Form Cms-2786u - Fire Safety Survey Report - Asc & Esrd 2012 Life Safety Code Page 2

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Name of Facility
2012 LIFE SAFE TY CODE
ID
NOT
MET
N/A
REMARKS
PREFIX
MET
PART I – NFPA 101 LSC REQUIREMENTS
(Items in italics relate to the FSES)
SECTION 1 – GENERAL REQUIREMENTS
General Requirements – Other
K100
List in the REMARKS section any LSC Section 20.1 and 20.1 General
Requirements that are not addressed by the provided K-tags, but are
deficient. This information, along with the applicable Life Safety Code or
NFPA standard citation, should be included on Form CMS-2567.
Building Rehabilitation
K111
Repair, Renovation, Modification, or Reconstruction
Any building undergoing repair, renovation, modification, or reconstruction
complies with both of the following:
•
Requirements of Chapter 21
•
Requirements of the applicable Sections 43.3, 43.4, 43.5, and 43.6
20.1.1.4.3, 21.1.1.4.3, 4.6.7, 43.1.2.1
Change of Use or Change of Occupancy
Any building undergoing change of use or change of occupancy
classification complies with the requirements of Section 43.7, unless
permitted by 20.1.1.4.2 or 21.1.1.4.2
20.1.1.4.2, 21.1.1.4.2, 43.1.2.2 (43.7)
Additions
Any building undergoing an addition shall comply with the requirements of
Section 43.8. If the building has a common wall with a nonconforming
building, the common wall is a fire barrier having at least a 2 hour fire
resistance rating constructed of materials as required for the addition.
20.1.1.4.1, 21.1.1.4.1, 4.6.5, 4.6.7, 43.1.2.3 (43.8)
Form CMS-2786U (10/2016)
Page 2

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