Risk Exposure Checklist

This checklist is a tool to aid Project Managers (PM) in identifying and addressing potential risk exposures during initial project planning. It is intended to be a guide and not an all-encompassing document. When completed, the checklist will be uploaded to the Procore project file and retained per State retention standards.

Agency: Building : Projected Contract Date:

Project Number and Name: Project Manager:

Site Walk Date: Agency Contact:

Brief Description or Project Scope of Work:

Please check one of the below, or fill in Other

NEW CONSTRUCTION RENOVATION EXCAVATION DEMOLITION Other:

Compliance with A.A.C. R2-10-201 and 202: (before any Sealed drawings)

The cost to construct, alter, or repair a state-owned or leased building will exceed $100,000, and/or

Involve specialized safety or security equipment systems exceeding $50,000

If either of the above triggers are met, please complete the Risk Management notification located at: https://staterisk.az.gov/building-project-submittal-form

Many projects require notice to be given, permits to be obtained and fact sheets or guidance to be referenced. Contact information and hyperlinks are included for your convenience. If hyperlinks to forms do not function, go to the main web page of the regulator. Main page links are noted below:

ADEQ https://azdeq.gov/

Maricopa Co. https://www.maricopa.gov/

Pima Co. http://webcms.pima.gov/

Pinal Co. http://www.pinalcountyaz.gov/Pages/Home.aspx

Registrar of Contractors https://roc.az.gov/

OSHA https://www.osha.gov/

ADOSH https://www.azica.gov/divisions/adosh

EPA https://www.epa.gov/

 For questions regarding this form, please contact ADOA GSD Lead Building Inspector at 602-364-4872.

Rev Mar 2019 Page 1 of 12

Contact Risk Management with any questions: 602-542-2182

Environmental

Air Emissions Equipment YES NO N/A Required Actions Comments

Will the project include the installation of equipment, other than fuel-burning equipment, that will release emissions into the air? (E.g., non-steam sterilizers, or kilns, printing operations, blasting, earth moving, trenching, etc.)

Facility may need to obtain or amend existing air permit to include new equipment. Refer to the following:

ADEQ: https://azdeq.gov/AQ

Maricopa Co. https://www.maricopa.gov/4058/Permits-Certifications-Notifications

Pima Co. http://webcms.pima.gov/government/environmental_quality/air

Pinal Co. http://www.pinalcountyaz.gov/AirQuality/Pages/IndustrialPermitsProcess.aspx

Use a Registered Contractor to work on natural gas lines and appliances.

https://roc.az.gov/

Will the project include the installation or modification of fuel-burning equipment? (E.g., boilers, generators, hot water heaters, internal fuel combustion engines, etc.)

Boilers over 200,000 BTU/hr. need to comply with Arizona Boiler Act (Title 23, Chapter 2, Article 11). Refer to Industrial Commission ADOSH Boiler Safety:

https://www.azica.gov/divisions/adosh/boiler-section

Facility may need to obtain an Air Permit, or if Facility has an Air Permit, then new equipment may need to be added to Air Permit. Refer to the following:

ADEQ 10-100 Million BTU https://azdeq.gov/why-do-i-need-boiler-facilities-general-permit-0

https://www.maricopa.gov/4058/Permits-Certifications-Notifications

http://webcms.pima.gov/cms/one.aspx?portalId=169&pageId=61413

Use a Registered Contractor to work on natural gas lines and appliances.

https://roc.az.gov/

Particle Pollution Initial Review

Required Actions Comments YES NO N/A

Will dust or particulates be generated (e.g. concrete work, excavations) for a total surface area greater than 0.1 acre, 4356 sq.ft?

For dust outdoors, refer to A.R.S. § 49-457.05. The Dust Action General Permit identifies a series of Best Management Practices (BMPs) for specific dust generating operations. Refer to:

ARS: https://www.azleg.gov/ars/49/00457-05.htm

Maricopa Co. Air: https://www.maricopa.gov/1244/Air-Quality

https://www.maricopa.gov/1913/Dust-Sources-Control-and-Training

Pima Co.http://webcms.pima.gov/government/environmental_quality/air

Pinal Co. http://www.pinalcountyaz.gov/AirQuality/Pages/home.aspx

Rev Mar 2019 Page 2 of 12

Will the project generate excessive dust, chemical odors, gases or other air emissions into interior space or next to occupied areas or air intake equipment?

☐ ☐ ☐

Install barriers or enclosures around any activity generating dust or odors

inside the building.

If required, consult an Industrial Hygienists for guidance on indoor control methods.

Asbestos YES NO N/A Required Actions Comments

Will any building materials other than unpainted wood, glass, or metal be disturbed?

☐ ☐ ☐ Request the most current asbestos inspection report from the Facility’s asbestos program manager. Check with Statutory Review about available reports on file.

Does the facility have a current asbestos survey? ☐ ☐ ☐

The asbestos inspection report must be current (within one year). If not, re-certification by a qualified (AHERA Building Inspector) person is required.

Are asbestos containing materials present? ☐ ☐ ☐

Contractors must be informed of the presence, location, and quantity of Asbestos Containing Material (ACM).

Does this project involve disturbance of asbestos-containing material (ACM) or material suspected to be ACM?

☐ ☐ ☐ Qualified contractors must conduct asbestos abatement and disposal.

Clearance sampling is also required.

Will this project disturb Regulated Asbestos Containing Material (RACM) at a regulated facility above these threshold amounts?

● 260 linear feet

● 160 square feet

● 35 cubic feet or more

☐ ☐ ☐

A County NESHAP Notification must be filed 10 working days before asbestos abatement occurs.

Maricopa Co.https://www.maricopa.gov/1244/Air-Quality

Pima Co.http://webcms.pima.gov/government/environmental_quality/air

Pinal Co. http://www.pinalcountyaz.gov/AirQuality/Pages/home.aspx

ADEQ has information on NESHAP Notifications and links to Maricopa, Pima & Pinal Co NESHAP forms: https://azdeq.gov/neshap

Lead YES NO N/A Required Actions Comments

Does the scope of work involve impacting or removing painted interior or exterior materials?

☐ ☐ ☐ The Contractor shall be registered with the EPA as a Renovation, Repair, and Painting Contractor. Refer to:

http://www.epa.gov/lead/renovation-repair-and-painting-program

See the EPA guidance on lead containing work at: http://www2.epa.gov/lead/lead-based-paint-activities-professionals%23d. The Contractor must adhere to the federal requirements listed in 29 CFR 1926.62 OSHA Construction Standard for Lead.

Ensure the waste is characterized using a composite TCLP and disposed of properly. Keep waste manifest(s).

Will this project generate lead-containing paint debris? (E.g. windows, window sashes, doors, jams, moldings, trim, etc.)

☐ ☐ ☐

Will this project be performed on a school or residential building?

☐ ☐ ☐

Will this project generate any lead-paint-contaminated waste?

☐ ☐ ☐

Air Pollution Control for Project Initial Review

Required Actions Comments YES NO N/A

Will the project involve sandblasting, concrete cutting, grinding, or chemical cleaning of the outer surfaces of a building?

☐ ☐ ☐ The general contractor should be responsible for obtaining any necessary permits. Wastewater needs to be managed and workers may need respiratory protection.

Rev Mar 2019 Page 3 of 12

If yes to the previous question, will this work be performed on painted surfaces? ☐ ☐ ☐

Paint needs to be analyzed to determine if it is lead-based paint (greater than 0.5% lead by weight). An approved industrial hygiene firm should collect paint samples.

Will there be cutting, sawing, grinding, drilling, or crushing of stone, rock, concrete, brick, block, and mortar?

☐ ☐ ☐

Precautions are needed to prevent silica exposure. OSHA Action Level is action level of 25 µg/m3. OSHA PEL is 50 μg/m3 https://www.osha.gov/dsg/topics/silicacrystalline/

Will project include new carpet, flooring or, indoor paint

☐ ☐ ☐

Use chemicals that are low Volatile Organic Compound (VOC) and apply with adequate ventilation to prevent the build-up of chemical odors. Certain products, such as new carpet or new furniture, should be aired for at least 48 hours prior to installation and re-occupancy.

Property/Land Acquisition YES NO N/A Required Actions Comments

Will the project include acquisition of new property, land, or development of previously undeveloped land?

☐ ☐ ☐ All Appropriate Inquiry (AAI) shall be done in accordance with EPA using ASTM standard for Phase I investigations.

Is the land able to be used for its intended use? Are there any land use restrictions (historical, environmental, cultural), any flood plain issues

☐ ☐ ☐

Consider finding a different location for development. Be aware of restrictions. Land use restrictions can be found at the County recorder’s office an/ or ADEQ

Soil YES NO N/A Required Actions Comments Will there be digging, boring, trenching or excavations?

☐ ☐ ☐

Utility Clearance (AZ Blue stake) required. Within Maricopa County the number to call is 602-263-1100. Elsewhere in the state, the number is 1-800-STAKE-IT (800-782-5348).

Refer to: http://www.azcc.gov/divisions/utilities/gas/bluestake-faqs.asp

For Trenching and Excavation safety, refer to OSHA: https://www.osha.gov/SLTC/trenchingexcavation/ http://www.osha.gov/OshDoc/data_Hurricane_Facts/trench_excavation_fs.pdf

Will the project include the removal or fill of suspected contaminated soil on Agency Property?

☐ ☐ ☐

Consultants are on SPO contracts under “Pollutant” or “Emergency Response.” To perform a waste characterization, soil is to be tested for suspected contaminates or group of contaminates.

Verify that fill is “clean fill,” by either testing or having the sand & gravel

company provide a written certification. Refer to:https://www.azdeq.gov/function/laws/download/2014/Petroleum%20Contaminated%20Soil%20(PCS)%20Sampling%20Fact%20Sheet.pdf

Universal Waste YES NO N/A Required Actions Comments

Will this project generate any waste streams other than normal construction debris and universal wastes? (E.g., flammable or corrosive chemicals, cleaning solutions, etc.)

☐ ☐ ☐

Have Contractor characterize the waste streams. If characterization determines the waste is hazardous, then follow the haz-waste guidance below. Retain copies of waste manifest(s).

See this EPA link at: https://www.epa.gov/hw

ADEQ link: https://azdeq.gov/HazWaste

Rev Mar 2019 Page 4 of 12

Will the project generate any waste batteries? (E.g., lead acid, alkaline, Nickel-Cadmium, etc.)

☐ ☐ ☐

Regarding waste management procedures, batteries will need to be separated from all other waste streams. Use this web site to find local battery recycle locations: http://search.earth911.com/.

Will the project generate fluorescent bulbs, or other regulated waste? ☐ ☐ ☐

Fluorescent light bulbs need to be separated from other wastes streams.

See the EPA guidance on https://www.epa.gov/hw/universal-waste

Will the project generate waste Mercury-containing devices? (E.g., mercury switches, thermostats, etc.)

☐ ☐ ☐ Mercury-containing devices need to be separated from other waste streams. Federal Universal Waste Rule (see 40 CFR 273 & 40 CFR 273.13(c)) lays out the basic standards. Refer to EPA guidance at: https://www.epa.gov/mercury

Will the project generate waste light ballasts that contain PCBs? Ballasts need to be separated from other waste streams and disposed of properly.

☐ ☐ ☐

If not broken or leaking, they can be disposed of as Universal Waste. Otherwise, the fixture is not regulated PCB waste and can be recycled or disposed of as municipal solid waste.

Refer to https://www.epa.gov/pcbs/disposal-fluorescent-light-ballasts-flb

Hazardous Waste YES NO N/A Required Actions Comments Will the project generate hazardous waste requiring disposal? ☐ ☐ ☐

The waste must be characterized and disposed of in an appropriate landfill.

Waste Manifest and associated disposal documents (Characterization lab work, waste profile, bills of lading) shall be maintained as required.

Demolition Initial Review

Required Actions Comments YES NO N/A

Will this project involve demolition?

☐ ☐ ☐

A demolition permit must be obtained from the County or ADEQ. Refer to: https://azdeq.gov/permits-needed-demolition-andor-renovation-activity-0

http://webcms.pima.gov/government/environmental_quality/air/

http://www.pinalcountyaz.gov/AirQuality/Pages/home.aspx

https://www.maricopa.gov/1701/Asbestos

All building materials are to be considered ACM until proved otherwise. Test results will be submitted to the County or ADEQ.

Will there be any chemicals or materials in the structure that need to be removed prior to demolition?

☐ ☐ ☐

Do not attempt to remove the materials; create an itemized list of unused chemicals and unwanted materials for waste characterization.

Consult a hazardous waste disposal company to determine disposal requirements.

Will project disturb or expose workers to hazardous materials/substances other than ACM? ☐ ☐ ☐

Ensure that the contractor is aware of the hazardous materials present and their disposal needs. The contractor will be responsible for OSHA training for their workers who may encounter hazardous materials. Refer to:

https://www.osha.gov/Publications/OSHA3114/OSHA-3114-hazwoper.pdf

State workers that work in the area will also need to meet the same standards.

Tanks & Oil-Containing Equipment YES NO N/A Required Actions Comments

Will the project include the removal of an Underground Storage Tank (UST)? ☐ ☐ ☐

Use a state contracted vendor which is an ADEQ certified “Tank Service Provider.” AHJ oversight is required. Submit notifications to ADEQ.

Rev Mar 2019 Page 5 of 12

Will the project involve an installation of an UST? ☐ ☐ ☐

Provide ADEQ and the Fire Marshal with the type, size, and contents of the UST. Use the State “Installation, Repair and Maintenance of Petroleum Storage Tank Systems” contract, and an ADEQ certified “Tank Service Provider.”

Will the project include the installation or removal of an Above Ground Storage Tank (AST)? ☐ ☐ ☐

Provide the Fire Marshall or AHJ with the location of the AST, size, and plans. Apply for the required permitting.

If over 1,320 gallons of oil is stored at a facility, a Spill Prevention Control and Containment Plan will be required. Refer to: https://www.epa.gov/sites/production/files/documents/spccbluebroch.pdf

Storm Water YES NO N/A Required Actions Comments

Is the project on Federal land or will it disturb 1 or more acres of land, or less than 1 acre that is part of larger project that will ultimately disturb more than 1 acre?

☐ ☐ ☐

Ensure that the contractor attains an Arizona permit associated with Construction Activities. Refer to:

https://www.azdeq.gov/

For construction and renovations, will the structure have any pollution sources exposed to stormwater? (E.g., uncovered dumpsters, uncovered outdoor material storage, outdoor equipment, etc.)

☐ ☐ ☐

Use engineering controls such as swales and berms to ensure that storm water (rain) is not exposed to potential pollution sources. If a drywell is used for containment of storm water, ensure that soil inclusion is prevented. Drywells may require permitting and all are to be registered. When the project is complete, ensure closure of the drywell in accordance with ADEQ requirements.

Wastewater Initial Review

Required Actions Comments YES NO N/A

Will this project introduce a new wastewater discharge?

☐ ☐ ☐

A wastewater discharge permit may be required if discharge is not to a sewer companies collection system. Refer to:https://azleg.gov/arsDetail/?title=49

Contact ADEQ for a determination of applicability, anticipated discharge rates, and proposed discharge locations. Due to the Clean Water Act do not discharge into streams, water bodies or dry washes without consulting ADEQ.

Radiation Safety YES NO N/A Required Actions Comments

Are there any sources of ionizing radiation? (E.g., alpha particles, beta particles, neutron particles, x-rays or gamma rays.)

☐ ☐ ☐

For all line items under Radiation Safety:

The ADHS Bureau of Radiation Control has licensing requirements for both ionizing and non-ionizing radioactive materials. Refer to https://www.azdhs.gov/licensing/radiation-regulatory/index.php

Follow the requirements listed in the OSHA Standard for Ionizing Radiation protection, 29 CFR 1910.1096.

Are there any sources of non-ionizing radiation? (i.e. cell phone towers, radio booster arrays, lasers, mercury lamps, arc welding, tritium exit signs)

☐ ☐ ☐

Follow the requirements listed in OSHA 29 CFR 1910.97 Subpart G Nonionizing radiation. Refer to:

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9745

Rev Mar 2019 Page 6 of 12

Will Americium-containing ionization smoke detectors be removed or installed? ☐ ☐ ☐

See this guidance on Disposal of Fire/Smoke Detectors:

https://about.usps.com/postal-bulletin/2012/pb22334/html/cover_025.htm

Are there tritium-containing exit signs on the property and will they be removed?

☐ ☐ ☐ See this guidance on disposal of Tritium in Exit Signs: http://www3.epa.gov/radtown/tritium-exit-signs.html

Will any radiation or laser equipment be removed, modified, or installed? ☐ ☐ ☐

See this guidance on lasers:

http://www3.epa.gov/radtown/lasers.html.

Health and Safety

Fire/Safety Initial Review

Required Actions Comments YES NO N/A

Are there special hazards requiring specialized extinguishing systems? (E.g., Clean Agent, Kitchen Hood, Foam and Mist Systems.)

☐ ☐ ☐

Evaluate occupancy hazards and fire protection systems for new or added hazards.

Consult the State Fire Marshal’s office for guidance.

Does the project indicate that a panic alarm will be included or upgraded?

☐ ☐ ☐ For guidance, consult ADOA - Physical Security at 602-542-4381.

Will there be alterations or penetrations made through load bearing ceilings, walls, or floors?

☐ ☐ ☐ Ensure that penetrations are filled with fire-rated materials matching the surface penetrated. Penetrations through load bearing walls require prior review by Statutory Review.

Will hot work be performed? (Hot work includes welding, grinding, soldering, torch cutting, etc.)

☐ ☐ ☐ Verify that the contractor has a Hot Work Permit process addressing controls (ventilation, insolation, PPE) to eliminate buildup of hazardous particulates (e.g. fumes, mists, dust, smoke), vapors, or gases, as well as fire watch procedures.

Is the project a new construction? If building is greater than 75 feet above grade, then certain building codes and fire regulations apply.

☐ ☐ ☐

Refer to IFC-Chapter 93:

Work with State Fire Marshal’s office to ensure compliance with the IFC and Building Codes of the AHJ.

Is the electrical system for the new construction or renovation? If so, you must have an arc flash and electrical safety analysis conducted.

☐ ☐ ☐

Include the analysis in the scope of work for the electrical installations per the requirements of the NFPA 70E - Section 130.5.

Fire-Smoke Protection Equipment YES NO N/A Required Actions Comments

Does the project involve the addition, removal, or alteration of fire protection systems?

☐ ☐ ☐ Submit plans to the Fire Marshal’s office and Loss Prevention for review.

Rev Mar 2019 Page 7 of 12

Will fire alarm, fire sprinkler, or specialized suppression need to be shutdown at any time during the project? ☐ ☐ ☐

Ensure that the contractor provides trained individuals to perform fire watch, and the Fire Marshal’s office has approved the submittal. Refer to:

http://www.dfbls.az.gov/userfiles/files/fire_marshal/Permiting/fire%20watch%20procedures%20(2).pdf

Will exterior construction, landscaping, or storage impede access to fire hydrants, FDC’s or other Building Fire Safety features?

☐ ☐ ☐ Ensure the contractor maintains access to exterior fixed fire equipment throughout the project.

Are all locations of pull stations, fire exits, fire extinguisher placement, fire alarm panels, fire alarms, strobes/horns, and any life safety/fire items located on the construction prints?

☐ ☐ ☐

Please ensure copies with these items listed are given to the State Fire Marshal’s office, Loss Prevention (Risk Management Division), and GSD.

Is the Fire Department Information Center (FDIC) in place at any new construction site with directions for employees for Fire/Life/Safety issues?

☐ ☐ ☐

Please review IBC Standards section 911.1.5 for guidance:

Are automatic dampers required to be in place for non-rated ceilings? (I.e., tied into the smoke alarm/detector)

☐ ☐ ☐

Review IFC 2003 section 704, 909, 1507, and 1803:

http://blog.belimo.com/Blog/bid/71397/Code-Required-Testing-of-Fire-Smoke-and-Combination-Dampers

Chemical Storage Areas YES NO N/A Required Actions Comments

If there is chemical storage, is public access limited?

☐ ☐ ☐ Designate an area for chemical storage that meets this requirement. Refer to: http://www.ecfr.gov/cgi-bin/text-idx?rgn=div8&node=29:5.1.1.1.8.8.33.6

Are flammable liquids and/or gases stored in the chemical storage area inventoried?

☐ ☐ ☐ Provide Loss Prevention and the local fire authority with an inventory, including volumes of flammable materials.

Are required storage conditions set up for compressed gas cylinders that are stored in the chemical storage area?

☐ ☐ ☐

Consult OSHA 1910.101 (section A and B), or contact the local fire authority for assistance with storage requirements. Refer to: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9747

Are precautions in place if corrosive chemicals, such as acids or bases, are to be stored in a chemical storage area?

☐ ☐ ☐

Ensure that emergency eyewashes and showers are located inside the storage area, and are accessible within 10 seconds of all points in the area. Refer to: http://www.selectsafetysales.com/t-emergency-eyewash-requirements.aspx, http://gvsafety.com/Documents/SAFETY%20HANDOUTS/Emergency%20Procedures/Emergency%20Equipment/Emergency%20Eyewash%20&%20Showers%20PowerPoint%20Presentation.pdf

Are flammable cabinets made available for items that meet the criteria of flammable materials?

☐ ☐ ☐

All flammable storage areas should have flammable cabinets available to store those items in accordance with OSHA regulation.

Rev Mar 2019 Page 8 of 12

Existing and/or new plumbing/piping and water supply

Initial Review Required Actions Comments

YES NO N/A

Is plumbing to be altered, and will it affect the availability of water closets, restrooms, and/or sanitary issues? ☐ ☐ ☐

OSHA standards must be met. Alternate restrooms, sinks, and water closets must be made available. See J Table. Refer to:

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9790

Is new or existing plumbing to be connected to non-potable water or other substances? ☐ ☐ ☐

Ensure that mandatory backflow guidelines are followed. Refer to https://www.phoenix.gov/pdd/development/inspections/inspecttypes/backflow-prevention-program

Is the water supply for building(s)? ☐ ☐ ☐

Consider hydraulic flow needs to support water usage for the new project. New water sources are to be tested if used by Staff or Public.

Is the water supply provided by a new well source? A public water system (PWS) has 15 or more service connections (hook-ups) or serves 25 or more people, and is regulated by ADEQ and some Counties.

☐ ☐ ☐

Provide documentation of origin of water source and distribution method to Loss Prevention. Provide documentation of ADEQ approval and well record (55#) from ADWR, copies of permits and applicable water tests for intended use. If not a PWS, provide a plan for routine testing surrounding land use.

Does the project involve modifying, repair, or expansion of a Public Water System?

☐ ☐ ☐ Review the ADEQ approval documentation, copies of permits, and well record (55#) from ADWR.

Does the project involve reuse or receiving water that is recycled, grey water or effluent that must meet specific requirements?

☐ ☐ ☐

Consult with ADEQ on permitting and additional requirements.

ACC R18-9-711. & 18-9-719 provides insight on “other” Gray water uses.

Provide documentation if future plans incorporate recycled, grey water or effluent use.

Does the project includes installation or taps into existing or new installation of gas lines?

☐ ☐ ☐ Use a Registered Contractor to work on natural gas lines and appliances. Refer to https://roc.az.gov/

Confined Spaces YES NO N/A Required Actions Comments

Are confined spaces present and are they correctly classified? (Confined Space or Permit Required Confined Space)

☐ ☐ ☐ Ensure that the contractor is aware of the confined space and that it is notated on plans. The OSHA link identifies confined or permit required spaces, refer to: https://www.osha.gov/confinedspaces/faq.html

Does the contractor have a confined space program, employee training and proper equipment for the type of confined space entry required for this project?

☐ ☐ ☐

Ensure that the contractor has a confined space program, applicable training, equipment, permits if required, and documentation process for confined space work.

Rev Mar 2019 Page 9 of 12

Exits and Elevators Initial Review

Required Actions Comments YES NO N/A

Will protective openings to the fire barrier (penetrations, and vertical exit enclosures) be disturbed or altered during the project?

☐ ☐ ☐

Consult NFPA101 .8.3.4 and beginning with IFC 703 and 704.

Protect fire barrier openings with the proper fire and smoke resistance as indicated by Code and AJH.

Consult the State Fire Marshal’s office for further guidance.

Is panic hardware to be installed on exit doors?

☐ ☐ ☐

UL rated fire exit devices are required on fire doors. Consult the State Fire Marshal’s office for guidance. To verify that the correct devices are being installed refer to https://www.facilitiesnet.com/doorshardware/tip/Codes-to-Know-for-Panic-Hardware--38711

Does this construction or renovation impede or entail changes to egress route components?

☐ ☐ ☐

Ensure that changes to egress routes, lighting, doors, and closures are reviewed

by the Fire Marshal’s office for compliance with NFPA 101 and IFC 2003.

Swing with the direction of travel and ensure automatic closers are in place as required.

Refer to OSHA Link:

https://www.osha.gov/OshDoc/data_General_Facts/emergency-exit-routes-fact

sheet.pdf

If the plan impacts egress and exits, have temporary emergency egress and exits been identified?

☐ ☐ ☐

Are egress doors to be installed or altered? ☐ ☐ ☐

Does the project affect or alter any emergency lighting provided by an Emergency Power Supply System (EPSS)? (E.g., UPS, generators)

☐ ☐ ☐

Ensure that this system meets NFPA 110 emergency and standby power. http://www.generac.com/resources-and-tools/engineer-resources/power-connect-newsletter/power-connect-archive/june-2015/installation-acceptance-testing-(nfpa-110-requirem

Consult the State Fire Marshal’s office for further guidance

Is this area accessible to the public or individuals requiring mobility accommodation?

☐ ☐ ☐ Ensure that the contractor and architect are aware that the finished areas need to be compatible with American Disabilities Act. Refer to:

http://www.ada.gov/business.htm http://www.ada-compliance.com/ada-compliance/ada-elevators.html https://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-ada-standards/ada-standards/chapter-5-general-site-and-building-elements

Is the area subject to access requirements of ADA 403-404, for door width and hardware?

☐ ☐ ☐

Is this area subject to access requirements of ADA 504 or 505, for stairway, ramps, and handrail design?

☐ ☐ ☐

Rev Mar 2019 Page 10 of 12

Are any new elevator(s) to be installed? Are exiting elevator(s) to be altered?

☐ ☐ ☐

Ensure that the contractor uses a certified elevator company and notifications are made to the Industrial Commission: http://www.neii.org/iccfsae.cfm https://www.azica.gov/divisions/adosh/elevator-section

Fall Protection Initial Review

Required Actions Comments YES NO N/A

Is any work to be performed on a surface that is elevated at 6 feet or above the next lower level, including: unprotected sides and edges, leading edges, through hoist areas, and holes in roofs and floors?

☐ ☐ ☐

A fall protection plan will be developed that addresses work to be performed, worker training and documentation maintained. Refer to: https://www.osha.gov/ https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10759

Are fixed ladders to be installed for this project? ☐ ☐ ☐

Review requirements for fixed ladders to comply with OSHA 1926.1053 and/or 1910 subpart D. For overall reference: https://www.osha.gov/Publications/osha3124.pdf

Is scaffolding on projects? If used, must meet certain criteria and requirements. ☐ ☐ ☐

Scaffolds must be erected in accordance with OSHA 1910.28. Scaffolds greater than 75 feet in height may require a permit from the Authority having Jurisdiction. Refer to: https://www.osha.gov/SLTC/etools/scaffolding/faq.html

Has fall protection training been conducted with employees working at heights and a fall protection plan put into place? ☐ ☐ ☐

A fall protection plan will be developed that addresses work to be performed, worker training and documentation maintained . Refer to: https://www.osha.gov/

Noise YES NO N/A Required Actions Comments

Will activities or equipment generate excessive noise?

☐ ☐ ☐ Evaluate and implement noise controls, including scheduling after peak business hours.

Will the project generate excessive noise levels to neighboring occupancies that may not be acceptable? ☐ ☐ ☐

Work with contractor to identify a different process to decrease the noise hazard to surrounding occupants.

Corrective actions must be taken to minimize the noise levels.

Traffic Control/Public Safety YES NO N/A Required Actions Comments

Will the project block sidewalks, walkways, or regularly used pathways?

☐ ☐ ☐ Alternate walkways and signage must be provided.

Does this project require work to be done overhead or above sidewalk?

☐ ☐ ☐ Please ensure adequate protection for sidewalk is provided for falling objects. Sidewalk roof covers, etc. need to be in place.

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Is the project area accessible to emergency vehicles?

☐ ☐ ☐ Plan accessible areas prior to beginning work. Consult the AHJ and Fire Department to plan for accessing the site for emergencies.

Does the project require a crane or other hoisting equipment? ☐ ☐ ☐

Notification to the local Planning and Development office, City Engineer, and/or City Manager to ensure proper permits and documentations are in place prior to beginning project. https://www.osha.gov/SLTC/cranehoistsafety/

Will the project impact local traffic and or roadways?

☐ ☐ ☐ Please ensure that all agencies that have traffic control over said project area are contacted prior to activity commencing, to ensure an alternate traffic flow.

Rev Mar 2019 Page 12 of 12