Appendix I – A health study

in the factory before shipping. MC secures the preservation at factory, shipping and at site to avoid risks for damages.

At site commissioning packages are defined. Contractor is calling for inspection when specific equipment has been installed, but before testing and commissioning. This is the first step. During this inspection, punch items are documented and categorised in A or B. All A items must be cleared before the specific system can go over to next phase RFC (Ready for Commissioning). When packages are in RFC status, commissioning can be performed. Before going to next phase RFO (Ready for Operation), all remaining punch items must be cleared as well. Under certain conditions, some B items can be transferred to operation. The figure below describes a Mechanical Completion process.

Misunderstandings

The name completion is somehow misleading and is making people think this process is done at the project end, which is clearly wrong. To get the quality on documentation of the entire production process, including equipment testing, it is important that MC starts in the engineering phase.

Quality control in general is checking if the product is in accordance with the contract requirements. While quality control in the MC process is only one part of the documentation and verification, beside many other activities like scoping, punching and the various completion verifications, and last, but not least the documentation of the actual project completeness.

Conclusion of the completion system application

One of the main questions is, whether this rather heavy, costly, and time-consuming procedure is justified for the controls it provides?

By doing MC from the project start following the quality milestones, many errors and omissions will be discovered at the earliest possible stage. The later a problem is identified and corrected, the more costly will it become to repair.

Experience from The Follo Line project, and many other projects, has shown that the use of the MC process system, with qualified MC engineers, is

Figure 20-3: Principles of the Completion and Commissioning process.

providing a complete project status, which helps to plan resources and the systematic documentation process, secures the required quality and functionality. In case of unexpected situations, like termination of contracts before finishing of works, the system provides an accurate overview of the project status, which was very helpful in the Follo Line project on the occasions when two of the main contracts of the project, EPC Tunnel D&B in the northern part of the tunnel and EPC Oslo S Civil, had to be terminated early in 2018.

Lessons learned

It is generally challenging to maintain continuous high quality in construction projects since each project is unique. Industrial production has usually well-defined processes with execution under similar conditions. Construction projects are always at different locations with distinct boundary conditions, which makes it difficult to establish specific procedures in advance.

In an EPC contract with lump sums, the two parties’ understanding of the contract requirements are not always fully aligned. Contractor is often faced with a trade-off between efficiency/cost saving and quality, whilst the client expects the highest possible quality. “Sufficiently good”, “Fit for purpose” and “Highest possible” are subjective terms and leave room for interpretations. This room for interpretation can only be minimized by specific and detailed requirements in the Contract. In case this is not achieved, endless discussions at site may follow, leading to frustration and commercial discussions from both sides.

The environmental impact is continuously gaining importance in construction projects as well, and this can introduce further areas of discussion.

Bane NOR, as the project owner, considered it necessary to increase its own quality control during project execution, to secure the necessary quality and functionality, in order to satisfy the 100 years theoretical service lifetime.

References

UOS-00-A-90022 rev. 04E, 2018. «Sentralt prosjektstyringsdokument for gjennomføringsfasen», internal Bane NOR document

UOS-00-Q-90024 rev. 02E, 2015. «Follobanens kvalitetsplan», internal Bane NOR document

UOS-00-Q-90021 rev. 01E, 2015. «Overordnet verifikasjons- og valideringsplan», internal Bane NOR document

UFB-00-Q-00004 rev. 01E, 2019. «FB Tunnel TBM Oppfølgingsstrategi for EPC kontrakten», internal Bane NOR document

UOS-00-A-90053, rev. 00B, 2014. “Project Completion Requirements”, internal Bane NOR document

Is it a health benefit with the TBM method?

The health effect on tunnel workers with TBM method have not been in much focus. Minor studies have been conducted in recent decades, so when the Follo Line project was going to use four TBMs for drilling the tunnels, the National Institute of Occupational health (STAMI) saw an opportunity to more thoroughly and to a greater extent be able to study what health benefits drilling with TBM could have. Earlier, STAMI had conducted a study in close cooperation with Bane NOR on the Ulrikken-tunnel project in Bergen. This tunnel was excavated by an open TBM. Now they saw the opportunity to do a similar study on a double shield TBM in The Follo Line project. They contacted Bane NOR, once again, and the idea of conducting this study was presented for the entrepreneur, Acciona Ghella Joint Venture (AGJV), which was more than happy to put their workers on the project at disposal for a study project in this area.

The study had a start-up in 2016, shortly after the start-up of the first TBMs and continued during the entire excavation period. The target group consisted of tunnel construction workers using the TBM technique. A reference group was recruited among other construction workers and administrative personnel, who were minimally/not exposed to dust.

Background

It is raised above any doubts that conventional drill and blast of tunnels have in generations had negative health effects on tunnel workers. More technically advanced and more efficient methods for operation have been conducted through the years, but the environment in the tunnels is still a source to health problems for tunnel workers. The exposure and health effects among tunnel workers, operating the drill and blast methodology, were studied in Norway in the 1990’s and 2010-2011.

The study showed i.e. that a high proportion of active tunnel workers had chronic obstructive pulmonary disease (COPD). The high contamination in the work atmosphere could be a potential cause to the development of COPD. Other studies have also shown an increased occurrence of pulmonary diseases among tunnel workers and other construction workers connected to the “underground work”. By conventional drill and blast, the tunnel workers could be exposed to several chemical substances like dust, included α-quartz (crystalline silica), diesel exhaust, oil mist and nitrogen dioxide in a variating degree, and this exposure could have a negative health effect in short- and long terms. (Ulvestad et al, 2001) Experiences and earlier studies have shown that the content of crystalline silica is a special problem since exposure in the bronchial tree and alveoli are suggested to cause obstructive lung changes and silicosis.

One of the main questions raised was whether excavation of tunnels by TBMs gives less exposure of respirable dust and crystalline silica for the workers than tunneling by drill and blast gives? Another question was whether the type of TBM had an influence of the degree of exposure or not.

The goals by studying TBM-excavation as conducting method

Construction of tunnels with TBM as conducting method have been used in Norway earlier i.e., in connection with hydropower development, but it was little knowledge about which health effect this method has had on the tunnel workers, which was why STAMI saw the opportunity to achieve more knowledge on this conducting method. Since it would be four TBMs in operation on the Follo Line project at the same time, it would give a good starting point considering the big amount of people working underground, which gave a large basis of analysis.

The goals for the study were to:

• Study crystalline silica exposure for tunnelworkers during excavation by TBM. • Study the pulmonary function and gas diffusion capacity of TBM workers during the period of the TBM-drilling. • Study biomarkers in serum for lung inflammation • Study the relationship between exposure and the measured power parameters • Control the interrupting exposures like contamination from vehicles in the tunnel, nitrous gases, particles, oil mist from hydraulics and lubrication of machines.

In the health monitoring project on The Follo Line project the study goals were:

• The change in pulmonary function as a cause of exposure of dust from stones and quartz, with both bronchial effects and the lungs gas exchange ability. • The change in the blood content of markers for changes in function in blood vessels and lung

tissue which can be “early detection” of diseases in the lungs and cardiovascular system. • Nose cells inflammation regulations (which could be a parallel to the regulation of the lung cells) –

Currently only for tests, with possibility to later apply for financial support for the analysis.

In the exposure project on The Follo Line project, the goals were:

• Contribute to control the exposure level, and based on series of measurements identify relevant mitigations which can be implemented during the project • Get an overview over the workers exposure of dust, quartz, as well as particles with a rougher particle size which could have an effect for the exposure in alveoli (associated with cardiovascular effects and fibrosis risk) and the bronchi (associated with obstructive pulmonary effects as COPD) • Use the series of measurements in the health database to find connections between the level of exposure and health effects.

Implementation of the study

A protocol was approved by Bane NOR, AGJV and Regional Ethics Committee (REK), and in addition to Bane NOR, AGJV and STAMI, Synergi Helse came in as collaborators to conduct the health surveys.

To be able to conduct the health surveys in a correct way, STAMI contributed with training for occupational health professionals from Synergi Helse, which was supposed to perform the health survey in action. Scientists from STAMI assisted the surveys conducted through the project period i.e., quality assurance of the samples. The samples that were collected in order to look at the health effect and exposure effect, were analyzed by STAMI (exposure samples). The blood samples were analyzed by Oslo University Hospital.

Figure 1: All the companies involved in the study. Figure 2: Calibration and set-up for the main exposure – rock dust.

Statistical analysis was conducted by STAMI. The status in the project was reported regularly through the project period. The analysis of the health results is still ongoing, and both analysis and compilation of results are a meticulous and comprehensive laboriously work, which needs to be done carefully to be sure that the results are reliable. When the final results are presented, they will be reported to the client and the entrepreneurs. The outcome of the project will also give the basis for further preparation of scientific articles, both at a national and an international level. This work is ongoing directed by STAMI.

In order to establish the health effect on the tunnel workers, the participants performed a health examination, consisting of lung volume tests, spirometry, blood tests, and collection of nasal epitheliums.

Some chronic diseases and regular use of medication can influence the biomarkers. Information about chronic diseases and medication was obtained and registered by the questionnaire. This could include rheumatism, diabetes mellitus, known alcoholism/ drug abuse, chronic or acute inflammatory conditions and regular use of ASS, statins, or anti-inflammatory drugs. Since those mentioned parameters could have an impact on the results, the collected data from the affected participants were analyzed separately.

Information on earlier and present smoking habits were obtained by a questionnaire, and serum was analyzed for nicotine and cotinine. Body weight and height were measured, and the body mass index (BMI) was calculated and evaluated in the statistical analysis. Some of the chosen biomarkers can be influenced by physical activity, so the participants were asked about their level of physical activity as well.

In addition, background variables, and other relevant information of interest (ethnicity, work experience, education, respirable health), were recorded using a self–administered questionnaire.

The completeness of the answers was checked during the health examinations. Self-reported airway symptoms at present and during the last 12 months were also recorded.

It was also conducted health checks through the entire excavation period, and after the excavation period was finished. These tests were supposed to be the basis, in order to analyze the health effect dust exposure have had. In total, there were conducted seven rounds with samples of the dust exposure effect. The sample equipment was carried by persons who worked different places on the TBMs and in the tunnels in general, Workers from all the four TBMs participated to cover any potential differences between the four machines.

What did the sample tests indicate?

It appeared that it was a difference in the dust exposure, including crystalline silica, the tunnel workers were exposed for, based on where they worked at the TBMs and where in the tunnel, behind the TBMs, they were working. How much time the person spent in the different areas did also affect the exposure. Workers who worked in the area close to the cutterhead, i.e., changing the cutters, had a higher exposure than those who worked in the backup of the TBMs with i.e., extension of the process water pipeline. The longer time the persons spent in the different areas, the higher the exposure. For the persons who worked in the other parts of the tunnel, the exposure of dust was significantly lower than for the persons who worked on the front parts of the TMBs, close to the cutterhead.

It was also taken samples in areas where the workers were exposed by exhaust (diesel particles) and/or oil mist. The analysis of those samples showed that

Figure 3: Sample bags “ready for work”. Figure 5: Blood test.

Figure 4: Measurement of lung volume. Figure 6: A large number of samples were taken and analyzed during the study.