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Stage Proposal Mississauga Halton Local Health Integration Network

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					                           Stage 2 Submission Requirements Checklist


MOHLTC-LHIN Joint Review Framework for Early Capital Planning
Stages
Stage I: Proposal Submission Requirements Checklist
   Health Services Provider Name:
   Site:

   Proposed Project Name:
   Proposed Project Ministry Number:
   Contact:

            Stage 1: Proposal
                    1.0 Service Delivery Model Report
                    2.0 Service Support infrastructure Report
                    3.0 Business Case / Options Analysis
                    4.0 Facility Development Plan
            Stage 2: Functional Program
                    1.0 Program Parameters (Optional)
                    2.0 Functional Program
                    3.0 Block Diagrams
                    4.0 Phasing Plan
                    5.0 Project Budget
                    6.0 Project Schedule
            Stage 3: Preliminary Design Development
                    3.1 Block Schematic Report
                    3.2 Sketch Plan Report
            Stage 4: Contract Document Development
                    4.1 Working Drawings and Specifications
                    4.2 Final Estimate of Cost
            Stage 5: Implementation

            * References
            - Canadian Standard Form of Contract for Architectural Services, Document 6, 2002
            - Canadian Handbook of Practice for Architects (CHOP)

   The Health Care Facility has ensured that:
   1. This submission meets the policies and procedures identified in the Capital Planning Manual
   2. This submission is complete, with explanation when requirements have not been met
   3. It will comply with all regulations under applicable legislation relating to this health care facility

   Board Chair Name:
   Board Chair Signature:
   CEO Name:

   MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
   October 25, 2010
                                                                                           Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist


CEO Signature:




                                                                                                                 Not Submitted**
                                                                                                     Submitted
**All information marked as “Not Submitted” must be accompanied with
a rationale explaining why the information is not required to be submitted.


i.       Executive Summary


         Proposal Synopsis

                  Key Facts

                  Anticipated outcomes



PART A Elements

1.0      Service Delivery Model Report


         1.1      Master Program



                  The master program is a document that reflects the health care facility’s
                  present and future service role within the community. It outlines current
                  and projected program, staffing, and departmental space requirements
                  based on the demographic data in the health care services plan.

                  1.1.1    Present service delivery

                           1.1.1.1 Program parameters

                                    1.1.1.1.1         Model of care

                                    1.1.1.1.2         Organizational Structure

                                    1.1.1.1.3         Hours of operation



MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                                      Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist


                           1.1.1.2 Scope of services provided

                           1.1.1.3 Historical workload for each service for the past 3 years

                           1.1.1.4 Historical service volumes for the past three years

                           1.1.1.5 Historical attendances for the past 3 years

                           1.1.1.6 Historical beds for the past 3 years



                  1.1.2    Future service delivery

                           1.1.2.1 Program parameters

                                    1.1.2.1.1         Model of care

                                    1.1.2.1.2         Organizational structure

                                    1.1.2.1.3         Hours of operation

                           1.1.2.2 Scope of services provided

                           1.1.2.3 Projected workload

                           1.1.2.4 Projected service volumes

                           1.1.2.5 Projected attendances

                           1.1.2.6 Projected beds

                           1.1.2.7 Other factors affecting space (e.g. Non-clinical staff)



                  1.1.3    Options for Delivering Changes in Service Delivery

                           1.1.3.1 Model of care options

                           1.1.3.2 Operating implications




MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                                         Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist


                           1.1.3.3 Capital implications




         1.2      Human Resources Plan

                  1.2.1    Staffing plan

                  1.2.2    Project impact




         1.3      Preliminary Operating Cost Estimate

                  1.3.1    Changes in model of care

                  1.3.2    Operating cost estimate




MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                      Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist




                                                                                                                   Not Submitted**
                                                                                                       Submitted
PART B

2.0      Service Support Infrastructure Report



         **All information marked as “Not Submitted” must be accompanied with a
         rationale explaining why the information is not required to be submitted.

         Site and space analysis are essential pre-design services. They include the
         Evaluation of an existing or potential site in relation to the building program,
         budget and construction schedule.

         2.1      Executive Summary

                  2.1.1    Facility Development Plan summary

                  2.1.2    Grant request



         2.2      Spatial requirements (previously within the Master Program)



                  2.2.1    Major elements that affect space

                  2.2.2    Clinical space drivers

                           2.2.2.1 Beds

                           2.2.2.2 Operating rooms

                           2.2.2.3 Specialized rooms

                           2.2.2.4 Patient areas

                  2.2.3    Administrative space drivers




MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                                        Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist


                           2.2.3.1 Offices

                           2.2.3.2 Workstations

                  2.2.4    Other space drivers

                  2.2.5    Existing Component Gross Square Feet (CGSF)

                  2.2.6    Projected Component Gross Square Feet (CGSF)



         2.3      Multi-Year Infrastructure Plan

                  2.3.1    Current year project plan

                  2.3.2    Next fiscal year project plan




MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                          Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist



         2.4      Technical Building Assessment

                  2.4.1    Description of major building systems

                  2.4.2    Elementary assessment of building systems

                  2.4.3    Recommendations for capital investment

                  2.4.4    Implications for deferring capital investment




         2.5      Master Site Plan



                  Depending on the scope and nature of the project, a physical feasibility
                  study may be required for an existing facility. The physical feasibility
                  study evaluates potential use of existing buildings that have a reasonable
                  life expectancy. The facility should determine prior to master planning,
                  if they need to undertake this type of study.

                  2.5.1    Site Evaluation Report

                           2.5.1.1 Physical factors

                           2.5.1.2 Cultural factors

                           2.5.1.3 Regulatory factors

                           2.5.1.4 Recommendations

                           2.5.1.5 Summary

                  2.5.2    Site Plan

                           2.5.2.1 Survey

                           2.5.2.2 Site utilization




MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                                      Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist


                  2.5.3    Building Plan

                           2.5.3.1 Floor plans

                  2.5.4    Planning and Building Approvals

                           2.5.4.1 Summary

                           2.5.4.2 Strategy

                           2.5.4.3 Schedules



         2.6      Master Building Plan

                  The master plan defines long-term development strategies for specific
                  sites, campuses or communities, including considerations related to
                  current and future infrastructure, site development, site circulation and
                  spatial relationships. A master plan, which is required following completion
                  of a master program, establishes the process for the program’s staged
                  implementation over time.

                  2.6.1    Options for Development

                           2.6.1.1 Site plan options

                           2.6.1.2 Building plans

                           2.6.1.3 Preferred option



         2.7      Options for Master Plan

                  2.7.1    Master Plan options



3.0      Business Case/Options Analysis



         3.1      Summary of available Development Plan options


MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                                      Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist


         3.2      Factors considered

         3.3      Prioritization

         3.4      Preferred Development Plan option



4.0      Facility Development Plan



         4.1      Proposed floor plans

                  4.1.1    Floor plans

                  4.1.2    Program location and boundaries

                  4.1.3    Major blocks and intra-component corridors

                  4.1.4    Building and component entrances and exits

                  4.1.5    Building circulation (vertical and horizontal)



         4.2      Proposed space summary

                  4.2.1    Total Building Gross Square Feet (BGSF)

                  4.2.2    Component Gross Square Feet (CGSF) by program



         4.3      Implementation / Phasing Plan



         4.4      Schedule



         4.5      Other Operational Issues

                  4.5.1    Adherence to planning and design guidelines




MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                            Component 3 – Checklists
                          Stage 2 Submission Requirements Checklist


                  4.5.2    Information technology

                  4.5.3    Furniture & Equipment



         4.6      Funding / Financing Plan



         4.7      Project Estimate

                  4.7.1    Hard costs

                  4.7.2    Soft costs

                  4.7.3    Financing costs

                  4.7.4    Total cost of Development Plan




MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
October 25, 2010
                                                                      Component 3 – Checklists

				
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