CONSTRUCTION SAFETY MANAGEMENT MANUAL

“Improving health, comfort and life” Revised 4/2017

CONSTRUCTION SAFETY MANAGEMENT MANUAL

Contractor/Vendor Requirements

for Performing Construction or Maintenance

Table of Contents Introduction ......................................................................................................... i Purpose ............................................................................................................... i Acronyms, Abbreviations & Terms ...................................................................... i Roles & Responsibilities ..................................................................................... ii

Contractors ................................................................................................................................... ii The Environmental Safety Officer (ESO) ..................................................................................... ii Design and Construction .............................................................................................................. ii Plant Operations Management and Engineering Staff .......................................................... iii Health Information Technology Staff ...................................................................................... iii Interim Life Safety Committee (ILSC) ......................................................................................... iii Barrier Management Team (BMT) .............................................................................................. iii

Required Notifications ....................................................................................... iv 72-Hour NOTICE for any Utility Service Shutdowns and/or Interruptions................................... iv Hot Work ...................................................................................................................................... iv Safety Related Incidents ............................................................................................................. iv Occupational Injury/Illness, Incidents, and Near Misses .............................................................. v

Required Documents & Records ...............................................................vi Work Orders ................................................................................................................................ vi Signage ....................................................................................................................................... vi General Liability - Workers Compensation & W9 IRS Form ....................................................... vi Confidentiality & Privacy .............................................................................................................. vi Safety Data Sheets (SDS) ........................................................................................................... vi Project File ................................................................................................................................... vi

On-site Safety & Security Procedures ............................................................... vii Site Safety Orientation ............................................................................................................... vii Identification ............................................................................................................................... vii Keys ............................................................................................................................................ vii Parking ....................................................................................................................................... vii Tools & Equipment ..................................................................................................................... vii Construction Elevator Usage ...................................................................................................... vii Tobacco-Free Campus .............................................................................................................. viii Confidentiality & Privacy ............................................................................................................ viii Project Meetings and Communications ..................................................................................... viii Fire (CODE RED) Guidelines & Procedures for Construction Personnel ................................. viii

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False and Nuisance Alarms ........................................................................................................ ix When the contractor or any of the contractor’s personnel are known to have caused a nuisance alarm, the contractor is subject to a fine. ..................................................................... ix Dust and Odor Control ................................................................................................................ ix Noise & Vibration ......................................................................................................................... ix Plumbing ...................................................................................................................................... ix Abandoned pipes shall be removed and capped at the main feed. This includes Pneumatic Tube Systems.............................................................................................................................. ix Construction Access and Debris Routes ..................................................................................... ix Clean and Tidy Work Space & Disposal ..................................................................................... ix Interior Signage/Barricades .......................................................................................................... x Outdoor Construction Activities .................................................................................................... x

Special Considerations for Construction Projects at Pathways ......................... xii High Security and Limited Access .............................................................................................. xii Securing Tools & Materials ........................................................................................................ xii Confidentiality & Privacy ............................................................................................................. xii

Environmental Considerations ......................................................................... xiii Hazardous Waste Management ................................................................................................ xiii Asbestos-Containing Materials (ACM) ...................................................................................... xiii Lead-based Paint and Fungal Growth ...................................................................................... xiii Indoor Air Quality ....................................................................................................................... xiii

Project Planning ............................................................................................... xiv Forms & Uses .................................................................................................. xv

Utility Management Shutdown Request ..................................................................................... xv CONSTRUCTION PLAN ........................................................................................................... xvi

CONSTRUCTION SAFETY MANAGEMENT MANUAL Kalispell Regional Healthcare

310 Sunnyview Lane Kalispell, Montana 59901

Phone 406-756-3695 • Fax 406-751-2957

C O N S T R U C T I O N S A F E T Y M A N A G E M E N T M A N U A L

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Introduction he key to safely performing any task begins with communication. Kalispell Regional Healthcare (KRH) is committed to providing a safe and healthy environment for all patients, staff, visitors and you! Our employees are trained in all aspects of healthcare safety and we expect that all of our contractors will be competent, knowledgeable and compliant, as well. The program guidelines put forth in this manual have been designed and are applicable to all employees of companies contracted and subcontractors performing work activities in and on properties of KRH, as well as, leased spaces. Work activities are defined as, but not

limited to, construction, remodeling, renovating, maintenance and/or repair. Construction activities in a healthcare environment can sometimes last for extended periods of time and can impact major parts of the facility. It is imperative that contractors remain knowledgeable and compliant with these safety guidelines during all facets of construction.

Purpose he purpose of this program is designed to institute and document Interim Life Safety Measures (ILSM) and Temporary Safeguards (TS); reduce the risk, mitigate potential adverse impacts of building life safety systems, utilities, and control of exposure and prevention of the spread of infection during construction, demolition, renovation and repair projects on any of KRH properties. The intent is to give a better understanding of what is unique about construction work in a medical facility. Before working on any of the KRH properties, all Contractors must understand the importance of developing a well thought-out Construction Plan to any

activity at KRH that may create dust; which can cause illness, cause discomfort or disruption to patients or staff, could potentially destroy KRH medical materials, equipment, or impact life safety protections; such as: fire detection systems or emergency evacuation routes. In addition to the requirements of this program, Contractors are expected to comply with all federal, state and local laws, current codes and standards. These guidelines are not intended to be comprehensive or address every situation on a worksite, but will provide answers to the worker’s most important life safety or infection prevention related questions.

Acronyms, Abbreviations & Terms NFPA National Fire Protection Association KRH Kalispell Regional Healthcare ESO Environmental Safety Officer IBC International Building Codes

NEC National Electrical Code AIA American Institute of Architects CDC Centers for Disease Control and Prevention CMS Center for Medicaid and Medicare Systems ILSC Interim Life Safety Committee ILSM Interim Life Safety Measures

ICRA Infection Control Risk Assessment POM Plant Operations and Maintenance APIC Association for Professionals in Infection KRH Kalispell Regional Healthcare

Control and Epidemiology HC the HealthCenter OHS Occupational Health Services HIT Health Information Technology HIPAA Health Insurance Portability and WO Work Order Accountability Act OSHA Occupational Safety Health Association TS Temporary Safeguards

T T


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Roles & Responsibilities alispell Regional Healthcare’s organization has developed a multi-disciplinary Interim Life Safety Committee (ILSC) that will be involved from initial project planning through to the occupancy of the space. The ILSC includes leadership from the following departments: Administration, Design & Construction, Health Information Technology, Plant Operations/Engineering, Infection Prevention, Quality and Safety Services, Occupational Health & Safety, Security and Risk Management. Other department leadership will be included and consulted when necessary. Responsibilities for ensuring that construction project meet the requirements lies with the KRH Project Managers,

Design Professionals, Contractor, Infection Preventionist, and Environmental Safety Officer (ESO). The KRH Project Coordination Manager’s will take the lead in including the appropriate stakeholders throughout the process.

Contractors Contractors will follow guidelines, policies and procedures outlined in this program, as well as, all applicable health and safety code requirements of the job. For Contractors, one of the biggest challenges is working in close proximity to patient care areas while not disrupting patient care. Every aspect of your work in our facilities, including your conduct on the job, has the potential to affect patients and everyday operations. It’s vital that we work together to do all we can to minimize disruption to patient care services. It is the responsibility of the Contractor to coordinate with KRH Project Managers and other designated KRH staff, to complete the necessary construction forms and Construction Plan for each project. Once the Construction Plan has been submitted to the ILSC members and approved, it will be the responsibility of the Contractor to provide equipment and materials to comply with the risk mitigation requirements and life safety measures outlined in the plan. Where required, Contractors will perform daily inspections of dust containment and interim life safety measures, log results, and initiate corrections when deficiencies are discovered. All logs or checklists used during this process will be turned in to Plant Operations where they will be kept for 5 years.

The Environmental Safety Officer (ESO) ESO is an integral part of the safety team and acts as the primary safety resource for plant operations or facilities, project management, and infection prevention. The ESO works closely with and acts as a compliance advisor to architectural/engineering firms, Contractors, KRH departments, City, State, and Federal entities. The ESO may inspect jobsites for occupational and user safety, OSHA, and directs changes in practices and procedures pro-actively before emergency measures are necessary. In the absence of the primary ESO, the role of the ESO can be assigned to multiple competent persons, which may include any active members of the ILSC.

Design and Construction Design and Construction department and their respective Project Managers/Coordinators, and Architects will provide project oversight and project coordination services to renovation and construction projects. These services work in conjunction with architectural/engineering personnel and/or firms, Contractors, and KRH departments to guide a project from the initial planning stages, design, and occupancy of the space. KRH Project Managers provide the primary liaison between plant operations or facilities, safety, infection prevention, and plant operations. KRH Project Managers work closely with the design team during the design phase to ensure that the program elements are included in contract documents and routinely monitor for Contractor compliance with this program. Preliminary planning stages will include, but aren’t limited to considering alternate egress routes when construction affects exits, appropriate signage directing vehicle and patient/staff foot traffic, compartmental fire rating compliance, and appropriate barriers and placing thereof.

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Plant Operations Management and Engineering Staff Plant Operations and Engineering staff provide infrastructure and mechanical knowledge to construction projects. Plant Operations will also assist Contractors and manage coordination services to utility shutdowns, hot work permitting as well as fire alarm system testing and verification. Plant Operations staff will be present whenever it is necessary to shut down, remove/replace any or all utilities that will have an impact on our current infrastructure. Plant Operations or ESO will work in conjunction with affected department’s managers to ensure that any education on altered life safety practices is provided to staff.

Health Information Technology Staff Health Information Technology (HIT) staff provide infrastructure and technical knowledge to construction projects. HIT will also assist Contractors and manage coordination of Telecommunications and Data Utility shut downs. HIT staff will be present whenever it is necessary to shut down any or all utilities that will have an impact on our current infrastructure.

Interim Life Safety Committee (ILSC) ILSC reviews, amends, finalizes and approves submitted Construction Plans and retains all documents and corresponding inspections. It is the policy of KRH that all Contractor activities that may cause contamination and or disruptions to life safety protections associated with new construction, renovations, repairs, and other Contractor activities are a concern due to the vulnerability of patients, occupants, lab or surgical activities, and sensitive equipment; such as MRI’s that are near those activities shall be evaluated by the ILSC. The ILSC will determine any negative impact to the project area or adjacent occupied spaces. The degree to which the activity or project will require dust and/or life safety hazard abatement measures is determined by conducting an Infection Control Risk Assessment (ICRA) and all establishing the provisions that will be met during the project. All members have authority to perform inspections on construction projects and make recommendations or citations.

Barrier Management Team (BMT) BMT is a team of professional’s that are certified in the fire protection discipline, and understand the building code and fire code requirements. This team assesses the architectural drawings and performs periodic site inspections before, during and upon completion of construction projects. Inspections documents are filed with ILSC. Anytime a smoke/fire wall will be included in the construction project, the BMT team will be notified in advance and a clear set of prints of the affected area will be given to the team by the contractor and the project managers. In addition, all smoke/fire walls will be identified above the ceiling with a BMT approved decal.


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Required Notifications 72-Hour NOTICE for any Utility Service Shutdowns and/or Interruptions Kalispell Regional Healthcare requires that projects maintain uninterrupted utility services to ensure patient, staff & visitor safety. It is imperative that all utility shutdowns be planned and coordinated with the Plant Operations Department. These plans must be presented and approved by ILSC 72 hours before the work is scheduled. A Utility Shutdown Request form (APPENDIX “B”) should be completed, and brought to Plant Operations prior to scheduling a full ILSC meeting. A full Risk Assessment Construction Plan with interim measures will be completed based on the type of outage, location, and effects on departmental operations and patient care. The plan may require documents; such as floor plans, copies of correspondence, emergency contacts, and backup plans. All copies will be retained by ILSC.

**Unplanned interruptions or damages must be immediately reported to the Plant Operations Department at 406-751-1814**

Hot Work Any hot work involving open flames, heat and/or sparks will need an approved hot work permit. Hot work includes but is not limited to, brazing, cutting, grinding, soldering, torch-applied roofing and welding. All hot work must be authorized by Environmental Safety Officer or designee. Hot work permits will not be issued per project -hot work permits are required per shift. No hot work shall be performed until all sections of HOT WORK PERMIT form has been completed and approved. Hot work permits can be attained through Plant Operations. Should the project require hot work, the Contractor must post the permit next to the project until hot work has been completed. Once completed, the hot work will require sub sequential inspection steps taken by Plant Operations to ensure the area is free from fire danger, including a 30 minute Fire Watch. Copies will be retained by ILSC.

Safety Related Incidents All safety related incidents that involve Contractors or occur in/at Contractor controlled jobsites must be immediately reported to Plant Operations (406-751-1814) and the Environmental Safety Officer (406-756-3522). Examples of such incidents that require immediate notification include but are not limited to:

• Accidents that result in injuries or damage to property • Dust or odor release to areas outside of Contractor controlled job sites • Fires • Gas or Chemical odors • Interrupted or breached Fire Sprinkler Systems • Plumbing accidents causing water flow • Chemical spills • High-hazard work in occupied areas

For emergencies, Contractors should always follow their company and any site specific emergency procedures. For KRH construction projects, a quality notification process and procedures must be incorporated into all Contractors’ emergency protocols. Contractors are responsible for addressing any emergency repairs and providing emergency response at their own expense for issues that arise as a result of work being performed by the Contractor on the job site during business and off-hours.


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Occupational Injury/Illness, Incidents, and Near Misses Contractors are responsible for maintaining an OSHA 300 log for their employees; however, any incident involving an occupational related injury or illness or near miss occurring on the jobsite must be reported to Quality and Safety Services department immediately. The Contractor is responsible for conducting a thorough investigation of every occupational injury, illness incident and near miss to determine root cause and actions to be taken to prevent recurrence. Copies of any incident report, interview or any other related documentation must be provided to quality and risk management. KRH’s Risk Management may conduct its own separate investigation. If it is determined at the conclusion of this investigation that the incident may have been caused by the Contractors’ negligence, then the Contractor may be subject to disciplinary action or potentially being removed from future work, barring the Contractor from bidding on any future projects.


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Required Documents & Records Work Orders All projects must be assigned a KRH Work Order. It is important to note that an invoice without an assigned number could be delayed.

Signage For construction projects, the Contractor must post in a conspicuous and an accessible place an accurate list of all emergency contact information, including availability and multiple contact telephone numbers. This is critical to ensure that at any time day or night, a responsible person can be contacted to address any type of emergency that may arise.

• Caution – • No Access Authorized Personnel Only – • No Smoking – • Hard Hats & Safety Glasses Required • Notice – • Construction Area • Emergency Contact Information

o Altered Egress directional signage –(if applicable)

General Liability - Workers Compensation & W9 IRS Form KRH requires that contracted work performed on KRH property must be under Liability & Workman’s Compensation Insurance coverage. Provide copies to Plant Operations Department. If your company is new to our organization we must have on file a complete W9 Form before work commences.

Confidentiality & Privacy Protection of patient privacy is of paramount importance to our organization and compliant with Health Insurance Portability Accountability Act (HIPAA) as described at the following website: https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html It is the policy of KRH that Contractors relay this important message to all subcontractors and vendors, and be contractually bound to protect health information to the same level as our policy endorses.

Safety Data Sheets (SDS) SDS are intended to outline special precautions, hazards and controls necessary for the safe use and handling of chemical /hazardous materials. KRH requires written or printed material concerning hazardous chemicals that is prepared by the manufacturer for each hazardous chemical they produce. As required by OSHA, SDS’s will be provided to Quality and Safety for any chemical brought on premises during the construction project.

Project File The Contractor and each Subcontractor shall keep a project file at the site. Specific records must be kept readily available for inspection by various Kalispell Regional Healthcare departments at any time. Records to be maintained by the Contractor/Subcontractor are described herein, and include, but are not limited to:

1. Proof of annual influenza vaccinations 6. Safety Data Sheets 2. Medical Gas Certifications and Inspections 7. Documentation for each key and badge issued for the

project 3. ILSC Construction Plans’ 4. Contractor Safety Training 5. Proof of Contractor training and annual review of the KRH Construction Safety Management Manual

https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html



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On-site Safety & Security Procedures Site Safety Orientation Contractors are required to conduct a safety orientation for their employees. This orientation must cover at a minimum:

• Specific fire reporting and evacuation procedures in the event of an emergency in the facility where the work is being performed

• Dust control plan, and life safety interim measures implemented by the approved Construction Plan if required for the work/project

• Logistics plan, if required for the work/project • Contractors’ construction safety or OSHA safety programs • Hazard Communication information if working with or in locations where hazardous materials are used/stored • Lock-out, tag out. Notify Plant Operations (1814). All contractors will follow OSHA guidelines before working

on any electrical circuits, machinery, and equipment requiring lock out tag out. I **Contractors must document all safety orientations conducted. Documentation must be available for review upon request**

Identification Contractors working in KRH facilities or on the properties are to have official identification (ID) badges that will be issued by the KRH Human Resources Department. The badge shall be prominently displayed at all times. All badges must be returned upon completion of each project.

Keys Keys may be issued to the Contractor for spaces that must be accessed for construction purposes. The issuance of keys will be through the Plant Operations department upon approval. The Contractor shall sign for each key received and warrant that he is responsible for the security of keys received and the spaces controlled by those keys. The Contractor shall return all issued keys prior to final payment being made. Should a key be lost or not returned the Contractor shall be charged the cost of re- keying or replacing all locks that the lost key operated. The cost shall be paid prior to final payment being made.

Parking Parking on-site at any KRH property is at a premium and must be reserved for patients, hospital visitors and staff. Contractors shall utilize designated parking areas for their vehicles. Ask the KRH Project Manager for details on the location of your designated parking area. For larger construction projects, KRH will provide special provisions for parking. General Contractors’ will be responsible for ascertaining that their employees and subcontractors park in the designated areas. Parking citations will be issued to Contractors that park outside the designated areas. No parking is permitted in Fire Lanes, Sidewalks, or areas that may impede or cause patients to deviate from approved walkways.

Tools & Equipment Contractors will furnish their own tools and equipment and are solely responsible for their safekeeping. KRH will not be responsible for damage to or loss of contractor tools, equipment, or supplies left unsecured on the jobsite.

Construction Elevator Usage Use of the building passenger elevator is strictly limited to personnel, patients and visitors. Material, debris and tools must be transported via the building stairwells or freight elevator, if available. If no other option, use must be designated in the Construction Plan to minimize traffic patterns and dust disbursement.


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Tobacco-Free Campus Smoking or tobacco use of any kind is prohibited on all KRH properties.

Confidentiality & Privacy Protection of patient privacy is of paramount importance to our organization and compliant with Health Insurance Portability Accountability Act (HIPAA). It is the policy of KRH that Contractors relay this important message to all subcontractors and vendors, and be contractually bound to protect health information to the same level as our policy endorses. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

Project Meetings and Communications During the course of construction there will be project meetings held. The Contractor will inform KRH Project Manager of any change in the scope of work that may affect the Construction Plan as submitted. The contractor will report unusual occurrences or circumstances that take place during the project. The Project Manager will review the correct or recent deficiencies with the Contractor at each construction progress meeting to ensure that the plan is being followed. The Contractor shall report measures taken to correct the deficiencies and prevent recurrence. These actions shall be documented in the progress meeting minutes and carbon copied to ILSC Chairperson. Life Safety and Infection Control will be standing agenda items for every project meeting.

Fire (CODE RED) Guidelines & Procedures for Construction Personnel

GENERAL FIRE GUIDELINES • Contractors should familiarize themselves on where the nearest fire extinguisher, nearest pull station and

nearest fire exit is located in the area of their work. • Never block fire doors or prop open a fire door. These doors are meant to close automatically; held open by an

approved devices, or remain closed at all times. • Never remove or alter an exit sign without prior approval of the ILSC • Alarm stations are located near exits.

FIRE IN THE WORKSITE

When a fire alarm is sounded, the Communication Center will announce CODE RED, via overhead paging, the effected Zone (area). KRH personnel will respond to the alarm and determines the status of the alarm (false alarm, actual fire, system malfunction, etc.). Each department has procedures to follow to ensure that patient, visitor and staff are safe; as well as to prevent the spread of fire or smoke. The following are some guidelines for awareness and when a fire (CODE RED) is called.

• Evacuate all personnel in immediate danger and contain the fire by closing doors. DO NOT re-enter the area. • If workmen discover a fire, pull the nearest fire pull station and announce “CODE RED” loud enough to be heard

by a hospital employee, who will call in the CODE. • Dial 2420 and give Communication Center the exact location and nature of the fire. • Extinguish the fire, only if it is safe and you are trained to do so. • Advise the Fire Dept. of any special (chemical) hazards.

FIRE IN OTHER AREAS

*Upon notification (activation of fire alarm): • Cease all work in progress • Shutdown all heat/flame sources

- R: Remove persons in danger - A: Alert others - C: Confine - E: Extinguish - E: Evacuate (only as directed)



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• Follow R.A.C.E.E. • Non-hospital personnel should follow the instructions of hospital staff. • Do not enter or use any elevator during a CODE RED. • Do not open or travel through any closed set of smoke or fire doors unless smoke or flames are present in the

work area.

False and Nuisance Alarms When the contractor or any of the contractor’s personnel are known to have caused a nuisance alarm, the contractor is subject to a fine.

Dust and Odor Control Contractors are to include all precautions necessary to mitigate dust migration for all projects. Depending on the project; examples of dust control include, but are not limited to: sealing doors, sealing vents, water misting work surfaces, HEPA vacuum, walk-off mats, removal or isolation of HVAC system, and/or use of containment cube. The Contractor shall install temporary dust and/or odor absorbing filters for any odor or dust generating construction work within 40-feet of fresh air intakes or return air opening. Keep in mind that leaving vehicles run can hinder indoor air quality, as well. Determination of these control measures will be documented in the Construction Plan.

Noise & Vibration The Contractor shall endeavor to keep the work areas as quiet as possible. If power activated tools, screw guns or other such devices must be used to accomplish the work, the Contractor shall notify the KRH Project Manager and advise him of the type of equipment to be used and the duration of the work to be done. At times it will become necessary for the Contractor to be stopped from making noise or creating vibrations due to adverse effects of healthcare operations or patient care. The Construction Plan will include provisions to keep noise and vibration to a minimum, including construction activities that occur outdoors.

Plumbing Abandoned pipes shall be removed and capped at the main feed. This includes Pneumatic Tube Systems.

Construction Access and Debris Routes With respect to KRH operational needs and identified higher risk settings, determine the most efficient route to feed the job. Reducing the tracking of dust, dirt, and debris through patient care areas is vital. Therefore the construction plan should note the pathway in which construction crews will be utilizing.

Clean and Tidy Work Space & Disposal 1. Contractors must always plan to keep corridors and exit doors clear at all times, including proper storage of

construction materials and tools. Fire egress cannot be impeded without approved ILSM. Good housekeeping must be maintained at all times. Special care must be taken not to block walkways, roadways, or fire-fighting and safety equipment.

2. All dirt and dust must be completely swept and/or wet mopped at the end of each work shift. This includes cleaning behind enclosed spaces and in ceilings.

3. All ceiling tiles in occupied areas must be back in place by workday end, both for infection prevention, as well as maintain fire stopping integrity.

4. All carpet, flooring, and walls must be maintained and kept in the original condition as existed at the start of construction unless those surfaces are a part of the project scope.


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5. All KRH furnishings and equipment shall be moved out of the construction area and not be damaged in any way. All damages shall be reported to the Project Manager for appropriate and immediate action.

6. Medical waste containers (sharps, biohazard, etc.) should be removed by Environmental Services prior to the start of construction. If the units have not been removed, notify the Project Manager immediately. Do not move or touch any medical waste or sharps containers.

7. The storage of material in mechanical or electrical rooms is expressly prohibited. 8. Existing doors, fixtures and equipment being removed but not re-used in this project shall be delivered to and

turned over to Design & Construction Project Coordinator by the Contractor when so stipulated in the construction documents.

9. Take measures to protect adjacent areas to the construction area from dust, dirt and debris. Debris shall not be allowed to accumulate within or around the work area. All debris shall be disposed of each day off the campus or in a Contractor supplied dumpster.

10. Dumpsters shall be supplied by the Contractor, unless otherwise stipulated in their contract. Open bins and dumpsters shall be covered if any materials other than wood, metal, plastic or glass are placed in them to prevent contaminated residues from washing out into storm drains. KRH dumpsters shall not be used, nor shall trash carts. KRH’s floats, or pallet jacks, shall not be used without permission from the Project Manager.

11. All existing floors, walls, ceilings, roofs, partitions, doors, frames, etc. damaged by removal of existing work and/or by installation of new work, or by movement of materials or workmen shall be patched or replaced and finished to match original or adjacent work.

Interior Signage/Barricades Contractors are to utilize physical barricades to clearly identify work areas, so long as those barricades do not interfere with egress or alternate egress paths that have been established. In addition, signage is to be posted that clearly identifies the work area, or reroutes foot traffic, as well as identifies dangers. 1. Signs will be installed in a manner that provides an unobstructed view of all exit signs 2. Locate EXIT signs and other visible communications device to the right side of the corridor as viewed when exiting from the center of the building towards the outside. 3. It is important that all jobsite signage visible to the public look professional. 4. Do not use paper signs. All signs should be laminated, plastic, or metal. 6. Architectural signage will be to code and standardized throughout the facility. Please consult the Project Manager should you have questions regarding signage.

Outdoor Construction Activities Construction activities outside the building should be reviewed by the ILSC. There are both Life Safety precautions, as well as Infection Control measures that will need to be addressed. Some things to consider when performing work outside the building.

1. Windows facing construction site a. Cover with plywood or other means of protection of glass b. Insulation or buffer noise c. Window film

2. Security 3. Follow all City Ordinances, including time of day for noisy activities 4. Loading dock or ED access

a. Vendor contacts and scheduling b. Emergency services awareness and planning

5. Doors/Windows a. Check gaskets in high-risk areas b. Environmental Services frequency increased in certain areas

6. HVAC


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a. Air intake locations b. Filter changes

7. Education/Marketing a. PR with neighbors/community b. Method of communications c. Traffic rerouting

8. Construction practices and excavation including vibration a. Keeping worksite continuously wet b. Loose debris hauled in covered trucks c. Underground utility locates and Risk Assessment by KRH Leadership


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Special Considerations for Construction Projects at Pathways

Pathways is a hospital setting that provides care and treatment for people with diagnoses of chemical dependency and behavioral and mental health illnesses. Acute crisis intervention and stabilization is the goal and thought of as the Intensive Care Unit of psychiatry and chemical dependency. Safety of the patients, staff and visitors and Contractors is of utmost importance. The people we care for can at times be unable to think and/or act rationally and because of these and other factors, are at a significant level of risk. Environmental and special considerations must be attended to when visiting this facility to perform contractor duties. All contractors working at this facility must receive additional training prior to entering the facility.

High Security and Limited Access To minimize risks; Pathways is a secure and locked unit, meaning all entry and exit is controlled by key-lock, camera monitoring, and strict check-in and out procedures. Not all of the locations within the Pathways building are secure areas, but once you have crossed the threshold of a secure door, certain key concepts and rules must be followed. Contractors must check-out with the front office staff or with the nurse station if front office is not available, before every departure of the building. Contractors will be denied access if they do not host a Contractors badge and have not checked in with the proper personnel.

Securing Tools & Materials No tools or materials will be left unattended at any time. This includes having your back to any and all equipment, supplies, etc. It is imperative that any and all items are secure at all times. Utilize a second Contractor or ask the nursing staff for assistance.

Confidentiality & Privacy Once in the locked and secure unit, interactions between you and the people in care at Pathway’s will be very limited. If interactions with our patients become necessary for your job performance, please seek assistance from staff. Should you see anyone you recognize at Pathways, their presence SHALL NOT be acknowledged outside of Pathways as strict State and Federal Law insures patient privacy and confidentiality.


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Environmental Considerations Hazardous Waste Management The Contractor must provide KRH with a list of actual and potentially hazardous wastes to be generated during the project. Hazardous waste generated by the Contractor as part of its work is the responsibility of the Contractor. Contractors must ensure that their hazardous waste is properly identified, stored, transported and disposed of in accordance with all applicable local, state, and federal laws. Contractors will maintain an adequate emergency plan and equipment to address spills, fire etc. Contractors and/or sub-Contractors shall not remove any instruments, refrigerators, freezers or containers from any lab or room on campus that has a radioactive or biological hazard symbol on it unless it has a tag on it authorizing its removal from that lab or room.

Asbestos-Containing Materials (ACM) As a mandate of the Montana Department of Environmental Quality, all construction projects require an inspection for asbestos. As part of each construction planning protocol, KRH will have the proposed project site inspected by an accredited inspector. Should the area contain asbestos, abatement will be performed by an accredited remediation company and no project work will be performed until a final clearance inspection has been performed on the area. Only non-asbestos containing materials may be used. If it is found that any construction materials containing asbestos are used in the work, the Contractor using them shall pay for all abatement, re-installation of non-asbestos containing materials, and any other refurbishment of adjacent areas associated with removal and re-installation.

Lead-based Paint and Fungal Growth It is the responsibility of the Contractor to notify the owner immediately if ACM, Lead-based Paint, or Fungal Growth is found before or during construction activities. All removal or abatement and disposal must be performed by firms licensed to perform such work.

Indoor Air Quality Contractors shall make every effort to maintain acceptable indoor air quality on KRH properties while performing their work, and to reduce the generation of unwanted odors, dust, vapors, gases and fumes that potentially can make their way into the spaces of employees or patients in adjacent areas and buildings. Before using odorous chemical compounds or other materials (glues, epoxies, paints, thinners, etc.) inform the KRH Project Manager who will advise the ESO of what materials are to be used, where, and for how long. ESO will then be able to advise any inquirers or complainants about the materials being used and resulting potential odors. Take all precautions advised on container labels when using chemical compounds, and establish proper ventilation prior to using them, especially with odorous products. The Plant Operations Department may arrange to confine your building air supply to only the immediate work area. Always advise the KRH Project Manager before odorous compounds are used.


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Project Planning Design phase:

1. Consult Infection Prevention on the design as it relates to: clean and soiled utility rooms; hand washing sinks. Isolation rooms, negative pressure rooms, wall and floor coverings, ceiling types.

2. Consult with ESO on design as it relates to NFPA and fire/smoke wall requirements. Project planning begins with a pre-construction meeting with the KRH Project Manager. Items to be discussed should include:

3. Parking and staging 4. Construction Plan form Appendix “A”; which includes the ICRA will be completed.

Schedules and impact on surrounding departments. Care should be taken for cleaning, noise, shutdowns of life safety, utility and mechanical systems, pathways for contractors, etc. Appropriate Plant Operation services personnel shall be involved in any mechanical system changes and/or shutdowns

Revising egress routes, evacuation plans, and appropriate directional signage for staff, patients, and visitors

(ICRA) Infection Control Risk Assessment Identifying patient populations that could potentially be affected adjacent to the actual construction area using ICRA

When necessary: Utility Shutdown Guidelines should be reviewed and the use of Utility Shutdown Request Form – Appendix “B”

5. Schedule ILSC meeting to review the plan 6. Coordination for hazardous materials, abatement or safety procedures (if applicable) 7. Appropriate training of construction personnel on KRH’s Construction Safety Management 8. Relocating staff or patients as needed or determining construction work-hours as to minimize the effect on

patient care 9. Installing appropriate barriers and containment issues 10. If necessary, appropriate Plant Operation services personnel shall be involved in any system changes and/or

shutdowns 11. Ensure the integrity of the water system during and after construction if applicable 12. Required inspections and scheduling thereof 13. Written documentation of all HVAC changes to included documentation of balancing, air exchanges, and

pressure differential will be submitted to Plant Operations (in addition to requirements for O&M’s) upon project closeout.

14. Planning for verification and inspection of systems that were altered during the construction Considerations to project planning at KRH locations:

• Loading dock • ED access • Vehicle and pedestrian traffic hazards and control


xv

Forms & Uses

Utility Management Shutdown Request Kalispell Regional Healthcare requires that projects maintain uninterrupted utility services to ensure patient, staff & visitor safety. Should any one of the following utilities be shutdown, a Utility Shutdown Request Form, unless the shutdown is included in a submitted Construction Plan, should be submitted: Alarm Systems Chilled Water Potable Water HVAC Electric Elevator Heating Water Medical Air, Medical Vac Steam Oxygen Fire Systems It is imperative that all utility shutdowns be planned and coordinated with the Plant Operations Department and approved by ILSC. A Utility Shutdown Request form (APPENDIX B) should be completed, and brought to Plant Operations prior to scheduling a full ILSC meeting. A full Risk Assessment Construction Plan with interim measures will be completed based on the type of outage, location, and effects on departmental operations and patient care. The plan requires documents; such as floor plans, copies of correspondence, emergency contacts, and backup plans. All copies will be retained by ILSC.


xvi

CONSTRUCTION PLAN Construction plans Appendix “A” are necessary for each construction, renovation and maintenance project by performing Life Safety, General Safety, and Infection Control Risk Assessments that serve as a guide to implementing the appropriate temporary safeguards to permit the provisional disruption of life safety, utility systems and/or normal operations of the facility. Work or projects affecting multiple locations or multiple phases may require additional assessments to be completed to address all potential impacts related to the work or project phase. Prepare your documents with full scope of work and attach necessary construction drawings/plans. The committee can reject the assessment if the Construction plan is incomplete and does not include drawings. **It is recommended to provide construction drawings or ask for walk-through of the proposed construction site should the plan entail complex plans and/or if the plan includes phases in project work.


xvii

CONSTRUCTION PLAN: LIFE SAFETY

E G R E S S

Egress routes cannot be impeded or blocked without approved Interim Life Safety Measures. All external exit ways, walks, and drives must be kept free from debris, ladders, carts, material, tools and vehicles. Do not block fire extinguishers, fire alarm pull stations and fire doors at any time. Corridors, stairwells and exit doors must be kept clear at all times. Should at any phase the project require a corridor width reduction (no less than 4 feet), fire lane obstruction, traffic detour, exiting stairwell, or corridor impairments - the KRH Project Manager must be notified and a construction plan must provide detailed provisions to be reviewed by ILSC. The plan, drawings, and provisions should depict approved code compliant egress reconfigurations, and redefining of exits. The plan should also take into account providing fire-rated corridors where necessary and maintaining all required travel distances. **Construction drawings with altered egress pathway should accompany Construction Plan. Egress signage and/or other means of notification must be utilized to inform people of the interim alternate route. Depending on the severity of the alteration, length of time, and/or location of the obstructed or altered egress, the ILSC members will determine the proper interim measures; such as:

• means of communication, education & training to affected staff • added security or surveillance • temporarily relocate staff or patients

ADA Access to handicap entrances must be maintained at all times during the course of a project. Alternate routes must be designated prior to the project. A contingency plan should accompany the proposed route in the event routes have to be altered.

E M E R G E N C Y & E X I T S I G N A G E / L I G H T I N G

Should the project require the temporary blocking or disconnecting of Emergency Signage/Lighting, the Contractor will work with the KRH project manager to determine the provisions to be set in place to accommodate and add directional signage for patients, visitors and staff. In some cases, temporary directional signage, as well as, temporary passageway lighting may be necessary so that traffic has clear vision when traveling through or around the area. Your plan must include these provisions for safety. In addition, it may be necessary to remove or cover an exit and/or direction al signage so individuals are not falsely directed in the interim and signage should be very clear to the audience as to the emergency exit. When a Life Safety System will be interrupted or removed. Examples include: Fire Suppression, Fire Detection; Fire Pump; Pull Stations, Exit Lighting, or other Emergency directional signage etc. Signage will be used to advise individuals of the danger, caution, notice of exit closure, etc. . If an egress route is compromised, signs will indicate where the alternative egress is located and notification will be given prior to the disruption to those individuals who likely would have need of that egress. **Construction drawings should accompany Construction Plan.


xviii

C O M P A R T M E N T A L F I R E R A T I N G

Compartmental fire rating must be maintained during projects. It is the Contractor’s responsibility for maintaining all fire and smoke rating requirements during the project, as well as, to ensure the project area is returned to full NFPA compliance upon completion of the project. Current drawings or documents addressing all structural features of fire protection should be accessible and reviewed by the ILSC for all projects. Any existing penetrations located during the initial visit of the construction area shall be brought to Barrier Management Team’s attention. Any penetrations not identified prior to beginning work shall be the responsibility of Contractor to fire-stop with the approved STI product before final sign-off of the project. Should the project require the smoke/fire walls/doors be compromised at any time during a project for any reason such as: running pipe, low voltage, data or electrical lines, it will be noted in the construction plan and fire safety provisions will be implemented to protect surrounding departments and the spread of smoke and fire. Prior to the demolition of the rated walls between the construction area and an occupied space, in some circumstances, a rated wall of equal or higher fire rating must be installed. Temporary construction barriers must be 1-hour fire rated or non-rated if the construction area is fully sprinklered. Plastic sheeting can be used on a very limited and short term basis to control dust and to provide a level of protection to building occupants for infection prevention measures; however, plastic sheeting does not meet the requirement for limited combustible material. Temporary construction barriers are to be smoke tight and built of noncombustible or limited combustible materials, such as sheetrock and gypsum, which are materials that will not contribute to the development or spread of fire. KRH requires that all Contractors use approved STI fire and smoke sealing systems when running pipe, low voltage, data or electrical lines through rated walls or partitions. As with all projects, the BMT will intermittently inspect the walls to ensure that no penetrations are left unsealed or walls compromised during the project. Upon completion a full inspection of the penetrations will be performed before the project can be considered completed. **Drawings depicting the compartmental fire ratings should accompany all Construction Plans.


xix

F I R E S U P P R E S S I O N

KRH requires suppression, as well as, fire pumps and standpipes remain operable during all construction projects. Should the project require any component of the fire system service be turned off, or disconnected due to construction activities, the Contractor must describe in detail what activity will take place that will require the shutdown. Reporting the sprinkler head location, count and activities will ensure that Plant Operations can verify the activity against the fire sprinkler program. The Construction plan should include:

Removing sprinkler heads; the number of sprinkler heads that are being removed, and identify the existing location of the sprinkler heads

Adding sprinkler heads; the number of heads added; and location of heads Moving sprinkler lines and locations therein Repair sprinkler lines: What zones, floors or departments of the system will be affected during this period of

the shutdown? And how long. All shutdowns should be coordinated with the Plant Operations Departmental staff, duration, and include an impairment plan. Impairments plans may require installation of a temporary, but equivalent system, fire watch, or other means of protection. A FIRE WATCH will be mandated whenever fire suppression is out or impaired for more than a 10 hour period OR whenever fire detection/alarm system is out of service for more than 4 hours in a 24-hour period. A fire watch will not be needed should the Contractor have a supplementary suppression system installed in the construction area. The 2012 NFPA Code Requirements on a Fire Watch state that the FIRE WATCH be constant, and assigned a designated person. These devices have specific nomenclature that is indicative to KRH and various platforms that utilize the unique labels. It is imperative that these devices are not only installed and working properly, but host the proper labels and nomenclature upon completion of the project. All construction projects will not be considered completed until these systems have been tested and entered into the correct database, and verified. Administrative ILSC Actions: Plant Operations Leadership notifies the State of Montana when a fire alarm system is out of service for more than 4 hours in a 24-hour period in an occupied building.


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D E T E C T I O N & F I R E A L A R M S Y S T E M

KRH requires fire detection and fire alarm systems remain operable during the duration of all construction projects. Should the project require the fire system service be turned off, or disconnected due to construction activities, the Contractor must describe in detail what activity will take place requiring the shutdown. Per code NFPA 25; NICET II certified technicians are required for removal, demolition, and installation of these systems. Should the construction plan require a smoke-head to be covered during a project, upon completion of the work-day shift, the smoke head should be uncovered. Contractors are required to document in the Construction plan and report to ILSC and Plant Operations anytime the project requires:

1. Completely removing detection devices; the number of devices removing, and location of detection devices. And/or

2. Adding detection devices; the number of detection devices adding; and location of the devices Reporting to include what zones, floors or departments of the system will be affected if any of the above is part of the construction plan? FIRE WATCH will need to be implemented and part of the Construction Plan whenever fire detection/alarm system is out of service for more than 4 hours in a 24-hour period or whenever fire suppression is out or impaired for more than a 10 hour period. These devices have specific nomenclature that is indicative to KRH and various platforms that utilize the unique labels. It is imperative that these devices are not only installed and working properly, but host the proper labels and nomenclature upon completion of the project. All construction projects will not be considered completed until these systems have been tested and entered into the correct database, and verified.

O T H E R L I F E S A F E T Y D E V I C E S A N D S Y S T E M S C O N S I D E R A T I O N S

All life safety devices affected should be noted in the construction plan as to what activities will be involved that will or could potentially affect these devices. Interim measures may be necessary if these systems are compromised during construction. Other Life Safety devices include, but are not limited to:

• Nurse Call Systems; • Code Blue Systems; • Fire Pull Stations; and • Overhead Speakers tied into the Fire System and or other emergency notification systems

These devices have specific nomenclature that is indicative to KRH and various platforms that utilize the unique labels. It is imperative that these devices are not only installed and working properly, but host the proper labels and nomenclature upon completion of the project. All construction projects will not be considered completed until these systems have been tested and entered into the correct database, and verified.


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P R O H I B I T E D A C T I O N S T O L I F E S A F E T Y

At no time will the following be allowed (without interim life safety measures and a construction plan): • Exits or pathway or stairwells to an exit be blocked • Wedged open fire doors or smoke doors • Removed or modified exit signage or emergency lighting • Removal of smoke detection, or any other signaling device or suppression equipment • Compromise the fire rating of a door, or other barrier to smoke and fire spread • Leave supplies, materials, tools, equipment, scaffolding or other objects in public or common areas outside the

worksite, unattended • Hot Work performed

Should there be deficiencies discovered during an inspection, corrective actions will be implemented.


xxii

CONSTRUCTION PLAN: INFECTION PREVENTION

While working in healthcare environments there are many construction activities that can potentially harm patients. It is KRH’s goal to work with all contractors through education and construction planning, limiting the potential exposure to our patients, staff, visitors and you! Construction activities produce or disturb dust and moisture pose serious risk to at-risk patients. Construction practices can impact a patient’s well-being by disseminating bacteria and filamentous fungi that can cause infections. Airborne fungal spores live on wood, paper, and the space above false ceilings. Infectious organisms can be airborne or waterborne.

FACTS: • Mold produces large numbers of spores which become airborne and tend to be very resilient. • Bacteria proliferate in biofilms in water systems can be released when systems are interrupted or disturbed –

when a breach of the water main occurs changes in water pressure can dislodge biofilm and free Legionella into the water system, while dirt and other materials can be introduced into the water and use up disinfectant

• Legionnaire bacteria are waterborne, but can cause infection when droplets are inhaled. • Construction vibrations and changes in water pressure can dislodge biofilm and free Legionella into the water

entering the facility Generally, “at-risk patients” are grouped together in ICU’s and other patient care areas; however, it is important to note that they can and do transit between departments such as the Emergency Room, Radiology, and/or Oncology, which heightens their risk of exposure. These patients are considered to be the most vulnerable to contracting an infections during a hospital stay. An infection-control risk assessment (ICRA) conducted before initiating repairs, demolition, construction, or renovation activities can identify potential exposures of susceptible patients to dust and moisture and determine the need for dust and moisture containment measures. This assessment centers on the TYPE and SCOPE of the construction or repairs in the work area but may also need to include adjacent patient-care areas, supply storage, and areas on levels above and below the proposed project. Identify the GROUP or “at risk” population in relation to the construction, possible transmission route of likely pathogen, and mitigations to the potential threat. Refer to the matrix within the Construction Plan for complete overview of the ICRA. Infection Prevention is accomplished by three major categories to consider when accomplishing full infection prevention during a construction project: CONTAINMENT, NEGATIVE AIR, & CREW DECONTAMINATION. In addition to these, other infection control concerns may include:

Be aware of tanks and piping that may have stagnant water Do not create dead legs when removing existing pipes Flush systems prior to putting into service Keep all ducting covered. New ducting should be packaged and stored in dry, clean location prior to install


xxiii

C O N T A I N M E N T & B A R R I E R S

It is the responsibility of each Contractor to include job site containment in the Construction Plan. Containments are used to isolate a contaminated area from the adjacent work spaces, ductwork, and the rest of the hospital. A general overview of each class and its requirements are better defined in the ICRA portion of the Construction Plan. While this gives a generalized summary of each class, each project will pose unique situations that will be analyzed with the ILSC during the assessment phase of the project. When planning for infection control it is important to also recognize the area surrounding the construction project area, and assessing potential impact to these areas as well. General Containment Rules:

• Doors should be closed and sealed with tape to prevent the dust and debris from escaping • If the work area cannot be contained by walls and doors, use a plastic, or other fire rated barrier and seal the

seams with duct tape. Tape off any holes. • Barriers must be properly assembled and fully inspected prior to any construction or demolition taking place. • Reassess your containment area DAILY to assure dust is not escaping - Holes, tears, or other perforations

should be repaired promptly with tape. • Entry and exit routes must be limited to those openings that result in the least amount of exposure to patients,

visitors, and staff. When possible, use dedicated doors, windows, and stairways. • Supply ducts should be blocked off and return air ducts should be covered with pleated air filters. • Exhaust fans may be used in conjunction with HEPA filter System and MUST run continuously.

Barriers capable of containing smoke and dust will confine fungal spores to the construction area. The specific type of barriers required depends on the project’s scope and duration and on fire codes. Short-term projects that result in minimal dust dispersion; example: installation of new cables or wiring above ceiling tiles) require only portable Control Cube with negative pressure and HEPA filtration of the exhaust air from the enclosed work area. If the project is extensive but short-term, dust-abatement, fire-resistant plastic may be adequate. These should be completely airtight and sealed from ceiling to floor. More elaborate barriers are indicated for long-term projects that generate moderate to large amounts of dust. These barrier structures typically consist of rigid, noncombustible walls constructed from sheet rock, drywall, plywood, or plaster board and covered with sheet plastic. Barrier requirements to prevent the intrusion of dust into patient-care areas include

• Installing a plastic dust abatement barrier before construction of the rigid barrier • Sealing and taping all joint edges including the top and bottom; • Extending the barrier from ceiling to deck, which takes into account the space above the finished, drop-down

ceiling; and • Barriers built with fire-rated/resistant materials • Closures with zipper or door • Fitting or sealing any temporary doors connecting the construction zone to the adjacent area.


xxiv

N E G A T I V E A I R

It is the responsibility of the Contractor in the Construction plan to set up a negative air system. By maintaining negative air, it often prevents any unnecessary exposure to dust, dirt, and/or fumes along with other potential airborne particles. An area will remain negative, which means; more air is removed from the area than is replaced. When used along with methods of containment, negative air assists in controlling contamination and reduces patient, visitor, staff and worker exposure to airborne dust and infectious agents. Typical methods used along with containing of the construction area are: HEPA equipped air-filteration units or keeping exhaust fans operating; in conjunction with ensuring door gaskets are sealed, closures work properly and taping doors.

As a Contractor, it is important to understand how air flow works in the hospital. Typically, the overall direction of airflow will be from clean areas to dirty areas. There are some rooms that are kept at a positive pressure. These “positive” pressure rooms include but are not limited to: operating rooms, clean utility rooms, the central supply area, and some patient rooms. On the other hand, typical negative air flow rooms are areas such as utility rooms, mechanical, public restrooms.

C R E W D E C O N T A M I N A T I O N

It is the responsibility of each Contractor to develop a Construction Plan that assesses the amount of dirt, dust and debris in and around the job site and, if applicable, include prevention of contamination through personnel transport including, but not limited to: Paper Suites; Shoe Coverings; Wipe bottom of feet; HEPA Vacuum crew clothing when exiting jobsite.


xxv

E X T E R N A L D E M O L I T I O N A N D C O N S T R U C T I O N

External demolition, planned building removals, and excavation generate considerable dust and debris that can potentially travel to unwanted areas. When there is an outdoor construction activity, a construction plan should be issued to review potential risks and when necessary implement the correct precautionary measures to mitigate any infiltration to the hospital, water systems and patient-care areas.

• Review of any air intakes to the hospital system close to the work zone o It may be necessary to change filters more often – consult Plant Operations

• Inspect window and door seals – particularly to the high-risk areas, • Common travel of immune-compromised patients is eminent; interim measures may be to reroute patients, or

temporarily relocation • Overhead and or underground utilities in proximity to proposed excavation should be carefully investigated and

the construction plan should include all necessary precautions and risk assessments

Recap to Infection Prevention Construction Planning: • Prepare for the project by conducting the ICRA and walkthrough with project manager & KRH staff • Complete the Construction Plan to include all temporary safeguards necessary in accordance to the ICRA. • If necessary, KRH and the ILSC team may need to implement precautions or interim measures such as:

o Relocating target patient populations based on the risk assessment. And, if deemed necessary, relocating of patients will have to be arranged in advance to avoid delays

o Protective respiratory equipment issued for at-risk patients when outside their patient rooms • Determine appropriate barrier method for the project. • If vibration-causing construction is part of the project, precautions should be implemented to mitigate

infiltration into water system. • Establish proper ventilation for the project:

o Shut off return air vents in the construction zone. Seal around grilles o Exhaust air and dust to outside o If recirculated air from the construction zone is unavoidable, use a pre-filter and HEPA filter before the

air returns to the HVAC system o When vibration-related activities take place that may dislodge dust in the ventilation system or when

modifications are made to the ductwork serving occupied spaces, install filters on the supply grilles temporarily

o Maintain negative pressure in the construction zone • Determine routes and schedules for debris removal and construction personnel so it does not hinder KRH normal

operations and risk to patients when routing construction crews and debris • Control any risk for water damage

o Keep dry storage of material and absolutely no install of wet/porous material • Control dust in air and on surfaces

o This may require that KRH supplies or equipment be moved to a temporary location to complete the project.

• Finalize the project o If necessary, flush the main water system to clear dust contamination lines o Terminally clean before containment barriers are removed o Remove containment barriers – breaking down inward to contain the remaining dust o Verify appropriate ventilation requirements are active for the space before occupancy and commission

space, if required


xxvi

APPENDIX “A”

Construction Plan

Project Title Project Start Date: Project Duration Contractor

Contractor Contact:

1 | P a g e

PROJECT SCOPE OF WORK: Will project have smaller phases that will require ILSM at different times of the project? If so, please indicate.

LIFE SAFETY ASSESSMENT EGRESS & EMERGENCY SIGNAGE/LIGHTING THE SECTION IN BLUE WILL BE FILLED OUT BY ILSEC DURING THE MEETING

WILL ANY EGRESS PATHWAYS/CORRIDORS BE ALTERED, OBSTRUCTED, OR WILL THERE BE RESTRICTED ACCESS TO EMERGENCY SERVICES?

YES NO

IF YES, DRAWINGS DEPICT THE APPROVED CODE COMPLIANT EGRESS RECONFIGURATIONS, AND REDEFINING OF EXITS ARE INCLUDED WITH PLAN FOR ILSEC REVIEW

YES NO

WILL AN ALTERNATE ROUTE BE NECESSARY FOR EITHER PATIENTS OR STAFF DURING THIS PROJECT? ALTERNATE ROUTE MAPPED ON DRAWINGS AND IS ATTACHED *PLEASE PROVIDE THE MAPPED ALTERNATE ROUTE TO THE ILSEC WHEN PRESENTING THE CONSTRUCTION PLAN

YES NO

WILL EMERGENCY AND EXIT SIGNAGE BE OBSTRUCTED, OR REMOVED DURING THE PROJECT? IF YES, WHAT ALTERNATIVE METHOD OF SIGNAGE WILL DIRECT TRAFFIC IN THE EVENT OF AN

EMERGENCY DURING THE PROJECT? DIRECTIONAL ARROWS___ EXIT CLOSED ___ USE ALTERNATE EXIT ___ ILLUMINATED SIGNS NEEDED ___

YES NO

IS THERE A REQUIRED EVACUATION PLAN THAT MUST BE SUBMITTED TO THE CITY? * PROVIDE THE “APPROVED PLAN” TO THE ILSC TO BE REVIEWED. KRH PERSON RESPONSIBLE FOR PLAN TO CITY:___________

YES NO

SHOULD SURVEILLANCE/SECURITY BE INCREASED TO THE AREA DUE TO EGRESS IMPAIRMENT (DEPENDING ON AFFECTED AREA)?

YES NO

IF EGRESS IS OBSTRUCTED, ADDITIONAL FIRE DRILLS SHOULD BE CONDUCTED. IF YES, PLANT OPERATIONS LIFE SAFETY PERSONNEL TO BE NOTIFIED

YES NO

POST SIGNAGE FOR ALTERNATE EXITS YES NO

TEMPORARY RELOCATION OF STAFF OR PATIENTS IS NECESSARY FOR THIS PROJECT. IF YES, PERTINENT NAMES, LOCATIONS AND PLAN SHOULD ACCOMPANY THIS CONSTRUCTION PLAN.

YES NO

IF EGRESS IS SIGNIFICANTLY ALTERED/OBSTRUCTED, STAFF EDUCATION IS NECESSARY. PERSON RESPONSIBLE FOR STAFF EDUCATION ON EGRESS MEASURES: __________

YES NO

Construction Plan


Contractor Contact:

2 | P a g e

COMPARTMENTAL FIRE RATING

& BARRIER IDENTIFICATION

WILL SMOKE OR FIRE WALLS/DOORS/FLOORS OR ASSEMBLIES BE COMPROMISED (REMOVED, PENETRATED)? IF YES, PROVIDE FLOOR PLAN AND LOCATE WHERE AND THE TYPE OF CONSTRUCTION ACTIVITY

*FIRE RATING & LIFE SAFETY FLOOR PLANS INCLUDED WITH THE CONSTRUCTION PLAN

YES NO N/A

IDENTIFY ADJACENT DEPARTMENTS (ABOVE, LATERALLY & BELOW): TYPE OF BARRIER TO BE USED FOR SEPARATION OF CONSTRUCTION AREA TO OCCUPIED SPACES (SEE MANUAL OR PER NFPA CODE): CONSTRUCTION AREA IS FULLY SPRINKLERED AND WILL NOT BE COMPROMISED DURING THE PROJECT? TEMPORARY BARRIERS MUST BE 1-HR FIRE RATED IF THE CONSTRUCTION AREA IS NOT FULLY SPRINKLERED DURING PROJECT

YES NO N/A

THIS SECTION IN BLUE WILL BE FILLED OUT BY ILSEC DURING

THE MEETING

REQUIRED INTERIM MEASURES AS RECOMMENDED BY THE ILSEC PER SUBMITTED PLAN (CIRCLE APPLICABLE MEASURES)

• BARRIERS BETWEEN CONSTRUCTION AND OCCUPIED SPACE SHOULD BE 1 HR RATED __________

• ADDITIONAL FIRE FIGHTING EQUIPMENT IN CONSTRUCTION ZONE _____ • INCREASED SURVEILLANCE OR ROUNDS TO AREA_______ • CONTROL OF COMBUSTIBLE EXCESS______ • TRAIN PERSONNEL ADJACENT TO AREA ON NEW FIRE EGRESS PLAN______ • PERFORM ADDITIONAL FIRE DRILL IN AREA DURING CONSTRUCTION_____ • PERIODIC & FINAL INSPECTIONS PERFORMED BY BMT TO ENSURE CODE

COMPLIANCE OF FIRE-RATING _______

FIRE SUPPRESSION/ DETECTION

&

FIRE/LIFE SAFETY

DOES THE PROJECT REQUIRE THAT THE SMOKE DETECTION SYSTEM BE DEACTIVATED, COVERED OR REMOVED FROM SERVICE? IF YES, HOW LONG WILL DETECTION BE DEACTIVATED?______ HOW MANY HEADS WILL BE AFFECTED: _______ AND SUBMIT A UTILITY SHUTDOWN FORM THE PLANT OPERATIONS DEPARTMENT. DETECTION/ALARM SYSTEMS OUT OF SERVICE FOR MORE THAN 4 HOURS IN A 24-HR PERIOD REQUIRES A FIRE WATCH.

YES NO

DOES THE CONSTRUCTION PLAN REQUIRE ANY FIRE SUPPRESSION SYSTEMS TO BE TAKEN OUT OF SERVICE? IF YES, HOW LONG WILL THE SUPPRESSION SYSTEM BE DISABLED: ______ AND SUBMIT A UTILITY SHUTDOWN FORM THE PLANT OPERATIONS DEPARTMENT. SUPPRESSION SYSTEMS OUT OF SERVICE FOR MORE THAN 10 HOURS IN A 24-HR PERIOD REQUIRES A FIRE WATCH.

YES NO

DOES THE PROJECT REQUIRE CEILING TILES BE REMOVED? IF YES, HOW LONG WILL THE CEILING TILES BE REMOVED?_____ REMOVING CEILING TILES IS BOTH A LIFE SAFETY AND INFECTION PREVENTION CONCERN. CEILING TILES LEFT OUT COMPROMISES THE AREAS SURROUNDING THE CONSTRUCTION SITE. A FIRE WATCH MAY BE REQUIRED TBD BY ILSEC.

YES NO

DOES THE CONSTRUCTION PROJECT REQUIRE REMOVING, ADDING, REPAIRING OF: SPRINKLER HEADS NUMBER OF HEADS ____

SMOKE DETECTORS NUMBER OF DETECTORS: ___

NURSE CALL SYSTEM CODE BLUE SYSTEM

FIRE PULL STATIONS

OVERHEAD SPEAKERS? THE PLAN SHOULD ALSO INCLUDE TESTING& VERIFICATION OF THE

AFFFECTED SYSTEMS BEFORE COMPLETION OF THE PROJECT.

YES NO

Construction Plan


Contractor Contact:

3 | P a g e

DOES THE PROJECT REQUIRE A HOT WORK PERMIT DUE TO: CUTTING, WELDING OR SOLDERING DURING CONSTRUCTION? IF YES,

ATTAIN A PERMIT FROM PLANT OPERATIONS POST PERMIT NEXT TO CONSTRUCTION SITE ADD ADDITIONAL – SUPPLEMENTARY FIRE PREVENTION DEVICE CONTROL COMBUSTIBLE EXCESS HOT-WORK EQUIPMENT IS IN OPERABLE AND IN GOOD CONDITION SMOKE/FIRE DETECTORS IN THE IMMEDIATE AREA OF HOT WORK

TEMP. DISABLED SHUTDOWN REQUEST SUBMITTED (IF APPLICABLE) DRAINS/FLOOR OPENINGS/GRATES/WALL PENETRATIONS PROTECTED WORK AREA SECURED UPON COMPLETION OF HOT WORK,1/2 HOUR FIRE WATCH

IMPLEMENTED & REACTIVATION OF SMOKE DETECTION

YES NO

ANYTIME A HOT WORK PERMIT IS APPROVED, A FIRE SAFETY PLAN MUST BE IMPLEMENTED. EXAMINE THE AREA AND DETERMINE THE BEST FIRE EXIT PLAN, AND WHERE/IF YOU WILL STORE OR REMOVE COMBUSTIBLE MATERIALS. ALL CONTRACTORS MUST EDUCATE THEIR STAFF AND SUBS, AS WELL AS, PERSONNEL THAT RESIDE ADJACENT TO THE CONSTRUCTION AREA

UTILITY SERVICE

INTERRUPTIONS

IDENTIFY ALL UTILITY SERVICES THAT MAY BE INTERRUPTED, THE DURATION OF EACH INTERRUPTION, WHAT AREA THE SHUTDOWN WILL AF AND INCLUDE A PLAN FOR EACH INTERRUPTION:

AIR CONDITIONING DATA LINES ELECTRICAL GAS FIRE SYSTEM

HEAT SECURITY TELEPHONE

VENTILATION H20 STEAM SEWER

DESCRIBE THE INTERIM MEASURES NECESSARY FOR THE OUTAGE INCLUDING A BACKUP PLAN –IF THE INTERRUPTION AFFECTS PATIENT CARE AND OTHER AREAS OF THE HOSPITAL, A UTILITY SHUTDOWN REQUEST FORM SHOULD ACCOMPANY THIS

CONSTRUCTION PLAN FOR SHUTDOWNS THAT REQUIRE COORDINATION WITH PLANT OPERATIONS AND MECHANICAL NEEDS MEET

WITH PLANT OPERATIONS PRIOR TO THE ILSEC MEETING TO HAVE A TENTATIVE PLAN TO PRESENT TO THE COMMITTEE:

DESCRIBE THE PREVENTATIVE MEASURES THAT WILL BE TAKEN TO MITIGATE UNPLANNED INTERRUPTIONS

THE SECTION IN BLUE WILL BE FILLED OUT BY ILSC

DURING THE MEETING

DOES THE CONSTRUCTION PLAN REQUIRE A SUPPLEMENTARY FIRE PREVENTION DEVICE BE IN PLACE FOR THIS PROJECT?

YES NO

PLANT OPERATIONS TO NOTIFY MONTANA STATE OF SYSTEM WHEN ONE OF THE TWO ABOVE MENTIONED OCCUR (CC: ILSEC CHAIR)

YES NO

DOES THIS PROJECT REQUIRE A FIRE WATCH? YES NO

DOES THE PROJECT WARRANT ADDITIONAL TRAINING TO PERSONNEL DUE TO IMPAIRED LIFE SAFETY SYSTEMS? IF YES, NOTE THE DEPARTMENT HEADS TO NOTIFY AND TYPE OF EDUCATION THAT WILL BE PROVIDED AND BY WHOM. IF THE PROJECT PRESENTS DEFICIENCIES OR CONSTRUCTION HAZARDS WHICH WARRANT FACILITY-WIDE PERSONNEL, TRAINING MUST BE PROVIDED FACILITY-WIDE, AND NOTED HOW THAT TRAINING WILL OCCUR

YES NO

Construction Plan


Contractor Contact:

4 | P a g e

TABLE A: TYPES OF CONSTRUCTION ACTIVITY IDENTIFY TYPE:

TABLE B: POPULATION AND GEOGRAPHIC RISKS GROUPS* IDENTIFY RISK: LOW RISK MEDIUM RISK HIGH RISK HIGHEST RISK OFFICE AREAS NON-PATIENT AREAS BUSINESS OFFICE AREAS MECHANICAL SPACE CONFERENCE ROOMS

LOBBY MATERIALS MANAGEMENT PUBLIC CORRIDORS CLINICAL LABS CAFETERIA DIETARY ADMISSIONS/DISCHARGE CLEAN LINEN STORAGE NUCLEAR MEDICINE EDUCATION RESPIRATORY THERAPY

EMERGENCY ROOM RADIOLOGY/CT/MRI LABOR AND DELIVERY INTENSIVE CARE UNITS MICROBIOLOGY/VIROLOGY LABS INTENSIVE CARE UNITS NEWBORN NURSERY LONG TERM/SUB ACUTE UNITS DIALYSIS OUTPATIENT SURGERY PEDIATRICS PHARMACY POST ANESTHESIA CARE UNITS SURGICAL UNITS

ALL CRITICAL CARE AREAS COMPREHENSIVE CANCER CENTER PERI-OPERATIVE AREAS (INCLUDING PACU, L&D OR) STERILE PROCESSING CARDIO-PULMONARY ACUTE CARE UNITS CARDIAC CATHETERIZATION & ANGIOGRAPHY AREAS DIALYSIS AREAS ONCOLOGY ENDOSCOPIES AREAS RADIATION ONCOLOGY SUITE PHARMACY ADMIXTURE AREAS AMBULATORY SURGERY CENTER PEDIATRIC/OB CENTER OPERATING ROOMS INCLUDING C-SECTION

TABLE C: CONSTRUCTION ACTIVITY AND RISK GROUP MATRIX IDENTIFY CLASS OF PRECAUTIONS: CONSTRUCTION ACTIVITY

TYPE A TYPE B TYPE C TYPE D RISK LEVEL ↓ Low Risk Class I Class II Class II Class III/IV Medium Risk Class I Class II Class III Class IV High Risk Class II Class III Class III/IV Class IV Highest Risk Class III Class III/IV Class IV Class IV

INFECTION CONTROL RISK ASSESSMENT

TYPE A

INSPECTION AND NONINVASIVE ACTIVITIES THESE INCLUDE, BUT ARE NOT LIMITED TO: REMOVAL OF CEILING TILES FOR VISUAL INSPECTIONS (UP TO 4 SQ. FT) MOVEMENT OF EQUIPMENT, BUILDING STRUCTURES, ETC. FOR VISUAL INSPECTION PAINTING (BUT NOT SANDING) PUTTING UP 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

TYPE B

SMALL SCALE, SHORT DURATION ACTIVITIES THAT CREATE MINIMAL DUST THESE INCLUDE , BUT ARE NOT LIMITED TO: INSTALLATION OF TELECOMMUNICATIONS CABLING OPENING OF NO MORE THAN ONE CEILING TILE PER 10 TILES ACCESS TO CHASE SPACES CUTTING OF WALLS OR CEILING WHERE DUST MIGRATION CAN BE CONTROLLED.

TYPE C

WORK THAT GENERATES A MODERATE TO HIGH LEVEL OF DUST OR REQUIRES DEMOLITION OR REMOVAL OF ANY FIXED BUILDING COMPONENTS OR ASSEMBLIES (E.G., COUNTERTOPS, CUPBOARDS, SINKS) THESE INCLUDE, BUT ARE NOT LIMITED TO: SANDING OF WALLS FOR PAINTING OR WALL COVERING CUTTING OF WALLS, REMOVAL OF DRYWALL, REMOVAL OF FLOOR AND WALL COVERINGS, BASEBOARDS, CEILING TILES AND CASEWORK. NEW WALL CONSTRUCTION OR MODERATE RENOVATION OF EXISTING SPACE MINOR DUCT WORK OR ELECTRICAL WORK ABOVE CEILINGS MAJOR CABLING ACTIVITIES ANY ACTIVITY WHICH CANNOT BE COMPLETED WITHIN A SINGLE WORK SHIFT ANY ACTIVITY WHICH REQUIRES CONSTRUCTION OF A BARRIER THAT DOES NOT QUALIFY TO A TYPE D

TYPE D

MAJOR DEMOLITION, CONSTRUCTION AND RENOVATION PROJECTS THESE INCLUDE, BUT ARE NOT LIMITED TO: ACTIVITIES THAT REQUIRE CONSECUTIVE WORK SHIFTS HEAVY DEMOLITION OR REMOVAL OF A COMPLETE CABLING SYSTEM ACTIVITIES WHICH REQUIRE CLOSURE OF A WING/UNIT OR RELOCATION OF AN ENTIRE PATIENT CARE AREA DEMOLITION OF MAJOR FIXED BUILDING COMPONENTS, ASSEMBLIES OR STRUCTURAL ELEMENTS NEW CONSTRUCTION LOCATED IN CLOSE PROXIMITY (AS DETERMINED BY ILSEC) TO EXISTING PATIENT CARE FACILITY EXCAVATION ACTIVITIES WITHIN CLOSE PROXIMITY OF THE HOSPITAL PATIENT UNITS OF THE BUILDING

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REQUIRED INFECTION CONTROL PRECAUTIONS BY CLASS: CLASS

I

IMMEDIATELY REPLACE ANY CEILING TILE DISPLACED FOR VISUAL INSPECTION. ALL POLICIES & PROCEDURES FOR RENOVATION/CONSTRUCTION/MAINTENANCE WILL BE FOLLOWED.

IMMEDIATELY REPLACE ANY CEILING TILE DISPLACED FOR VISUAL INSPECTION – IF APPLICABLE EXECUTE WORK BY METHODS TO MINIMIZE RAISING DUST FROM CONSTRUCTION ACTIVITIES WHEN COMPLETE IMMEDIATELY CLEAN UP ANY DIRT OR DEBRIS

CLASS II

PROVIDE ACTIVE MEANS TO PREVENT AIR-BORNE DUST FROM DISPERSING INTO ATMOSPHERE BY USE OF THE CONTROL CUBE. VACUUM ATTACHMENTS ON TOOLS WITH HEPA VACUUM WHEN GENERATING DUST, OR HEPA VACUUMING IMMEDIATELY AS THE DUST IS GENERATED. REMOVE OR ISOLATE HVAC SYSTEM IN AREAS WHERE WORK IS BEING PERFORMED WATER MIST WORK SURFACES TO CONTROL DUST. SEAL UNUSED DOORS WITH TAPE. AIR VENTS MAY REQUIRE SEALING, PLEASE CONSULT PLANT OPERATIONS. PLACE TACK MATS AT ENTRANCE AND EXIT OF WORK AREA.

WIPE WORK SURFACES WITH CLEANER/DISINFECTANT. CONTAIN CONSTRUCTION WASTE BEFORE TRANSPORT IN TIGHTLY COVERED CONTAINERS. WET MOP AND/OR VACUUM WITH HEPA-VAC (NOT JUST HEPA-FILTERED VACUUM) BEFORE LEAVING WORK EACH DAY. MAINTAIN TACK MATS AT ENTRANCE AND EXIT ON COMPLETION OF WORK, RESTORE HVAC SYSTEM IN.

CLASS III

REMOVE OR ISOLATE HVAC SYSTEM IN AREA WHERE WORK IS BEING DONE TO PREVENT CONTAMINATION OF DUCT SYSTEM. MAINTAIN UNTIL BARRIER IS REMOVED AT COMPLETION OF PROJECT. DESIGNATE ENTRY AND EXIT TRAFFIC PATTERN, UNAUTHORIZED PERSONNEL ARE NOT PERMITTED TO ENTER WORK ZONE, DIRECTION AND CONSTRUCTION SIGNAGE IN PLACE EXPLAIN WHAT MATERIAL THE BARRIER WILL BE CONSTRUCTED OF AND WHERE IT WILL BE ERECTED. CONSTRUCT BARRIERS (SHEETROCK, PLYWOOD, FIRE RATED PLASTIC) TO SEAL CONSTRUCTION SITE AREA FROM NON-WORK AREA OR IMPLEMENT CONTAINMENT CUBE METHOD. (CART WITH PLASTIC COVERING AND SEALED CONNECTION TO WORK SITE AND HEPA VACUUM BEFORE CONSTRUCTION BEGINS). EXPLAIN WHAT MATERIAL THE BARRIER WILL BE CONSTRUCTED OF AND WHERE IT WILL BE ERECTED. MAINTAIN NEGATIVE AIR-PRESSURE WITHIN WORK SITE UTILIZING HEPA-EQUIPPED AIR FILTRATION UNITS. BOTH TO BE MAINTAINED UNTIL PROJECT AND TERMINAL CLEANING ARE COMPLETED AND ILSEC REPRESENTATIVE INSPECTS AND AUTHORIZES. PLACE TACK MATS AT ENTRANCE AND EXIT OF WORK AREA. COVER RECEPTACLES OR CARTS. TAPE COVERING UNLESS THE LID IS SOLID.

CONTAIN CONSTRUCTION WASTE BEFORE TRANSPORT IN TIGHTLY COVERED CONTAINERS DO NOT REMOVE BARRIERS FROM WORK AREA UNTIL COMPLETED PROJECT HAS BEEN THOROUGHLY CLEANED BY ENVIRONMENTAL SERVICES DEPARTMENT AND HAS BEEN INSPECTED. WET MOP AREA WITH CLEANER/DISINFECTANT. VACUUM WITH HEPA FILTERED VACUUM BEFORE LEAVING WORK EACH DAY AND FINAL COMPLETION. REMOVE BARRIER AND CONTAINMENT MATERIALS CAREFULLY (COLLAPSING INWARD) TO MINIMIZE SPREADING OF DIRT AND DEBRIS ON COMPLETION OF WORK, RESTORE HVAC SYSTEM BY COMMUNICATING WITH PLANT OPERATIONS PERSONNEL TERMINAL CLEANING BY ENVIRONMENTAL SERVICES

CLASS III IV

SEAL HOLES, PIPES AND CONDUIT PENETRATIONS IN WORK ZONE. ISOLATE HVAC SYSTEM IN AREA WHERE WORK IS BEING DONE TO PREVENT CONTAMINATION OF DUCT SYSTEM. SEAL UNUSED DOORS AND SEAL OFF VENTS CONSTRUCT ANTEROOM AND REQUIRE ALL PERSONNEL TO PASS THROUGH THIS ROOM SO CLOTHING CAN BE VACUUMED USING A HEPA VACUUM CLEANER BEFORE LEAVING WORK SITE OR PROVIDE CLOTH COVERALLS THAT ARE REMOVED EACH TIME THEY LEAVE THE WORKSITE. ALL PERSONNEL ENTERING THE WORKSITE ARE REQUIRED TO WEAR SHOE COVERS. SHOE COVERS MUST BE CHANGED EACH TIME THE WORKER EXITS THE WORK AREA, REMOVED IN THE ANTE ROOM WHEN EXITING MAINTAIN NEGATIVE PRESSURE WITHIN WORKSITE AND UTILIZE HEPA EQUIPPED NEGATIVE AIR PRESSURE MACHINES. BOTH TO BE MAINTAINED UNTIL PROJECT TERMINAL CLEANING IS COMPLETED AND ILSEC REPRESENTATIVE AUTHORIZES REMOVAL.

DO NOT REMOVE BARRIERS FROM WORK AREA UNTIL COMPLETED PROJECT HAS BEEN THOROUGHLY CLEANED BY ENVIRONMENTAL SERVICES DEPARTMENT AND HAS BEEN INSPECTED. CONTAIN CONSTRUCTION WASTE BEFORE TRANSPORT IN TIGHTLY COVERED CONTAINERS COVER RECEPTACLES OR CARTS. TAPE COVERING UNLESS THE LID IS SOLID. (THROUGH-OUT THE PROJECT) VACUUM WORK AREA WITH HEPA-FILTERED VACUUMS. REMOVE BARRIER AND CONTAINMENT MATERIALS CAREFULLY (COLLAPSING INWARD) TO MINIMIZE SPREADING OF DIRT AND DEBRIS. WET MOP AREA WITH CLEANER OR DISINFECTANT. TERMINAL CLEANING BY ENVIRONMENTAL SERVICES

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INFECTION PREVENTION PROVISIONS IDENTIFY SPECIFIC SITE OF ACTIVITY (PATIENT ROOM, CORRIDOR; MEDICATION ROOM; STORAGE ROOM, ETC.): IDENTIFY THE AREAS SURROUNDING THE PROJECT AREA, ASSESSING THE POTENTIAL IMPACT AND RISK LEVEL FOR THOSE LOCATIONS. IF MORE THAN ONE RISK LEVEL IS IDENTIFIED, SELECT THE HIGHER RISK LEVEL:

Unit Below Unit Above Lateral Lateral Behind Front Risk Group Risk Group Risk Group Risk Group Risk Group Risk Group

:

IDENTIFY ISSUES RELATED TO HVAC, VENTILATION, PLUMBING, ELECTRICAL IN TERMS OF THE OCCURRENCE OF PROBABLE OR UNPLANNED OUTAGES THAT WILL IMPACT PATIENT CARE: HVAC: DESCRIBE THE ABILITY TO LOCALIZE OR ISOLATE WORK SITE: HOW WILL NEGATIVE PRESSURE BE MAINTAINED: INDICATE POTENTIAL RISK OF WATER INTRUSION OCCURRING OUTSIDE THE WORK ZONE: WHAT SHIFTS WILL THE MAJORITY OF THE WORK BE PERFORMED: ILSEC: CAN THIS WORK BE PERFORMED DURING OCCUPIED TIMES: YES_____ NO____

ACCORDING TO THE ICRA MATRIX WHAT CONTAINMENT BARRIER TYPE WILL BE USED:

IS AN ANTE-ROOM REQUIRED UNDER THE ICRA MATRIX FOR THIS PROJECT?:

DESCRIBE THE CONSTRUCTION PLAN TO MINIMIZE NOISE AND VIBRATION: EXAMPLES: CONTAINMENT WALLS THAT REFLECT AND ABSORB NOISE, OR PERFORM MOST VIBRATION-INTENSIVE WORK OFF-SHIFT HOURS DESCRIBE THE CONSTRUCTION PLAN FOR TRANSPORTING CONSTRUCTION MATERIALS IN TO AND AROUND THE FACILITY AND WHAT ROUTE AND EXIT CONSTRUCTION WORKERS WILL UTILIZE DURING THE PROJECT, AS WELL AS REMOVAL OF MATERIAL & DEBRIS. DESCRIBE THE CONSTRUCTION PLAN TO ADDRESS TRAFFIC HAZARDS (SIGNAGE, CONES, ETC.) ILSEC – THINGS TO CONSIDER….

1. DESCRIBE THE CONSTRUCTION PLAN THAT IDENTIFIES ANYTHING UNIQUE TO THIS PROJECT THAT REQUIRES SPECIAL PROCEDURES OR PROTOCOLS, STAFF MEMBERS THAT SHOULD BE NOTIFIED, ETC.:EXAMPLES OF SPECIAL PRECAUTIONS: COORDINATING SPECIFIC TIME OF DAY WORK TO BE PERFORMED, SPECIFIC DAYS OF THE WEEK WORK TO BE PERFORMED, COORDINATING WITH HOSPITAL/DEPARTMENTAL SHIFT WORK OR OFFICE SHUFFLES MOVE OR RELOCATION OF PATIENTS, ENVIRONMENTAL COMPLIANCE ROUNDS.

2. DO EXTERIOR WINDOWS NEED TO BE SEALED TO MINIMIZE FILTRATION FROM EXCAVATION DEBRIS 3. DO EXTERIOR WINDOWS NEED TO HAVE BOARD INSULATION INSTALLED TO MINIMIZE NOISE AND VIBRATION? 4. DOES THIS PROJECT REQUIRE A CONSTRUCTION-ONLY ELEVATOR; ENTRANCE/EXIT; AND OR WALKWAY FOR THE CONSTRUCTION CREWS? 5. TERMINAL CLEANING RECOMMENDED FOR THIS PROJECT: 6. DOES THIS PROJECT REQUIRE DEBRIS TO BE REMOVED FROM WINDOW INSTEAD OF TRAVELING THROUGH PATIENT CARE AREAS? 7. ALL SHARPS CONTAINERS SHOULD BE COMPLETELY REMOVED BY ENVIRONMENTAL SERVICES PRIOR TO ANY CONSTRUCTION. DOES ENVIRONMENTAL SERVICES NEED TO

SCHEDULE THESE REMOVALS?


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APPENDIX “B”

Utility Shutdown Request Form Interruption/impairment Requirements: a. A minimum notice of 72 hours (3 business days) is needed for all

requests. b. A fire watch by the contractor is required for fire alarm or sprinkler

system interruptions of ≥ 4 hours (in 24 hours). c. Notify the facilities management team for building systems shutdowns.

i. KRH Plant Engineering: 24/7 -- 758-1814. Interruption/Impairment Information:

START DATE: TIME: AM/PM END DATE: TIME: AM/PM Utility System to be impaired

Water Electric HVAC

Med Gas

Other (specify)

Other (specify)

Will the proposed shutdown affect other systems (Fire System, HVAC, etc.): Click here to enter text. Contractor Performing Work:

Company: Contact & Number:

Areas affected (list buildings, floors, areas, programs): Click here to enter text. Reason for interruption or impairment – an accurate description of proposed scope of work will allow our Plant Operations team to evaluate the situation for approval and ability to identify additional utility precautions and departments that may be indirectly affected: Click here to enter text. Identified Precautionary/Interim Measures and backup procedures (KRH Project Manager & or KRH Representative should assist contractor with establishing these measures) – The ILSC team may identify other steps, as well Examples of Interim Measure: Perform work during “less critical” time periods, verify that critical patient areas have adequate oxygen tanks, verify that back-up, battery-operated equipment is functional, adequate “reminders” to staff of emergency procedures for “no power” situations, review procedures for actual normal power failure with Plant Operations Personnel, provide back-up for system “going down”, implement a fire watch if necessary (usually with Fire Systems), obtain fire extinguishers for area, provide portable wash stations, scheduled meetings with identified department managers.

Click here to enter text. Additional Information /Comments: Click here to enter text.

Review and Approvals Distribution List (select below)

Initial (approval)

Date

Troy Pilgeram Mark Chitwood Shannon Day Sam Nunnally Zack Bradley Kyle Hovey Bill Boyd Jan Blohm Josh Griffiths Laura Bermel Marcello Pierrottet

Melody Finch Mike Schlegel Shari Courser

Mark Young Randy Christensen

Chad Wermer

Request Submitted By:

Contractor (company):

Date Request Submitted:

Name of Facility (select): KRMC HC Other: Click here to enter text.

http://www.lancastergeneralhealth.org/LGH/home.aspx

To be filled out by ILSC Members Departmental responsibility during shutdown; if any (backup procedures, provide extra staff; schedule change for staff; patients move, or paitent schedule changes; other): Click here to enter text. Notifications necessary before, during and after: Click here to enter text. KRH Project Lead Identified: Click here to enter text.

2017


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CONSTRUCTION SAFETY MANAGEMENT MANUAL Kalispell Regional Healthcare

310 Sunnyview Lane Kalispell, Montana 59901

Phone 406-756-3695 • Fax 406-751-2957