Form Cms-2786u - Fire Safety Survey Report - Asc & Esrd 2012 Life Safety Code Page 35
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39Name of Facility
2012 LIFE SAFETY CODE
ID
NOT
MET
N/A
REMARKS
PREFIX
MET
Gas Equipment – Respiratory Therapy Sources of Ignition
K925
Smoking materials are removed from patients receiving respiratory therapy.
When a nasal cannula is delivering oxygen outside of a patient’s room, no
sources of ignition are within in the site of intentional expulsion (1-foot).
When other oxygen deliver equipment is used or oxygen is delivered inside
a patient’s room, no sources of ignition are within the area are of
administration (15-feet). Solid fuel-burning appliances is not in the area of
administration. Nonmedical appliances with hot surfaces or sparking
mechanisms are not within oxygen-delivery equipment or site of intentional
expulsion.
11.5.1.1, TIA 12-6 (NFPA 99)
Gas Equipment – Qualifications and Training of Personnel
K926
Personnel concerned with the application, maintenance and handling of
medical gases and cylinders are trained on the risk. Facilities provide
continuing education, including safety guidelines and usage requirements.
Equipment is serviced only by personnel trained in the maintenance and
operation of equipment.
11.5.2.1 (NFPA 99)
Gas Equipment – Transfilling Cylinders
K927
Transfilling of oxygen from one cylinder to another is in accordance with
CGA P-2.5, Transfilling of High Pressure Gaseous Oxygen Used for
Respiration. Transfilling of any gas from one cylinder to another is
prohibited in patient care rooms. Transfilling to liquid oxygen containers or
to portable containers over 50 psi comply with conditions under 11.5.2.3.1
(NFPA 99). Transfilling to liquid oxygen containers or to portable containers
under 50 psi comply with conditions under 11.5.2.3.2 (NFPA 99).
11.5.2.2 (NFPA 99)
Form CMS-2786U (10/2016)
Page 35
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