ILSM Matrix Date: Interim Life Safety Measures Facil. Impact Risk Assemt. in in path area areas Noise team safety safety access forces Quality Control Project: Utilities barriers loading systems fighting all training training d) smoking Vibration personnel identified local Project No. WO UVA PM: life life equipment Air c) Procedures notification fire surveillance of e) construction applicable drills/shift drills/shift on UVA CM: Forces organizational a) response -alternate GC: not Prohibit fire fire Infection Emergency additional 2 2 GC Supervisor: or hazard 6) b) combustible egress User Contact: Submitted By: operational 2b) training Additional Emergency Conduct incident Temporary Approved By: Emergency of f) 5) Compartmentation 4) Conduct Conduct Conduct Control Ensure 11a) Increase Ensure 2a) Applicable 9) 10) 7) 1) 8a) 8b) 3) 11b) NA Existing Code Deficiencies 1) Patient room door latching problem NA 2) Lacking a code complying smoke barrier NA 3) Fire exit stairs discharge improperly NA 4) Excessive travel distance to and approved exit NA 5) Lack of two remote exits NA 6) Nonconforming bldg. construction type NA 7) Improperly protected vertical openings NA 8) Large penetrations in fire barriers NA 9) Corridor walls do not extend to the structure NA 10) Hazardous areas not properly protected NA Construction Related Issues 11) Blocking off an approved exit NA 12) Rerouting of traffic to emergency room NA 13) Major renovation of an occupied area NA 14) Replacing fire alarm system (out-of-area) NA 15) Installing sprinkler system (out-of-service) NA 16) Significantly modifying smoke/fire barrier walls N/A 17) Adding and addition to an existing structure NA 18) Evaluate risk of accidental sprinkler activations: shut down system during construction NA NA Maintenance and Testing 18)Taking a fire alarm system out-of-service NA 19)Taking a sprinkler system out-of-service NA 20)Disconnection of alarm devices NA PM=Project Manager, CM=Const. Mgr. FI= HSPP Fire Prot.Inspector, Risk-H, high, L, Low, NA, Not Applicable
ILSM Matrix Facil. Impact Risk Assemt. Date: Interim Life Safety Measures Project: Project No. WO UVA PM: UVA CM: GC: GC Supervisor: User Contact: Submitted By: Approved By: Applicable or not applicable 1) Ensure egress -alternate path identified 2a) Emergency Forces access 2b) Emergency forces notification 3) Ensure operational life safety systems 4) Temporary construction barriers 5) Additional fire fighting equipment 6) Prohibit smoking 7) Control combustible loading 8a) Conduct 2 fire drills/shift in all areas 8b) Conduct 2 fire drills/shift in local area 9) Increase hazard surveillance 10) Compartmentation training of personnel 11a) Conduct organizational training on life safety 11b) Conduct additional training of incident response team a) Air Quality b) Infection Control c) Utilities d) Noise e) Vibration f) Emergency Procedures Existing Code Deficiencies NA 1) Patient room door latching problem NA 2) Lacking a code complying smoke barrier NA 3) Fire exit stairs discharge improperly NA 4) Excessive travel distance to and approved exit NA 5) Lack of two remote exits NA 6) Nonconforming bldg. construction type NA 7) Improperly protected vertical openings NA 8) Large penetrations in fire barriers NA 9) Corridor walls do not extend to the structure NA 10) Hazardous areas not properly protected NA Construction Related Issues 11) Blocking off an approved exit NA 12) Rerouting of traffic to emergency room NA 13) Major renovation of an occupied area NA 14) Replacing fire alarm system (out-of-area) NA 15) Installing sprinkler system (out-of-service) NA 16) Significantly modifying smoke/fire barrier walls N/A 17) Adding and addition to an existing structure NA 18) Evaluate risk of accidental sprinkler activations: shut down system during construction NA Maintenance and Testing NA 18)Taking a fire alarm system out-of-service NA 19)Taking a sprinkler system out-of-service NA 20)Disconnection of alarm devices NA PM=Project Manager, CM=Const. Mgr. FI= HSPP Fire Prot.Inspector, Risk-H, high, L, Low, NA, Not Applicable