Form Cms-2786u - Fire Safety Survey Report - Asc & Esrd 2012 Life Safety Code Page 32
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39Name of Facility
2012 LIFE SAFETY CODE
ID
NOT
MET
N/A
REMARKS
PREFIX
MET
Electrical Equipment – Other
K919
List in the REMARKS section, any NFPA 99 Chapter 10, Electrical
Equipment, 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.
Chapter 10 (NFPA 99)
Electrical Equipment – Power Cords and Extension Cords
K920
Power strips in a patient care vicinity are only used for components of
movable patient-care-related electrical equipment (PCREE) assembles that
have been assembled by qualified personnel and meet the conditions of
10.2.3.6. Power strips in the patient care vicinity may not be used for non-
PCREE (e.g., personal electronics), except in long-term care resident
rooms that do not use PCREE. Power strips for PCREE meet UL 1363A or
UL 60601-1. Power strips for non-PCREE in the patient care rooms
(outside of vicinity) meet UL 1363. In non-patient care rooms, power strips
meet other UL standards. All power strips are used with general
precautions. Extension cords are not used as a substitute for fixed wiring of
a structure. Extension cords used temporarily are removed immediately
upon completion of the purpose for which it was installed and meets the
conditions of 10.2.4.
10.2.3.6 (NFPA 99), 10.2.4 (NFPA 99), 400-8 (NFPA 70), 590.3(D) (NFPA
70), TIA 12-5
Form CMS-2786U (10/2016)
Page 32
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