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RIVERSIDE HEALTH SYSTEM

CONTRACTOR GUIDELINES

1 Revised: 6/10/15

Project Title:

Revision Date:

Revision Date:

RIVERSIDE HEALTH SYSTEM CONTRACTOR GUIDELINES

TABLE OF CONTENTS

SECTION SECTION TITLE

I. GENERAL FACILITY POLICIES

Article 01 OwnerArticle 02 Owner’s RepresentativeArticle 03 Shipping Instructions/Material ReceivingArticle 04 Interface with Facility OperationArticle 05 TrainingArticle 06 Contractor Responsibility of SubcontractorArticle 07 General Rules and RegulationsArticle 08 Rule Violation DisciplineArticle 09 Contractor’s EquipmentArticle 10 ParkingArticle 11 RHS Owned Tools/EquipmentArticle 12 Contractor BadgesArticle 13 HousekeepingArticle 14 Interim Life Safety Measures (ILSM)

II. SAFETY

Article 15 General SafetyArticle 16 Medical EmergenciesArticle 17 Respiratory ProtectionArticle 18 Hearing Protection/Eye ProtectionArticle 19 Facility HazardsArticle 20 Machinery SafeguardsArticle 21 Permitted Confined Space EntryArticle 22 Excavations/Overhead WorkArticle 23 Lock-Out/Tag-OutArticle 24 Hot Work Permits - Fire ProtectionArticle 25 Fire OccurrenceArticle 26 Aisles and ExitsArticle 27 Facility Evacuation ProcedureArticle 28 Ceiling Permit Policy

III. FACILITY SECURITY

Article 29 Traffic RulesArticle 30 VehiclesArticle 31 Theft Protection/Security

IV. FACILITIES / UTILITIES

Article 32 Break FacilitiesArticle 33 Change RoomsArticle 34 WaterArticle 35 Temporary Heat

V. CHEMICAL MANAGEMENT

Article 36 Bringing Chemical Materials On-SiteArticle 37 Chemical Material Safety Data Sheets (MSDS)Article 38 Chemical StorageArticle 39 Chemical Labeling

VI. ENVIRONMENTAL POLICIES

Article 40 Secondary ContainmentArticle 41 Air Quality StandardsArticle 42 Storm WaterArticle 43 Solid WasteArticle 44 Hazardous WasteArticle 45 Release Reporting Article 46 Spill Clean-upArticle 47 Fuel TanksArticle 48 Preconstruction Risk AssessmentArticle 49 Radioactive Material

VII ATTACHMENTS

A. Emergency Phone Numbers and Facility Contacts

B. Contractor Safety/Environmental PolicyC. Procedure for Shutdown of Utilities Affecting

Patient Care AreasD. Utilities Shutdown RequestE. Hot Work PermitF. Confined Space Entry PermitG. Interim Life Safety Measures (ILSM)

Assessment & Action Item SpreadsheetH. Preconstruction Risk AssessmentI. RHS CODESJ. Fire SafetyK. Fire Extinguisher UseL. Contractor Badge LogM. Contractor Daily Construction SurveyN. Ceiling Work Permit

2 Revised: 6/10/15


FOREWORD Riverside Health System (RHS) "Contractor Guidelines" is intended to present the facility’s policies and procedures pertaining to workers contracted by RHS, hereafter referred to as “Owner”. These Guidelines reference pertinent governmental regulations and standards that shall be considered the minimum requirements for job-site performance and may be superseded by RHS policies. Contractors must be knowledgeable of these governmental requirements since these Guidelines do not list the contents of all local, state and federal regulations.

General Contractors and any Subcontractors working for Riverside Health System must be on the “RHS Approved Contractor/Subcontractor List”. To be considered, a company must provide the following information to the RHS Construction Management office:

1. Description of when and how the Companies were formed, the legal structure of the Companies (e.g., stock corporation) and identify and describe any affiliated, parent, subsidiary, or brother/sister entities. Provide ownership information, including owner names and ownership percentage;

2. Income Statements and Balance Sheets for the previous three (3) fiscal years;3. Organizational documents; to include Articles of Organization or Operating Agreement, etc.;4. An organizational chart with the organization’s leadership positions; include a corporate

organizational chart if operated through multiple companies or divisions;5. Provide references, with complete contact information, where the Companies currently

provide services, particularly clients of a comparable size and complexity as Riverside Health System;

6. Operational fact sheet, including but not limited to company history and development, number of employees, scope of operations, etc.;

7. Resumes and/or biological information for all key management personnel that will be providing services to Riverside;

8. Description and evidence of insurance coverage, to include (as applicable) malpractice and general liability (include the identity of your insurance company and the amount of coverage and provide a summary of your claims history);

9. Evidence of authority to do business in the Commonwealth of Virginia; and10.Describe if the Companies or any individual employee, officer, director of the organization

has ever been excluded, sanctioned, or disciplined by any governmental entity. Describe any past or pending civil or criminal litigation (including settlements) involving the organization, employees, key management personnel, owners and directors/managers. Describe any material past or pending governmental or third party investigations, audits or settlements.

Riverside, in its sole discretion, reserves the right to require additional information not set forth herein.

I. GENERAL FACILITY POLICIESArticle 01. OwnerRiverside Health SystemFountain Plaza701 Town Center Drive, Suite 1000Newport News, VA 23601

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Article 02. Owner’s RepresentativeThe Owner’s Representative is the RHS employee as specified in Attachment A.

Article 03. Shipping Instructions/Material ReceivingAll material shall be consigned to the Contractor, attention of his representative. Contractors are responsible for material unloading, handling, and storage. Material shall not be delivered when Contractor is not on site unless prior arrangements have been made with the Owner’s Representative. Such material will not be received by the Owner and the shipment will be returned to supplier at the Contractor's expense.

Article 04. Interface with Facility Operation

4.1 The Contractor shall confine his activities to the areas set aside for him to do his work and shall not interfere with any facility activities. Unless specifically authorized by the Owner’s Representative, the Contractor's employees are prohibited from entering any facility area except those areas to which they are assigned.

4.2 Should any disruption of existing installations be necessary, the Contractor shall inform the Owner’s Representative well in advance of the time contemplated for the disruption. The Contractor shall complete and submit a RHS Utilities Shutdown Request form for all utility disruptions.

4.3 Due to the necessity of insuring against interruption of the continuous function of operating facility activities, the Contractor shall be required to have a competent supervisor in responsible charge at the site at all hours in which his employees or those of his Subcontractors are employed on the site.

Article 05. TrainingIt is the Contractor's responsibility to conduct and document all training required by governmental agencies and the Owner. It is required that all Contractor and Subcontractor employees be advised of the contents of this document.

Article 06. Contractor Responsibility of SubcontractorThe Contractor is responsible for the requirements of the Subcontractor. In addition, the Contractor is responsible for the Subcontractor while he is working on the Owner’s premises. Subcontractors must comply with all Federal, State, and Local regulations including the Owner’s Safety Programs, Policies, and Standards.

Article 07. General Rules and Regulations for ContractorsThe Contractor, including all Contractor Employees and Subcontractors, shall:

7.1 Comply with the latest revision of the OSHA/VOSH/EPA and all other pertinent Local, State, and Federal requirements for safety and environmental regulations.

7.2 Obtain a fully authorized Hot Work Permit from the Owner’s Representative before performing any welding, burning, or open flame work activities. Contractor must supply sufficient portable fire extinguishing apparatus.

7.3 Follow Lock-Out/Tag-Out Procedures as designated by the Owner’s Representative in accordance with Article 23. Lock-Out/Tag-Out.

7.4 Comply with all provisions of the facility's Confined Space Entry Procedures.

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7.5 Work involving asbestos material will be conducted by a State licensed professional and shall be coordinated through the Owner’s Representative. Contractor shall communicate information concerning hazards and appropriate protective measures to employees.

7.6 The Contractor shall maintain a Material Safety Data Sheet file on the job site of all materials located on premises. Material Safety Data Sheets of hazardous materials currently used by the Owner’s personnel are available through the Owner’s Representative.

7.7 Work in a safe, professional manner and not create a hazard to themselves or others. Personal protective safety devices such as face shields, welding masks, earplugs, etc., shall be used and provided by the Contractor.

7.8 Be responsible for securing all necessary permits and ensuring permit provisions are adhered to unless otherwise specified.

7.9 Maintain all vehicles in proper safe working condition. The contractor will be responsible for proper cleanup of vehicles leaking fluids (i.e., broken hydraulic lines).

7.10 Not remove any items belonging to the Owner from the property unless authorized by the Owner’s Representative.

7.11 No tobacco use of any kind will be permitted inside or anywhere on RHS Campus, including hospital ground and parking areas.

7.12 Not possess, use, or be under the influence of drugs or alcohol on the Owner’s property.7.13 Not wander from their assigned work areas. Disruptions to, or unsolicited involvement in,

the activities of other contractors will not be tolerated.7.14 Clean their work areas and secure their possessions at the conclusion of each work day

before leaving the facility. The Owner is not responsible for Contractor property left on premise. The Contractor is responsible for providing his own storage facility at the location designated by the Owner’s Representative.

7.15 Avoid damage or disruption of operations to existing facilities. If damage occurs, notify the Owner’s Representative immediately and clearly identify as to the necessary repairs required to restore the facility to its previous condition and use.

7.16 Remove from the job site all debris associated with their activities and provide for final disposal in accordance with Federal, State, and Local environmental regulations. Limited refuse disposal may be provided as designated by the Owner’s Representative.

7.17 Not possess firearms or explosives on the Owner’s property.7.18 Coordinate jack hammering, core drilling, and other noisy demolition and construction

activities, which occur adjacent to the Owner-occupied areas, with the Owner prior to occurrence. Accomplish jack hammering, core drilling, and other noisy work in areas during off hours.

OFF HOURS ARE DEFINED AS FOLLOWS: WEEKDAYS..................................beginning at....9:00 AM.......and ending at.9:00 PM WEEKENDS..................................beginning at. .10:00 AM.......and ending at.9:00 PM ALL STATE AND FEDERAL HOLIDAYSbeginning at10:00 AM. and ending at.9:00 PM

Failure to comply with the above General Rules and Conditions may result in dismissal of the individual(s) and up to and including the contractor involved.

Article 08. Rule Violation DisciplineThe Contractor shall remove, upon request of the Owner’s Representative, any person violating facility or safety rules.

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Article 09. Contractor’s EquipmentAll scaffolding, ladders, staging, equipment, etc., shall bear the Contractor's identification mark before they are brought onto the Owner’s property and shall be maintained in good working order. Contractor owned equipment in poor repair must be immediately removed from the jobsite by the Contractor.

Article 10. ParkingContractor's employees shall park their personal vehicles only in those areas designated by the Owner’s. Under no circumstances shall a Contractor park and leave a vehicle unattended. The Owner assumes no responsibility for vehicles, or articles stored in vehicles, while parked on the Owner’s property.

Article 11. RHS Owned Tools/EquipmentThe Owner’s facility equipment or tools will not be loaned to the Contractor's employees unless authorized by the Owner’s Representative.

Article 12. Contractor BadgesAll contractors involved in construction/remodeling projects and all vendors involved in repair/maintenance activities will be required to wear Identification Badges while on the premises. The badge must be displayed on their outer clothing (pocket or collar) at all times while on the premises. The Owner’s Representative will monitor the wearing of badges. If there are any variances, the Owner’s Representative will ensure that the contractor has a legitimate reason to be on the property. If necessary, work will be stopped until the matter is resolved.

Article 13. HousekeepingThe Owner’s standards for grounds appearance are of the utmost importance. The Contractor shall maintain excellent housekeeping standards at all times. Daily cleanup, to the satisfaction of the Owner’s Representative, of work, fabrication areas and personnel areas is required.

Article 14. Interim Life Safety Measures (ILSM)Prior to the initiation of any construction or renovation project, the Owners Representative shall evaluate the project impact on egress and life safety. The Owners Representative shall define the ILSM action items to be implemented as indicated per the ILSM Assessment and Action Item Spreadsheet.

II. SAFETYArticle 15. General Safety15.1 All Contractor personnel and truck drivers must wear OSHA/ANSI approved hard hats in

areas designated as hard hat areas. Appropriate attire, including shirts, long pants, and protective footwear are required.

15.2 The following policy will be followed when using gasoline, kerosene, or diesel powered equipment on the Owner’s property:The use of gasoline, kerosene, or diesel powered equipment in the confines of any building on the Owner’s property is strictly prohibited unless written permission is obtained from the Owner’s Representative. Refueling of equipment is subject to the following precautions:A) The engine shall not be refueled while it is running. Preferably, the refueling is to be

done at the start of the shift, when the engine is cool.

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B) Gasoline, kerosene, and diesel fuel must be transported in approved safety cans. Gasoline, or other fuel cans must be stored in approved flammable storage compartments.

15.3 All Contractors shall provide the Owner’s Representative, upon request, a copy of the OSHA log for Occupational Injury and Illness, or an equivalent document if the Contractor is exempt from keeping the OSHA form. Any OSHA Recordable injury or death sustained by the Contractor’s personnel while on the worksite shall be documented and reported to the Owner’s Representative on the Contractor’s standard form.

15.4 Contractor operations may be audited for safety rule compliance as determined by the Owner’s Representative.

15.5 The purpose of the safety audit is to ensure the safety of all personnel in or near Contractor operations and prevent damage to the Owner’s property. The audit may include or consider, but not be limited to, the following:A) Compliance of work site.B) Any hazardous exposure to facility employees.C) Contractor’s safety policies and procedures.D) Injury Log E) Training records. F) MSDS availability.

The Owner’s Representative shall be informed of any deviation from any safety requirements.

Article 16. Medical EmergenciesThe treatment and care of injuries sustained by Contractor's employees shall be, and remain, the responsibility of the Contractor. A formal written accident investigation report involving any OSHA Recordable injury or death shall be furnished by the Contractor to the Owner’s Representative. This report shall include incident description, causes, and steps taken to prevent recurrence. When emergency medical assistance is required, all reports of injury and accident investigations shall be copied and forwarded to the Owner’s Representative.

Article 17. Respiratory ProtectionContractors must adhere to the Federal and State respiratory protection regulations. These regulations require that employees working with hazardous chemicals be trained in the use and limitations of respirators. Documented proof of suitability to wear a respirator is required to be maintained by the Contractor.

Article 18. Hearing Protection/Eye ProtectionContractors shall be required to wear hearing and/or eye protection in accordance with Federal and State regulations. Contractors are responsible for obtaining their own hearing and eye protection. Safety glasses must be ANSI certified. Neither removable side shields on prescription "street" glasses nor "visitors' goggles" constitute acceptable eye protection.

Article 19. Facility HazardsIt shall be the Contractor's responsibility to become acquainted with the potential hazards, if any, to be encountered in the work area. This includes any health hazard associated with chemicals which may be encountered. Information pertaining to such hazards shall be obtained through the Owner’s Representative. All Contractors’ employees must be trained how to report chemical spills to the Owner’s Representative.

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19.1 Several utility services at the Owner’s facilities are located underground in pipelines and conduit. Most of these services are dangerous if exposed and could cause disruptions to other operations if damaged. Do not dig in any area of the facility without first notifying the Owner’s Representative.

19.2 Some buildings built prior to 1980 have materials that contain asbestos. Should the contractor or subcontractors recognize the condition, immediately stop work in the affected area and report the condition to the Owner in writing.

Article 20. Machinery SafeguardsGuards shall not be removed from machinery while it is operating. Guards must be installed before starting machinery. Workers shall never reach through or around guards on moving machinery. Critical safety devices/interlocks shall not be bypassed, without following the Lock-Out/Tag-Out Procedures described in these guidelines (Article 23).

Article 21. Permitted Confined Space EntryA Confined Space Entry Permit (Attachment F) shall be obtained from the Owner’s Representative whenever a Permitted Confined Space is to be entered. All preparation and conditions of entry shall be in accordance with OSHA/VOSH regulations and must be met before entry. Contractor employees entering a permitted confined space must be trained in confined space entry procedures and documentation of training is required to be maintained by the Contractor. It is the Contractor's responsibility to supply all atmospheric sampling and monitoring equipment. The confined space permit is valid for one eight (8) hour shift unless the employees are working overtime, in which case the permit is valid for up to twelve (12) hours. All sanitary sewer manholes and oil/water separators are Permitted Confined Spaces. The Confined Space Entry Permit should be returned to the Owner’s Representative at the completion of the job.

Article 22. Excavations/Overhead WorkAreas below overhead work must be barricaded. No personnel shall enter a barricaded area except to do assigned work. The barricades should be promptly removed upon job completion. The Contractor shall provide all barricade equipment.

Article 23. Lock-Out/Tag-OutLock-Out/Tag-Out procedures must be followed when an unexpected start up or release of stored energy from machines and equipment could cause injury to employees during servicing and maintenance. Danger tags and/or locks must be placed on switches, valves, and any other controls when work is being performed on a piece of equipment. Before working on electrical equipment, the switch must be locked in the open position, fuses pulled if applicable, and a danger tag bearing the Contractor's employees name affixed to the lock. It is the Contractor's responsibility to ensure his employee’s safety through verifying that the systems and equipment are safe to work on. The Contractor is responsible for furnishing all locks and tags.

Article 24. Hot Work Permits - Fire ProtectionThe Contractor shall, in all of his operations, conform to all fire regulations at the affected work location. There will be no burning, welding, grinding, or any other flame or spark producing operation without first securing an authorized Hot Work Permit (Attachment E) from the Owner’s Representative and complying with the conditions and instructions specified therein. The permits must be posted. The permit is valid for one eight (8) hour shift unless the employees are working overtime, in which case the permit is valid for up to twelve (12) hours. Temporary “FREE BURN ZONES” may be established only with written permission from the Owner’s Representative. Violations of Hot Work practices will result in a rescinding of the “FREE BURN ZONE” classification.

Article 25. Fire OccurrenceThe Contractor shall familiarize all employees with the following rules to be followed in case of fire:

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25.1 To report a fire, give the location and description of the building or area in which the fire is located.

25.2 Visiting the scene of a fire or accident by personnel other than members of fire or emergency personnel is prohibited.

Article 26. Aisles and ExitsAisles, safety showers, fire equipment, alleys, streets, manway covers, and exits must be kept free of obstructions. Parking of vehicles is restricted to areas designated by the Owner’s Representative.

Article 27. Facility Evacuation ProcedureThere are two basic types of evacuations: area and building. The reasons for an evacuation can vary but the basics of how to conduct the evacuation are consistent. In the event that a building would need to be evacuated, the occupants of the building will use exits to leave the building and meet in any assigned assembly. The most common reason will be a fire alarm or an actual fire, requiring an immediate evacuation.27.1 Contractors and their employees shall be aware of and familiar with the facility evacuation

announcements alarms.27.2 The Contractor Supervisor is to establish the success of a complete evacuation of

employees by a head count at the designated assembly area.27.3 The Contractor Supervisor will report the headcount results (full count or not) to RHS

Security. Contractors should not re-enter buildings to search for missing employees. Searches will be conducted through the Owner’s Safety and Protection Department or local Emergency Rescue organization.

27.4 Contractors and their employees will not re-enter buildings until advised by an Owner’s Representative that an "all-clear" has been sounded.

Article 28. Ceiling Permit PolicyDue to the major fire hazard concern created by missing ceiling tiles, a written permit system is in place at Riverside Health System (Attachment N). This document is intended to advise contractors working above the ceiling of the restrictions that apply at RHS Facilities.

If at any time a project requires that a ceiling within an occupied area must be entered, the following protocol will be followed:28.1 Requests for permits can be made by email or fax. No phone requests will be honored.

Please contact the Facilities office for a copy of the permit.28.2 Only the Plant/Engineering Manager, Project Manager, Director or designee can authorize

ceiling entry.28.3 Permits must be displayed at the location ceiling tiles are being removed. 28.4 Contractor superintendents or leads are responsible for assuring the compliance of all

subcontractors to this policy.28.5 In order to maintain the air quality of any area where ceiling tiles must be removed, the

contractor is advised that NO more than two (2) ceiling tiles may be removed at a time.28.6 In the event that more than two (2) ceiling tiles must be removed, the following are

required:A) Infection Control Risk AssessmentB) Protection by an Approved Interim Life Safety Measure (ILSM) Barrier

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28.7 With the exception of long term projects, ceiling tiles will be replaced as originally found daily.

28.8 In the event the contractor has to leave the work area for any reason, ceiling tiles must be replaced and the area left tidy as not to prohibit pedestrian traffic or the transport of any patient. Ladders must be kept to one side of the hall at all times. If this is not possible, then a spotter should be used to assist. Always move for patients and visitors. Tools and equipment cannot be left in corridors. Ladders, tools and equipment must be stowed safely during breaks, lunch, when workers are pulled off the job, and at the end of the workday. At no time will the means of fire escape be compromised.

28.9 Notify the Facilities Department of damaged ceiling tiles prior to beginning work.28.10All tiles damaged during the project will be replaced by the contractor at the company’s

expense.28.11Policy questions should be addressed with the Facilities Department.28.12Violations of the policy will be addressed with contractors and company presidents, if

necessary. Continuous violations will result in dismissal from the site.

III. FACILITY SECURITYArticle 29. Traffic Rules29.1 Posted speed limits are strictly enforced. If not posted, the speed limit is 15 MPH inside

all RHS Campuses. Vehicles must stop at all stop signs.

29.2 All vehicular traffic must comply with all traffic signs posted on the Owner’s property.

29.3 Pedestrians, emergency vehicles, and patient carrying vehicles are to be given the right-of-way at all times.

29.4 Notify the Owner’s Representative if any barricades, or closing of any areas or paths, are required. Barricades are the Contractor’s responsibility (including materials) and all ditches, holes, etc., shall be protected to preclude access.

Article 30. Vehicles30.1 Seat belts must be worn by the driver and all passengers, where provided, at all times

while on Owner’s property. Riding construction equipment (i.e. backhoes) as a passenger is prohibited.

30.2 Vehicles must be parked in marked spaces only. When loading/unloading, vehicles are not to block any gate, roadway, building entrance, fire lane, loading dock, handicap access, fire hydrant, or other emergency accesses.

30.3 Passengers cannot ride in the back of pickup trucks.

30.4 Call RHS Safety and Protection Management or local authority having jurisdiction, immediately to report all vehicle accidents, injuries, fires, or other emergencies.

Article 31. Theft Protection/Security31.1 The contractor shall take precautions against theft and shall be responsible for all

material, tools, and equipment.

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31.2 Persons judged to be under the influence of intoxicants will not be permitted on the job site. Fighting, possession of drugs, intoxicating beverages, firearms, and gambling on the Owner’s property is prohibited. Violation of this regulation will result in immediate and permanent removal of the individual employee from the Owner’s property by the Contractor, and may disqualify the contractor from the Owner’s approved bidder’s list.

IV. FACILITIES/UTILITIESArticle 32. Break FacilitiesThe Owner’s employee break areas and cafeteria/restaurants are "OFF LIMITS" to Contractor personnel unless otherwise approved in writing by the Owner’s Representative . Break areas for the Contractor’s employees shall be designated by the Contractor, and approved by the Owner’s Representative.

Article 33. Change RoomsClothes changing rooms/areas for employees shall be provided by the Contractor, if necessary. If the Contractor furnishes a trailer for this service, it will be located in an area designated by the Owner’s Representative. The Owner’s shower and change facilities are "OFF LIMITS" to the Contractor’s personnel except in emergencies.

Article 34. WaterWater for construction purposes will be made available through the Owner’s Representative. The Contractor shall supply his own apparatus such as hose, buckets, connections, etc. Contractor shall supply a backflow preventer when tying into water system. The use of water from the facility fire protection system is prohibited. If any component of the fire protection system is damaged, the Contractor must immediately notify RHS Safety and Protection Management and the Owner’s Representative.

Article 35. Temporary HeatThe contractor shall supply his own temporary heat. The type of temporary heat must be approved prior to use by the Owner’s Representative.

V. CHEMICAL MANAGEMENTArticle 36. Bringing Chemical Materials On-SiteThe Contractor shall:36.1 Properly train his employees in the OSHA Hazard Communication Standard.36.2 Inform his personnel of locations of the Owner’s MSDS files. The Owner’s master MSDS file is

located on the Riverside Health System Intranet.36.3 Dispose of all chemicals or hazardous wastes and empty containers in accordance with all

applicable regulations. Containers brought on site by contractors shall be removed by the Contractor.

36.4 Report all chemical spills immediately as per Article 44.36.5 Store all hazardous materials properly in accordance with their hazard classification.36.6 Remove all wastes and unused chemicals from the Owner’s property at the completion of

the job.

Article 37. Chemical Material Safety Data Sheets (MSDS)

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All chemical MSDS’s must be submitted to the Owner’s Representative prior to bringing any chemicals on site. Copies of the MSDS must be maintained at the work location by the Contractor at all times.

Article 38. Chemical StorageContractor will be assigned an area to store his materials. All chemicals must be placed in the assigned area EACH day when work is completed and stored in accordance with applicable regulations and its hazard potential.

Article 39. Chemical LabelingAll containers must be properly labeled with the contents in accordance with OSHA Regulations. No substances will be allowed on site without proper identification.

VI. ENVIRONMENTAL POLICIESArticle 40. Secondary ContainmentAll liquid substances in quantities greater than 55 gallons, must be stored with secondary containment which would hold the contents of the largest container. If the material is stored outside, the secondary containment must be 25% larger in capacity to hold rainwater. The containers must be inspected frequently for leaks and liquids that have accumulated in the secondary containment must be removed IMMEDIATELY and properly disposed of.

Article 41. Air Quality Standards41.1 All Volatile Organic Compound (VOC) containing material (thinner, solvents, glues,

paints, or any "fast drying" material) must be stored and used in a manner to reduce VOC's from entering the atmosphere. Containers must be closed when material is not actually being used.

41.2 Equipment containing any amount of any type of refrigerant, must be properly evacuated prior to disposal. This includes air conditioners, water fountains, ice machines, etc. The refrigerants must be reclaimed by certified workers using certified equipment. Venting of refrigerants is strictly prohibited.

41.3 Drivers are asked to limit vehicle idle time to no more than 5 minutes while on the property. If your wait is to be longer, please shut the engine off.

Article 42. Storm water42.1 Erosion and sedimentation control structures must be installed prior to the start of any

land disturbance activities. Control structures must be inspected frequently and maintained in proper condition.

42.2 The storm sewer system must only be used for storm water runoff. Clean, non-polluted, runoff from other sources, including irrigation and hose use, must be kept to a minimum to prevent drainage into the storm sewer system. Rinsing of equipment, pavement, or other objects is strictly prohibited without prior approval from the Owner’s Representative. Report ALL non-rainwater substances entering a storm water drain to the Owner’s Representative.

Article 43. Solid WasteContractors are responsible for removal of all construction debris and trash related to their work. Facility trash collection containers and dumpsters may be used only after prior approval from the

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Owner’s Representative. No construction debris may be left on the ground overnight. All areas MUST be free of debris at the end of each working day. Trash must be kept in a contained dumpster. 55 gallon drums are not permitted on site for use as trash collection containers.

Article 44. Hazardous WasteAll materials restricted from disposal in a solid waste container must be coordinated through the Owner’s Representative.

Article 45. Release ReportingAny loss of containment of any chemical or waste substances must be IMMEDIATELY reported as a Chemical Spill.

Article 46. Spill Clean-upSpill clean-up shall be the responsibility of the Contractor. The Owner reserves the right to call an outside response contractor, AT THE CONTRACTOR'S EXPENSE, if it is necessary for clean-up assistance. All Contractors must call Safety and Protection Management for incident reporting.

Article 47. Fuel TanksFuel storage tanks are not permitted on site without the permission of the Owner’s Representative. Approval is subject to size of tank, spill controls, material to be stored, location of tank, etc. Tanks must be inspected frequently by the Contractor for leaks and spills and secondary containment requirements must be met.

Article 48. Preconstruction Risk ManagementThe Owner’s Representative shall provide a multidisciplinary guideline for renovation and construction projects to minimize the risk of airborne and waterborne infections. The Contractor shall implement all of the measures as indicated per the Preconstruction Risk Assessment.

Article 49. Radioactive MaterialThe Owner’s Representative must be notified prior to bringing any devices containing radioactive materials on property.

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ATTACHMENT AEMERGENCY PHONE NUMBERS AND FACILITY CONTACTS

TO REPORT STEP 1 STEP 2 STEP 3

A Medical Emergency 911 Facility Contact()

RHS Safety/Protection – 24/7()

A Fire 911 Facility Contact()


A Chemical Spill 911 Facility Contact()


Material Safety Data SheetsIn an emergency or potential emergency situation (i.e. exposure, spill, poisoning, etc.), a copy of Material Safety Data Sheets can be obtained from the following:

RHS Chemical Products – RHS Facility Representative needed to access the site belowhttp://hq.msdsonline.com/riverside

CHEMTREC – 24 hr. emergency1-800-424-9300

Caller needs to provide: RHS Facility Your Name Fax Number you want MSDS sent to Product Name Manufacturer Name Product Number UPC Code

OWNER’S REPRESENTATIVE*

NAME:

PHONE:

CELL:

PAGER:

*The Owner’s Representative shall be the RHS Project Manager, Project Coordinator, Director of Facilities Operations (or their designee) or the Director of Construction Management (or their

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http://hq.msdsonline.com/riverside


designee).

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ATTACHMENT AEMERGENCY PHONE NUMBERS AND FACILITY CONTACTS

(Continued)

Provide the Owner’s Representative with the General Contractor Superintendent and Sub-Contractor Superintendent/Foreman contact information. Each company shall provide the following:

Name of Individual

Name of Contracting Company

Project Location/Description

Project Duration (Estimated Completion Date)

Company Office Number

Mobile/Pager Number (24 Hour Access number)

Back-Up Contact Person Mobile/Pager Number (24 Hour Access number)

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ATTACHMENT BRHS

CONTRACTOR SAFETY/ENVIRONMENTAL POLICY

The undersigned Contractor, as a condition of its work, certifies that:

1. Contractor has in place the Interim Life Safety Measures and the Preconstruction Risk Assessment described in this policy.

2. Contractor will conduct regular weekly safety meetings for all of its employees.

3. Contractor has trained, or prior to their first day of work on Owner’s job site will have trained, all its employees:

a. On all safety training elements included in Contractor’s Program; andb. On all of Owner’s specific safety and environmental information, training and

procedures shared by Owner with Contractor and identified in the attached summary of Owner’s safety information, the receipt of which Contractor hereby acknowledges.

4. If Contractor’s work may create non-obvious safety hazards for Owner’s employees, Contractor shall advise Owner’s on-site Representative of such hazards either before commencing such work or as soon as Contractor becomes aware of the safety concern.

(Contractor Name)

By:(Authorized Representative Signature)

(Authorized Representative Name Printed)

(Authorized Representative’s Title)

(Project Description)

(Date)

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ATTACHMENT CPROCEDURE FOR SHUTDOWN OF UTILITIES AFFECTING PATIENT CARE AREAS

Five (5) business days (minimum) prior to a utility shut down, a planned preliminary, abbreviated (five minute or less) shutdown shall occur for the following utilities that affect patient care areas:

Electrical Power Emergency Electrical Power Domestic cold water Domestic hot water Medical air Nitrogen Nitrous Oxide Oxygen Steam Vacuum

The Preliminary abbreviated shutdown will validate the areas affected by the shutdown prior to performing the actual longer shutdown scheduled for a later date.

The following guidelines shall be used:

The hospital staff in the affected areas will be notified by the contractor or the Owner’s Representative as part of the critical disruption.

The actual date and times the utility is secured and restored shall be recorded by the Owner’s Representative and documentation filed.

The contractor shall submit a critical disruption request and notice at least three (3) business days (72 hours) in advance.

The Owner’s Representative shall issue a critical disruption (via email) for the abbreviated shutdown at least two (2) business days (48 hours) in advance.

Failure to comply with this policy will result in disciplinary action up to and including termination from performing additional RHS work.

18 Revised: 6/10/15


ATTACHMENT D

RHS UTILITIES SHUTDOWN REQUEST

Form must be filled out and turned in to the Owner’s Representative 72 hours in advance of request.

Today’s Date:

Representative:

Project Name:

General Contractor:

Phone:

POC Superintendent:

Phone:

Subcontractor: Phone:

System Name:

Location:

Areas That Will Be Affected:

Requested Shutdown Date:

Requested Shutdown Time:

Reason for Shutdown:

ONCE THE ABOVE INFORMATION HAS BEEN FILLED OUT BY CONTRACTOR,THIS FORM MUST BE TURNED IN TO THE OWNER’S REPRESENTATIVE

Coordination of Meeting Request:

Date of Meeting:

RHS Response:

Approved:

19 Revised: 6/10/15


Approved as noted:

Disapproved:

Reason for Disapproval:

* Upon approval by Owner’s Representative, a Critical Disruption Notice and/or a Work Order Request is to be submitted.

20 Revised: 6/10/15


ATTACHMENT ERHS HOT WORK PERMIT

WORK LOCATIONDATE: BUILDING: ROOM:

ISSUED TO COMPANY:

PERMIT ISSUED FOR THE FOLLOWING WORK:

NAME:

PERMIT STARTS PERMIT EXPIRESDATE: DATE:TIME: (AM / PM)

TIME: (AM / PM)

DO NOT weld, burn, or perform hot work until the following precautions are taken and maintained. If conditions change during the course of the work, this permit is void and a new permit must be issued.

Yes No N/A 1. Notify Owner’s Representative and/or Safety and Protection Management of location of

fire watch.2. Applicable building sprinkler system is in service.3. Smoke detectors in area have been placed out of service.4. Systems cleaned and purged.5. Lock-out/Tag-out completed.6. ABC fire extinguisher at location.7. Firefighting equipment & nearest phone/fire alarm box identified and Contractor is

trainedin use of equipment and sound emergency alarm and notification.

8. Floor area swept clean/surrounding area cleaned.9. Combustible materials removed or protected with noncombustible shield if within 35

feet.10. No flammable liquids within 50 feet.11. Provisions made for safe placement and proper securing of compressed gas

cylinders.12. Precautions taken and Confined Space Policy reviewed if confined space entry is

required.13. Cutting and welding equipment is in good repair.14. Explosive atmosphere in area is eliminated.15. Air Horn in area when Fire Alarm System is inoperable.16. Heat Detection in area when Fire Detection/Suppression systems are inoperable.17. Notify Owner’s Representative and/or Safety and Protection Management when work is

complete.WELDING/BURNING/HOT WORK/MAY BEGIN AFTER IT HAS BEEN VERIFIED THAT THE ABOVE CONDITIONS

HAVE BEEN MET.

PERMIT MUST BE READILY VISIBLE AT THE WELDING/BURNING/HOT WORK TASK.

THE CONTRACTOR OR PERSON PERFORMING HOT WORK SHALL MAINTAIN A FIRE WATCH DURING HOT WORK OPERATIONS AND FOR A PERIOD OF TWO (2) HOURS AFTER WORK IS COMPLETE.

21 Revised: 6/10/15


Owner’s Representative* Fire Marshall Permit Holder Signature

Print Name Print Name Print Name

*The Owner’s Representative shall be the RHS Project Manager, Project Coordinator, Director of Facilities Operations (or their designee) or the Director of Construction Management (or their designee).

22 Revised: 6/10/15


ATTACHMENT FCONFINED SPACE ENTRY PERMIT

GENERAL INFORMATION PROCEDURES & EQUIPMENT REQUIREMENTSBOLD DENOTES MINIMUM REQUIREMENTS TO BE COMPLETED AND

REVIEWED PRIOR TO ENTRY. NOTE: Items that do not apply enter N/APermit #Confined Space LocationPurpose of Entry REQUIREMENTS COMPLETED DATE TIMEPermit Date: Time: Time: Lockout/De-energize/Tryout

From: To: Line(s) Broken-Capped-BlankedTHIS ENTRY PERMIT IS VALID ONLY FOR TH DATE & TIME SPECIFIED Purge-Flush and Vent

VentilationADDITIONAL PERMITS (check only those that apply) YES NO Secure Area (Post and Flag)Hot Work Breathing ApparatusLockout/Tagout Resuscitator – InhalerLine Breaking Standby Safety PersonnelOther Full Body Harness w “D” Ring

PERSONNELEmergency Escape Retrieval EquipmentLifelines

Entry Supervisor: Fire ExtinguishersAttendant(s): Lighting (Explosive Proof)ENTRANT(S): Time

InTime Out Protective Clothing

Respirator(s) (Air Purifying)Burning and Welding Permit

COMMUNICATIONONLY DESIGNATED PERSONNEL ARE AUTHORIZED TO ENTER THE PERMIT

SPACE ATTENDANT/ENTRANT: (Check all that apply) YES NOPERMIT SPACE HAZARDS Visual

HAZARDS (Check all that apply) YES NO RadioMechanical Other (Specify)Electrical

EMERGENCY SERVICESEngulfmentConfiguration (Entrapment) PROVIDED BYAtmospheric Name:

Oxygen Deficient Phone Number:Oxygen EnrichmentExplosive (Gas/Vapor) METHOD OF SUMMONING (Check all that

apply)YES NO

Explosive (Dust) RadioHydrogen Sulfide Phone (Specify)Carbon Monoxide Other (Specify)

Materials Hazardous to SkinOther (i.e. Radiation, Noise, Toxics)

TESTINGTIME

ACCEPTABLE CONDITIONS

RESULTAM/PM

RESULTAM/PM

RESULTAM/PM

RESULTAM/PM

RESULTAM/PM

RESULTAM/PM

RESULTAM/PM

Oxygen - Min >19.5%Oxygen – Max <23.5%Flammability <10% LEL/LFLH2S <10 ppmToxic (specify)CI2 <0.5 ppmCO <35 ppmSO2 < 2 ppmHeat oF/oCOtherOtherTester InitialsAUTHORIZATION CANCELLATIONI CERTIFY THAT ALL REQUIRED PRECAUTIONS HAVE BEEN TAKEN AND NECESSARY EQUIPMENT IS PROVIDED FOR SAFE ENTRY AND WORK IN THIS CONFINED SPACE. ENTRY CANCELLED BY:

23 Revised: 6/10/15


NAME: DATE: NAME: DATE:SIGNATURE: TIME: SIGNATURE: TIME:

THIS PERMIT MUST BE POSTED ON JOB SITE. VALID ONLY ON INDICATED DATE.

24 Revised: 6/10/15


ATTACHMENT GRHS INTERIM LIFE SAFETY MEASURES (ILSM) ASSESSMENT & ACTION ITEM SPREADSHEET

Project: Location:

Date:

Projected Start Date:

Projected Completion Date:

The hospital has a written Interim Life Safety Measure (ILSM) policy that covers situations when Life Safety Code deficiencies cannot be immediately corrected or during periods of construction. The policy includes criteria for evaluating when and to what extent the hospital follows special measures to compensate for increased life safety risk. ILSM shall be implemented during periods when a building does not meet applicable provisions of the Life Safety Code. The Owner Representatives shall determine to the extent of ILSM by utilizing the assessment and action item spreadsheet. (See also LS.01.01.01, EP 3)

ILSM’s To Be Implemented are Checked Below:

□ 1. The hospital notifies the fire department (or other emergency response group) and initiates a fire watch when a fire alarm or sprinkler system is out of service more than 4 hours in a 24-hour period in an occupied building. Notification and fire watch times are documented. (For full text and any exceptions, refer to: NFPA 101-2000: 9.6.1.8 and 9.7.6.1) (See also LS.01.01.01, EP 3)

□ 2. The hospital posts signage identifying the location of alternate exits to everyone affected.(See also LS.01.01.01, EP 3)

When the hospital identifies Life Safety Code (LSC) deficiencies that cannot be immediately corrected or during periods of construction, the hospital does the following:

□ 3. Inspects exits in affected areas on a daily basis. Inspection of exits in affected areas will be performed by the Hospital and/or Contractor on a daily basis when the egress is compromised during these periods of ILSM deficiencies. (See also LS.01.01.01, EP 3)

□ 4. Provides temporary but equivalent fire alarm and detection systems for use when a fire system is impaired. A Fire Watch and/or Temporary Heat Sensor shall be in place and operational during the fire system impairment period. (See also LS.01.01.01, EP 3)

□ 5. Provides additional fire-fighting equipment. Additional fire extinguishers shall be provided by the Contractor and Hospital when they are not accessible within 75 feet. (See also LS.01.01.01, EP 3)

□ 6. Uses temporary construction partitions that are smoke-tight, or made of noncombustible material, or made of limited-combustible material that will not contribute to the development or spread of fire. Temporary construction partitions shall be used when any work generates moderate to high levels of dust, requires demolition or removal of any fixed building components or assemblies. Includes, but is not limited to, sanding of walls for painting or wall covering, removal of floor coverings, ceiling tiles, and casework, new wall construction, minor duct work or

25 Revised: 6/10/15


electrical work above ceilings, major cabling activities, and any activity which cannot be completed within a single work shift. (See also LS.01.01.01, EP 3)

□ 7. Increases surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation and field offices. The Hospital shall provide increased surveillance when a Fire Watch is mandated. (See also LS.01.01.01, EP 3)

□ 8. Enforces storage, housekeeping, and debris removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level. The need for these practices is based on criteria in the hospital’s Interim Life Safety Measure (ILSM) policy. The Hospital enforces storage, housekeeping, and debris removal during any work that generates moderate to high levels of dust, requires demolition or removal of any fixed building components or assemblies. Includes, but is not limited to, sanding of walls for painting or wall covering, removal of floor coverings, ceiling tiles, and casework, new wall construction, minor duct work or electrical work above ceilings, major cabling activities, and any activity which cannot be completed within a single work shift. (See also LS.01.01.01, EP 3)

□ 9. Provides additional training to those who work in the hospital on the use of fire-fighting equipment. The Hospital provides additional training on fire-fighting equipment when staff cannot relocate from the immediate area (same smoke compartment) and the fire system is impaired. (See also LS.01.01.01, EP 3)

□ 10. Conducts one additional fire drill per shift per quarter. The Hospital conducts one additional fire drill per shift per quarter in any occupied area where the fire system will be impaired for more than 45 days. (See also EC.02.03.03, EP 1 and LS.01.01.01, EP 3)

□ 11. Inspects and tests temporary systems monthly. The completion date of the tests is documented. The Hospital shall inspect and test temporary heat sensors monthly. (See also LS.01.01.01, EP 3)

□ 12. The hospital conducts education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. The Hospital shall promote awareness of these items when a Fire Watch is implemented or egress has been modified. (See also LS.01.01.01, EP 3)

□ 13. The hospital trains those who work in the hospital to compensate for impaired structural or compartmental fire safety features. Staff training shall occur for impaired structural or compartmental fire safety features when such features will be impaired for more than 45 days. A Fire Watch shall be implemented immediately. (See also LS.01.01.01, EP 3)

Note: Compartmentalization is the concept of using various building components (fire rated walls and doors, smoke barriers, fire rated floor slabs, and so forth) to prevent the spread of fire and the products of combustion such as to provide a safe means of egress to an approved exit. The presence of these features varies depending on the building occupancy classification).

PROJECT:

SIGNATURE:

Owner Representative Date Contractor Date

Print Name Print Name

26 Revised: 6/10/15


SIGNATURE:

RHS Fire Marshal/Facility Designee

Date

Print Name

File Original in ILSM Book*The Owner’s Representative shall be the RHS Project Manager, Project Coordinator, Director of Facilities Operations (or their designee) or the Director of Construction Management (or their designee)

27 Revised: 6/10/15


ATTACHMENT HPRECONSTRUCTION RISK ASSESSMENT

Location of Construction: Project Start Date:RHS Project Manager / Phone#: Estimated Duration of Project:Contractor Performing Work: Expiration Date:Infection Control Practitioner:CONSTRUCTION ACTIVITYPlease indicate with an (X) which Construction Activity applies to the construction area.

YES NOType A: Inspection and Non-Invasive Activities. Includes, but is not limited to, removal of

ceiling tiles for visual inspections limited to 2 (two) tiles per 50 square feet, painting (but not sanding), wall covering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

Type B: Small scale, short duration activities which create minimal dust. Includes, but is not limited to, installation of telephone and computer cabling, access to chase spaces, cutting of walls or ceiling where dust migration can be controlled.

Type C: Any work which generates moderate to high levels of dust, requires demolition or removal of any fixed building components or assemblies. Includes, but is not limited to, sanding of walls for painting or wall covering, removal of floor coverings, ceiling tiles, and casework, new wall construction, minor duct work or electrical work above ceilings, major cabling activities, and any activity which cannot be completed within a single work shift.

Type D: Major duration and construction projects. Includes, but not limited to, activities which require consecutive work shifts, requires heavy demolition, removal of a complete cabling system, new construction, utility description, loud noise, vibration, and other hazards that affect care, treatment, and services.

INFECTION CONTROL RISK GROUPPlease indicate with an (X) which Risk Group applies to the construction area.

YES NOGroup 1:Least Risk - i.e., Office AreasGroup 2:Medium Risk - i.e., All other patient care units, Cardiac Rehab, Med/Surg Units,

NeurophysiologyGroup 3:Medium/High Risk - i.e., Emergency Room, Radiology/MRI/CT, PACU, L & D, Newborn

Nurseries, Renal Patients, Day Surgery, Nuclear Medicine, Admission/DC Units, PT – Tank Areas, Cafeteria, ECHO, Laboratories (Specimen).

Group 4:High Risk – i.e., Oncology, OR/Sterile Processing, CCU, CSICU, L & D/Delivery Operating Rooms, ICU, Cardiac Cath, Oncology, Anesthesia/Pump Areas, Endoscopy and Pharmacy Admixture)

Please circle the Construction Activity and Risk Level of the construction site that has been identified.

I. CONSTRUCTION ACTIVITY/INFECTION CONTROL MATRIX Infection Control Permit will be required when the Construction Activity and Risk Level indicate that Class III and Class IV Control Procedures are necessary.Construction

Activity Type “A” Type “B” Type “C” Type “D”Risk Level

Group 1 IIII II III/IV

Group 2 IIII III IV

Group 3 IIII III/IV IV

28 Revised: 6/10/15


Group 4III III/IV III/IV IV

29 Revised: 6/10/15


ATTACHMENT HPRECONSTRUCTION RISK ASSESSMENT

(Continued)

Class I: 1. Executive work by methods to minimize raising dust from construction operations.2. Immediately replace any ceiling tile displaced for visual inspection.3. Minor demolition for remodeling.

Class II: 1. Provide active means to prevent airborne dust from dispersing into atmosphere.2. Water mist work surfaces to control dust while cutting.3. Seal unused doors with duct tape.4. Block off and seal air vents.5. Wipe work surfaces with disinfectant.6. Contain construction waste before transport in tightly covered containers.7. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.8. Place dust mat at entrance and exit of work area.9. Remove or isolate HVAC system in areas where work is being performed.

Activities completed by the Project Coordinator and Contractor must be accompanied with an authorized permit.Class III: 1. Obtain Infection Control Permit from the Infection Control Department before construction

begins.2. Isolate HVAC system in area where work is being done to prevent contamination of duct system.3. Complete all critical barriers or implement control cube method before construction begins.4. Maintain negative air pressure within Work Site utilizing HEPA equipped air filtration units.5. Vacuum work area with HEPA filtered vacuums.6. Wet mop area with disinfectant.7. Remove barrier materials carefully to minimize spreading of dirt and debris associated with

construction.8. Contain construction waste before transport in tightly covered containers.9. Cover transport receptacles or carts. Tape covering if lid or covers are not tight.

Activities completed by the Project Coordinator and Contractor must be accompanied with an authorized permit.Class IV: 1. Obtain Infection Control Permit from the Infection Control Department before construction

begins.2. Isolate HVAC system in area where work is being done to prevent contamination of duct system.3. Complete all critical barriers or implement control cube method before construction begins.4. Maintain negative air pressure within Work Site utilizing HEPA equipped air filtration units.5. Seal holes, pipes, conduits, and punctures appropriately.6. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving Work Site or they can wear cloth or paper coveralls that are removed each time they leave the Work Site.7. Do not remove barriers from the Work Area until completed project is inspected by the Facilities Engineering/Construction Management Department and Infection Control Department and thoroughly cleaned.8. Vacuum work area with HEPA filtered vacuums.9. Wet mop area with disinfectant.

10. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

11. Contain construction waste before transport in tightly covered containers.12. Cover transport receptacles or carts. Tape covering.

Additional Requirements:

12 Hour Uninterrupted Air Exchange Required. (Date: / Initials: )

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

30 Revised: 6/10/15


Project Manager: Infection Control Practitioners Initial:(Class III & IV Only)

Date: Date:

31 Revised: 6/10/15


ATTACHMENT I

RHS CODES

32 Revised: 6/10/15


ATTACHMENT J

FIRE SAFETY

“CODE RED”

WHAT TO DOR = RESCUE

Rescue anyone in immediate danger

A = ALARM

Pull stations are located in hallwaysReport the FireGive the location of the Fire

C = CONTAIN

Close all Doors and Windows

E = EXTINGUISH

Only extinguish the fire if it is safe for you to do so.

Clear Hallways

33 Revised: 6/10/15

ORDINARY

COMBUSTIBLES

FLAMMABLE

LIQUIDS

ELECTRICAL

EQUIPMENT


ATTACHMENT K

FireExtinguishers

Your extinguisher must fit the fire.Type A: Ordinary combustibles, such as wood, cloth, paper, rubber, any plastics and other common materials.

Type B: Flammable liquids such as gasoline, oil, grease, tar, oil-based paint, lacquer and flammable gas.

Type C: Energized electrical wiring, fuse boxes, circuit breakers, machinery and appliances.

A multipurpose unit labeled ABC puts out the most common fires – ordinary combustibles, flammable liquids and electrical.

If you do fight the fire, remember the wordPASS

Note: Most portable extinguishers work according to these directions, but some do not. Follow the directions printed on the model you are using!

Pull the pin: Some extinguishers require

Aim low:

Squeeze the handle: This releases

Sweep from side to side: Keep the

34 Revised: 6/10/15


releasing a lock latch, pressing a puncture lever, or other first step.

Point the Extinguisher nozzle (or its horn or hose) at the base of the fire.

the extinguishing agent.

extinguisher aimed at the base of the fire and sweep back and forth until it appears to be out. If fire breaks out again, repeat the process.

35 Revised: 6/10/15


CONTRACTOR BADGE LOG PRINT ALL INFORMATION LEGIBLY ATTACHMENT L

PRINT Person’s Name (last and first) Date Issued

Company Name

Project Location

Project Name RHS Contact Person

Badge ID

36 Revised: 2/13/13


ATTACHMENT M CONTRACTOR DAILY CONSTRUCTION SURVEY

This form is to be completed daily on days that construction or demolition is being performed.

DATE:SURVEYOR:

BARRIERS Y N N/A

Y N N/A

Y N N/A

Y N N/A

Y N N/A

Y N N/A

Y N N/A

Are Construction signs and Exit signs posted for the area?

Are construction partitions smoke tight and built of non-combustible or limited combustible materials?

Are doors properly closed and sealed? Are floors clean, no dust tracked?

AIR HANDLING Are all windows closed behind barrier? Is negative air pressure maintained? Are air return vents sealed and supply vents sealed or

filtered?PROJECT AREA

Is debris removed in a covered container daily? Are fire alarms and sprinkler services operational? Is a temporary but equivalent fire system operational? Is additional fire-fighting equipment provided? Are fire extinguishers accessible within 75 feet?

TRAFFIC CONTROL Are exits readily accessible and unobstructed? Is the area restricted to contractor and necessary staff

only?

Comments:

37 Revised: 11/13/14 Revised: 11/13/14


38 Revised: 11/13/14 Revised: 11/13/14


ATTACHMENT NRHS CEILING WORK PERMIT

1. Job Location:

2. Job Description:

3. Number of Tiles to be Removed:

4. Department Requesting Work:

5. Date Work Is To Commence:

6. Date Work Is To Be Completed:

7. Communication Closets Affected:

8. Name of Company & Phone Number:

9. Name(s) Of Installer(s):

By signing below, the Contractor and all Subcontractors agree to the following: A copy of the ceiling tile permit policy has been received. The Contractor and all Subcontractors understand and will adhere to the ceiling tile permit

policy. Failure to comply with the ceiling tile policy can result in removal from the job site for the

day. Continued failure to comply with the policy can result in removal from the project and/or permanent dismissal from Riverside Health System.

Company Representative (Print Name) Riverside Representative (Print Name)

39 Revised: 11/13/14Revised: 11/13/14


Company Representative (Signature) Riverside Representative (Signature)

Date Date

40 Revised: 11/13/14Revised: 11/13/14

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