Form Cms-2786t - Fire Safety Evaluation System - Health Care 2012 Life Safety Code Page 2
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7DEPARTMENT OF HEALTH AND HUMAN SERVICES
2012 LIFE SAFETY CODE
CENTERS FOR MEDICARE & MEDICAID SERVICES
Form Approved OMB Exempt
Step 2 —
Determine Occupancy Risk Parameter Factors using Worksheet 4.7.2.
For each Risk Parameter in Worksheet 7.2, select and circle the appropriate risk factor value.
Choose only one for each of the five Risk Parameters.
WORKSHEET 4.7.2 –
OCCUPANCY RISK PARAMETER FACTORS
Risk Parameters
Risk Factor Values
Mobility Status
Mobile
Limited Mobility
Not Mobile
Not Movable
1.
Patient
Mobility (M)
Risk Factor
1.0
1.6
3.2
4.5
No. of Patients
1–5
6–10
11–30
>30
2.
Patient
Density (D)
Risk Factor
1.0
1.2
1.5
2.0
th
7
and
st
nd
rd
th
th
Floor
1
2
or 3
4
to 6
Basements
Above
3.
Zone
Location (L)
Risk Factor
1.1
1.2
1.4
1.6
1.6
Patients
One or More
4.
Ratio of
1–2
3–5
6–10
>10
1
1
1
1
Attendant
Patients to
None
Attendants
Risk Factor
1.0
1.1
1.2
1.5
4.0*
(T)
Under 65 Years and Over 1
65 Years and Over or 1 Year and
Age
5.
Patient
Year
Younger
Average
Age (A)
Risk Factor
1.0
1.2
*A risk factor of 4.0 is charged to any zone that houses patients without any staff in immediate attendance.
Step 3 —
Compute Occupancy Risk Factor (F) using Worksheet 4.7.3.
(1) Transfer the circled risk factor values from Worksheet 4.7.2 to the corresponding blocks in Worksheet 4.7.3.
(2) Compute F by multiplying the risk factor values as indicated in Worksheet 4.7.3.
WORKSHEET 4.7.3 - OCCUPANCY RISK FACTOR CALCULATION
M
D
L
T
A
F
x
x
x
x
=
OCCUPANCY RISK
Step 4 —
Compute Adjusted Building Status (R) - Use Worksheets 4.7.4 or 4.7.5.
(1) If building is classified as “NEW” use Worksheet 4.7.4. If building is classified as “Existing” use Worksheet
4.7.5.
(2) Transfer the value of F from Worksheet 4.7.3 to Worksheets 4.7.4 or 4.7.5, as appropriate. Calculate R.
(3) Transfer R to the block labeled R in Worksheet 4.7.9.
(4) In Worksheets 4.7.4 and 4.7.5, results are always rounded up (i.e., 3.2 is rounded to 4.0).
WORKSHEET 4.7.5 ADJUSTED
WORKSHEET 4.7.4 ADJUSTED
OCCUPANCY RISK FACTOR (EXISTING)
OCCUPANCY RISK FACTOR (NEW)
F
R
F
R
x
=
0.6
Form
CMS-2786T (10/2016)
Page
2
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