PROJECT START-UP
ENVIRONMENTAL CHECKLIST
PROJECT NAME: TCH – OB and Nurses Station Renovation
PROJECT NUMBER: 14J2030
SUPERINTENDENT: Dan Stansbury
PROJECT MANAGER: Justin Peterson
START DATE: 3-25-2014
COMPLETION DATE: 9-10-2014
In accordance with the Occupational Safety and Health Administration (OSHA) 29 CFR
1926.1101 Section 2 and the Colorado Department of Health and Environment (CDPHE)
Regulation #8.B. III.6 and the Environmental Protection Agency (EPA) NESHAP
requirement, the following documentation must be completed prior to project startup.
1.
2.
3.
4.
5.
6.
7.
Was the building constructed prior to October 12, 1988?
Y
N
Is the building a K-12 School ?
Y
N
If Yes has the District turned over the schools Asbestos Management Plan?
Y
N
Has the facility owner/manager performed an asbestos survey of the affected portions
of the building?
Y
N
If No to 2 or 3 above, Please forward notifications document ENV 1 to Owner.
Is any asbestos containing material (ACM) or presumed asbestos containing material
(PACM) likely to be disturbed during construction activities?
Y
N
Has the document been received by GHP for review ?
Y
N
Has the document been forwarded to Safety Department or Environmental
Consultant?
Y
N
Has GHP hired outside consultant serving as our Asbestos Competent Person?
Y
N
Please list the abatement contractor and/or (Outside Consultant) Competent Person
(Firm) below:
(Outside Consultant) Competent Person: KEMWest
James Devalois
Abatement Company: CRS
8.
Were asbestos containing materials identified by the owner?
Y
N
9.
10.
Is asbestos abatement required?
Y
N
Please list abatement contractor and air monitoring consultant, if known.
Contractor:
Outside Consultant:
11.
Has GHP received disclosure documentation in accordance with 29 CFR 1926.1101
Section d MULTI-EMPLOYER WORKSITES notifying location and duration of
abatement activities at the site?
Y
N
12.
If abatement is completed has the building owner transmitted clearance
documentation and close-out reports?
Y
N
13. Has superintendent distributed OSHA notification to all subcontractors?
Y
N
If No, Please forward notifications document ENV 2 to Subcontractors and Owner.
LEAD-CONTAINING MATERIALS
1.
2.
3.
4.
Has the building been tested for lead paint?
Y
N
If yes, was lead paint identified at the property?
Y
N
If yes contact GHP safety Department for assistance.
Was the building constructed prior to 1978?
Y
N
Is the building currently or will the building be used as a child occupied facility,
daycare or kindergarten?
Y
N
Will renovation and construction activities impact leaded materials and/or generate
lead dust?
Y
N
a.) Is lead lined drywall being removed?
Y
N
b.) Is lead lined drywall being installed?
Y
N
c.)If (a) or (b) is occurring, has the environmental plan and has negative exposure
assessment been completed by an outside consultant serving as our competent
person?
Y
N
If the answer to question 2, 3, or 4 is yes, work activities may be regulated by CDPHE and
EPA, Please contact GHP Safety Department for recommendations.
OTHER ENVIRONMENTAL CONCERNS
1.
2.
3.
Are there any PCB containing transformers, oil holding tanks, or fluorescent light
ballasts present?
Y
N
Will construction activities require impacting concrete, brick or other silica
containing materials?
Y
N
Is entry into a confined space i.e. utility tunnels, crawlspaces, tanks required during
the project?
Y
N
4.
5.
6.
Are any unknown chemicals, drums, solvents or refrigerant products located in the
construction areas?
Y
N
Are any electrical or computer components located on site that require disposal?
Y
N
Is there evidence of visible mold and/or fungus growth or past or present water leaks
and/or damage in the construction area?
Y
N
FORM ENV- 1
REQUEST FOR SUVEY DOCUMENTATION-HAZCOM
Date: 2-10-2014
OWNER: Torrington Community Hospital – Banner Health
RE:
Request for sampling and/survey documentation for Hazardous materials
Dear Brad,
In accordance with the Occupational Safety and Health Administration (OSHA), Wyoming
Department of Health (WYDoH) and the Environmental Protection Agency (EPA), GH
Phipps Construction Companies is requesting that any environmental or hazardous materials
related sampling, abatement, and inspection documentation be submitted to our safety
department for review. For the protection of building occupants, our employees and the
project site please copy our safety department on any of the following documents:




Phase I Environmental Site assessments
Asbestos assessment Surveys (Required by EPA and CDPHE prior to renovation)
Lead-Based paint Surveys (Required in pre-1978 housing/apartments and/or childoccupied facilities)
Chemical inventories
State and federal prohibits the commencement of construction activities until all affected
building materials have been identified and communicated to our employees and
subcontractors. Should the renovation impact any known hazardous materials, abatement
and labeling in accordance with State and Federal regulations may be required prior to
renovations.
As soon as we receive the necessary documentation and verify that our activities will not
affect any hazardous materials, GHP will begin construction.
Sincerely,
Justin Peterson
GH Phipps
Project Manager
FORM ENV - 2
MULTI-EMPLOYER WORKSITE NOTIFICATION
Asbestos
DATE: March 18, 2014
SUBCONTRACTOR/EMPLOYER:
1.
GH Phipps Construction Companies (GHP) will be performing general construction
and renovation activities in the following areas of the PROJECT SITE:
Torrington Community Hospital – Banner Health
OB Department
Nurses Station
2.
Asbestos and Presumed Asbestos Containing Materials (ACM and PACM) have been
identified in the work areas referenced above. Some construction and renovation
activities performed at this site constitute Class III or IV activities “activities which
may disturb or impact ACM or PACM.”
3.
The following building materials are known to contain ACM or PACM and should
not be disturbed under any circumstances:
VCT Floor Tile, Sheet Vinyl, and Floor Mastic
Exterior wall drywall joint compound
Acoustical spray on concrete tee’s
Sink insulation on SS Sinks
4.
GH Phipps Construction Companies is requiring that each subcontractor
confirm, by signing the attached Confirmation of Asbestos Notification form,
that all of your employees performing work on this project will have received a
minimum of two-hour Asbestos Awareness Training prior to beginning work.
(Asbestos Awareness training is an OSHA requirement for most remodel
projects).
5.
Unless directly instructed by GHP superintendent and/or GHP’s competent person in
writing, all building materials encountered that are not wood, glass or metal including
those listed above in paragraph 3, and must be considered as PACM and not disturbed
by your employees under any circumstance. Should any employee become aware of
known or suspected ACM or PACM material not previously identified, contact the
onsite superintendent or foreman immediately. Should a known or suspected ACM or
PACM material become disturbed or damaged in your work area, please remove all
employees from the affected work area, secure the work area and notify the onsite
superintendent or foreman immediately.
FORM ENV -3
MULTI-EMPLOYER WORKSITE NOTIFICATION
Lead Containing Materials
Section II.
DATE:
SUBCONTRACTOR/EMPLOYER:
Pursuant to OSHA Construction Standard 1926.62 and 1926.1200, please be advised of the
following:
1.
GH Phipps Construction Companies (GHP) will be performing general construction
and renovation activities in the following areas of the PROJECT SITE:
As a requirement of the OSHA Construction Standard for Lead 1926.62, Hazard
Communications, 1926.1200, we are providing this information to employees and
subcontractors working at the above site. Additionally, in an effort to fully comply
with this regulation(s) we are requesting a contractor/occupant mailing and contact
list for the expected contractors, subcontractors or occupants who will be working at
this facility during our activities.
2.
Lead based and lead containing coatings have been identified in the work areas
referenced above at [PROJECT SITE]. Some construction and renovation activities
performed at this site constitute Class I , II, III activities. GH Phipps Construction
Companies is preparing a Lead Compliance Manual which outlines various
compliance procedures for each task that may impact lead painted surfaces and
components.
3.
The following building materials are known to be Lead based:
1.
2.
3.
4.
4.
GH Phipps Construction Companies is requiring that each subcontractor confirm, by
signing the attached Confirmation of Lead-Based Paint Notification form, that all of
your employees performing work on this project will receive a minimum of two-hour
Lead Awareness training prior to beginning work.
5.
Unless directly instructed by GH Phipps Construction Companies superintendent
and/or GH Phipps Construction Companies competent person in writing, all building
materials encountered that are painted and not specifically listed above must be
considered as Lead-Based or lead containing and not disturbed by your employees
under any circumstance. Should any employee become aware of any known or
suspected Lead Based or Lead Containing material not previously identified, contact
the onsite superintendent or foreman immediately. Should a known or suspected LBP
or LCP material become disturbed or damaged in your work area, please secure the
work area and notify the on-site superintendent or foreman IMMEDIATELY and
remove all employees from the affected work area, secure the work area and notify
the on-site superintendent or foreman immediately. It is important for the safety of
tradesmen, building occupants and the general public that lead contaminated dust is
not created, and dispersed throughout the work areas and the common areas of the
facility. Any work activities that will generate lead contaminated dust must have
prior approval of the GHP Lead Compliance Officer and/or the superintendent to
ensure compliance with the Lead Compliance Program
Confirmation of Asbestos and Lead Notification
Project Name: TCH – OB and Nurse Station Renovation
Superintendent: Dan Stansbury
Site Phone Number: 307-399-4152
Project Manager: Justin Peterson
Phone Number: 720-889-0082
Project Work Dates: 3-25-2014 thru 9-10-2014
Asbestos Competent Person: KEMWest, Inc. General Manager
Regulatory Requirements:
US Department of Labor, Occupational Safety and Health Administration (OSHA):
1. Occupational Exposure to Asbestos, Tremolite, Anthophyllite, and Actinolite –Title 29
CFR1910.1001 and 1926.1101
2. Respiratory Protection – Title 29 CFR 1910.134
3. Construction Industry - Title 29 CFR 1926.58
4. Hazard Communication – Title 29 CFR 1926.1200
US Environmental Protection Agency, (EPA)
1. National Emissions Standards for Hazardous Air Pollutants (NESHAPS) Title 40 CFR 61,
Subpart M.
2. Asbestos Hazard Emergency Response Act (AHERA) – Title 40 CFR 763
3. Colorado Department of Public Health and Environment (CDPHE) – Emission Standards
for Asbestos Colorado Air Quality Control Division Regulation No. 8.
GH Phipps Construction Companies Requirements
1.
All individuals performing work on this project will have a minimum of two-hours
Asbestos or Lead Awareness Training, whichever is applicable, prior to beginning
work.
2.
Should any employee become aware of known or suspected ACM or PACM or Lead
Painted surfaces and components not previously identified, contact the on-site
superintendent or foreman immediately.
3.
Should known or suspected ACM or PACM or LEAD CONTAINING MATERIALS
become disturbed or damaged, remove all employees from the affected work area,
secure the work area and notify the onsite superintendent or foreman immediately.
4.
Below, provide a contractor/occupant mailing address and telephone number, with an
identified contact person, for the expected contractors, subcontractors or occupants
who will be working at this facility under your direction for the duration of this
project.
5.
Provide a copy of this 3-page document to each contractor working under your
direction on this project, and submit to GH Phipps a signed copy of page 3 for each
contractor listed. If needed, additional copies of the document may be requested from
the GH Phipps Construction Companies superintendent or project manager listed on
page 2.
I have read and understand the above notification and agree to abide by the project
requirements:
______________________
Signature
______________________
Company
___________
Date