by Fire Watch ___________________________________ Print Name in each Time Period Covered

(Day 1)

(Day 2)

DAY 2

NOTIFICATION FOR FIRE OR OTHER EMERGENCY: CALL FIRE DEPT USING A CELL PHONE: CALL 911 & PULL ALARM, OR CALL FIRE DEPT USING A LAND LINE PHONE: CALL 9-911 & PULL ALARM

FIRE WATCH INSPECTION FORM - Every 15 Minutes CONTRACTOR/DEPT _______________________ PROJECT _________________Initials of Fire Dept. Notification___________ Area To Be Covered by Fire Watch ___________________________________ Print Name in each Time Period Covered

NOTIFICATION FOR FIRE OR OTHER EMERGENCY: CALL FIRE DEPT USING A CELL PHONE: CALL 911 & PULL ALARM, OR CALL FIRE DEPT USING A LAND LINE PHONE: CALL 9-911 & PULL ALARM

Page | 24 WPP v AUGUST 24, 2017

SECTION 2.5

CONSTRUCTION SITE EXPECTATIONS

SECTION 2.5 INSTRUCTIONS

❶ At a minimum, contractors should review and evaluate their jobsites against these criteria.

❷ Jobsite inspections performed by NMCSD staff will include compliance with these requirements.

Performance Expectations of All Contracted Construction Personnel

Delivery Project Commissioning Documents. – Deliver all close out and commissioning documents to the Facility Manager for all projects within 60 days.

Documents should include at a minimum:

· Certifications

· Warranties

· Commissioning Documentation including TAB

· State and local authority required signoffs (i.e. AHJ, emergency power, medical gases, etc.)

· Operation and Maintenance Manuals

· RPIE documentation (Editable Inventory of all equipment/components removed) of all trackable equipment that is removed or added in the project area. The RPIE inventory process should be addressed at the Pre-Construction Meeting. The contractor can create an excel sheet that replicates the information required in the RPIE form. (See Appendix I)

· Asset Tag or

· Manufacturer

· Utility System

· Description

· Location

· Electronic. Editable Inventory of all equipment/components installed

· Manufacturer

· Model #

· Serial #

· Name/Tag (if a replacement)

· Utility System

· Description

· Installation Date

· Location

· Area Served

· Commission Date

· As-Built Drawings (see contract for electronic file types and format)

· Basis of Design

· Environmental documentation for asbestos abatement, lead abatement, and mold remediation projects that includes the following:

a. Signed hazardous waste and materials manifests.

b. All abatement documentation such as air monitoring results (daily and clearance as applicable)

c. As-Built Floor plans with room numbers to indicate where the abatement was performed as well as where clearance samples were collected.

d. Pictures

Parking – Contracted construction personnel are not permitted to park in any NMCSD-owned or leased parking facility.

Identification – All contracted construction personnel must wear a NMCSD issued identification badge or name tag on their outer garment. The tag must be displayed above the waist and remain readily visible.

Smoking – Smoking is not permitted on NMCSD property or adjacent sidewalks.

Attire – Inappropriate or controversial logos, illustrations, symbols, or verbiage is not permitted on any attire that is visible to others.

Food & Meal Breaks – Construction personnel may purchase food and beverage at the hospital cafeteria or other on-campus food service sites but may not use any tables or chairs in the cafeteria or other food service sites. Any food and beverage must be purchased on a “take out” basis and consumed outside of these locations.

Security – Construction personnel are not permitted to override, block open or in any other way compromise any locked door, closed corridor doors or fire exit doors. Fire exit doors and all means of egress can never be blocked by any construction-related material, equipment, or debris.

Noise – No construction-related noise can occur between 9:00 PM and 7:00 AM. Security Supervisors are authorized to issue a Stop Work Order to immediately resolve any noise-related complaints or concerns. Please refer to SECTION 2.2 PATIENT IMPACT RISK ASSESSMENT (PIRA) “NOISE” of this package.

Training – All construction personnel must receive a jobsite orientation from the project superintendent prior to beginning any work. Orientation must include jobsite expectations, required personal protective equipment, exit routes, fire pull stations, rally points, and the location of all jobsite safety information. Please refer to SECTION 2.7 CONTRACTOR TRAINING of this package.

Indoor Air Quality – Contractors are responsible for ensuring that any dust, odor, or air contaminants generated as a result of construction or demolition activities are prevented from migrating from the construction area(s) into areas occupied by NMCSD employees, patients, or the public. Please refer to SECTION 2.1 INFECTION CONTROL RISK ASSESSMENT (ICRA)

Electrical - All electrical work and installations must comply with OSHA standards 29 CFR 1926.400 through 1926.449, NFPA 70 (National Electrical Code), NFPA 70E, UFC, and any local requirements. Such work may only be performed by licensed electricians, skilled and knowledgeable in electricity and electrical work. Electrical panelboards and boxes must be covered. Where electrical components have exposed conductors, access to the area must be restricted to Qualified Electricians only.

Equipment Safety (Hand & Portable Powered Tools) - Each contractor is responsible for inspecting all tools and equipment used on their jobsite. This includes process machinery and equipment, hand tools, and portable powered tools.

Separation of Construction from Non-Construction Areas - A one-hour code compliant fire-rated partition shall be erected to separate construction areas from non-construction areas. This partition must be constructed of flame-retardant plastic or wood/materials.

Fire Prevention & Protection - It is the responsibility of all contractors to ensure there are fire extinguishers at a minimum of 75 feet throughout the construction site mounted on temporary construction mounts (OSHA required) These extinguishers must have an annual inspection tag affixed and evidence of the required monthly inspections.. Contractors are prohibited from tampering with or removing fire extinguishers belonging to NMCSD unless been approved by the fire and life safety department.

Flammable Materials - NMCSD prohibits the storing of flammable and combustible liquids overnight.

Personal Protective Equipment - Contractors are responsible for requiring the wearing of appropriate personal protective equipment in all operations where there is an exposure to hazardous conditions or where the need is indicated for use of such equipment to reduce the hazard to the employees.

Emergencies – For all EMERGENCIES, please refer to SECTION 2.7 CONTRACTOR TRAINING - SUBSECTION 2.7.A Construction Integration Plan of this package.

NMCSD ENVIRONMENTAL HEALTH AND SAFETY AND FIRE SAFETY DEPARTMENTS RESERVE THE RIGHT TO CONDUCT ADDITIONAL TRAINING AS NEEDED.

Page | 28 WPP v AUGUST 24, 2017

SECTION 2.5b

WEEKLY CONSTRUCTION SAFETY INSPECTION

SECTION 2.5b INSTRUCTIONS ❶ The Project Manager/Project Team is responsible that this inspection form is completed weekly and retained the a binder on the project site

Page | 29 WPP v AUGUST 24, 2017

WEEKLY CONSTRUCTION SAFETY INSPECTION

PROJECT NAME: _________________________ PROJECT MANAGER:_____________________

PROJECT #:___________________________ GENERAL CONTRACTOR:____________________

1. Construction Guidelines posted on entry door.

2. Exits free and unobstructed.

3. Workers wearing required ID.

4. Workers wearing hardhats.

5. Fire Alarm and suppression systems in good order, otherwise proper ILSM in place.

6. Fire extinguishers mounted charged and inspected.

7. If hot work, appropriate permits.

8. No smoking.

9. Housekeeping, debris removal and storage enforced.

10. Construction barriers intact.

11. Construction area secure.

12. Walk off mats clean and adequate number.

13. Construction entry and adjacent areas free from dust.

14. Construction debris carts covered during transport.

15. Construction personnel and debris carts use designated elevators.

16. Equipment used as required to prevent airborne particles (HEPA filters, vacuums, exhaust fans, etc).

17. Temporary lighting lit and protected.

18. Power properly secured at end of day.

19. All water supplies should be shut off at valves, not nozzles

20. Medical Gas pipes marked with flag every foot. Risk assessment of medical gas is required.(Impact if accidently hit or shut off, etc.)

21. Manometer calibrated and showing negative pressure.

WEEKLY CONSTRUCTION SAFETY INSPECTION

PROJECT NAME: _________________________ PROJECT MANAGER:_____________________

PROJECT #:___________________________ GENERAL CONTRACTOR:____________________

22. ICRA Posted

23. Tack Mats spent

24. HEPA Negative Machine exhausting to the outside.

25. Fire Watch Log Posted

26. Fire Watch person doing rounds timely (Check Sign-in sheet)

27. Fire Watch person understands policy and required task.

28. No flammable aerosols stored on jobsite. Check toolboxes

29. Negative are machine has maintenance records/logs available for review. Contractor understands when to change filter.

30. Missing exit signs

31. ILSM not posted

32. The site is clean. No buildup of flammable material.

33. HEPA vacuum on project has a back-up filter.

34. Area is secure.

CORRECTIVE ACTIONS FOR UNACCEPTABLE FINDINGS:

Project Manager Signature:__________________________________ Date: ___________________

Page | 31 WPP v AUGUST 24, 2017

SECTION 2.6

OTHER REQUIRED PERMITS

SECTION 2.6 INSTRUCTIONS

❶ Above the Ceiling and Penetration Permit: Must be submitted by the contractor to Fire Safety at least 72 hours in advance of the work; the contractor must comply with the permit requirements.

❷ Hot Work Authorization Permit: Must be submitted by the contractor DAILY to Fire Safety; once approved, the permit must be posted and the contractor must comply with the permit requirements.

❸ Utility System/Fire Safety Shutdown Request: A Shutdown Corrective Work Order must be submitted through Utilities Coordinator by the Project Manager to Facilities Management; once approved, the contractor must comply with the shutdown requirements.

Page | 32 WPP v AUGUST 24, 2017

SECTION 2.6a

ABOVE CEILING AND PENETRATION PERMIT

SECTION 2.6a INSTRUCTIONS ❶ This permit must be submitted to the Fire Safety Representative for your location approval at least 72 hours in advance.

❷ You must have the ICRA in place before you apply for the Above Ceiling Permit.

❸ UL System sheets and training certificates must be submitted for every type of penetration to be fire-stopped.

❹ Outside Vendors will not be able to submit invoices without a closed Above Ceiling Work permit certification.

Page | 33 WPP v AUGUST 24, 2017

ABOVE CEILING/PENETRATION PERMIT

Contractor _______________________________ In House Work ______ Permit #______

Date Issued: _____________ Expiration Date: ________________

Location: BLD:_______________Floor:_______Unit:___________

Briefly describe scope of work and provide a time table (locations and type of penetrations):

Select the Fire Stop product Manufacturer…