Form Cms-2786t - Fire Safety Evaluation System - Health Care 2012 Life Safety Code Page 5
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7DEPARTMENT OF HEALTH AND HUMAN SERVICES
2012 LIFE SAFETY CODE
CENTERS FOR MEDICARE & MEDICAID SERVICES
Form Approved OMB Exempt
Step 7 — Determine Mandatory Safety Requirement values using Worksheet 4.7.8A, 4.7.8B, or 4.7.8C.
(1) Using the facility type (i.e., Hospital or Nursing Home), classification (i.e., New, Existing or Rehabilitated)
and the floor where the zone is located, circle the appropriate value in each of the three columns found in
Worksheet 4.7.8A, 4.7.8B, or 4.7.8C.
(2) Transfer the three circled values to the blocks marked S
, S
, and S
in Worksheet 4.7.9.
a
b
c
(3) The Mandatory Safety Requirement value for basements are based on the distance of the basement level
from the closest level of discharge (See 4.6.1.2 and 4.6.1.3).
WORKSHEET 4.7.8A - MANDATORY SAFETY REQUIREMENTS –
NEW HOSPITALS, EXISTING HOSPITALS OR NEW NURSING HOMES
Containment
Extinguishment
People Movement
(S
)
(S
)
(S
)
a
b
C
Zone Location
New
Existing
New
Existing
New
Existing
st
1
story
a
a
11
5
15(12)
4
8(5)
1
nd
rd
b
2
or 3
story
a
a
15
9
17(14)
6
10(7)
3
th
4
story or higher, but not high rise
a
a
18
9
19(16)
6
11(8)
3
High rise
a
a
18
17
19(16)
16
11(8)
7
a.
Use ( ) in zones that do not contain patient sleeping rooms.
nd
b.
For a 2
story zone location in a sprinklered EXISTING hospital, as an alternative to the mandatory safety requirement values set
specified in the table, the following mandatory values set shall be permitted to be used: Sa=7, Sb=10, and Sc=7
WORKSHEET 4.7.8B - MANDATORY SAFETY REQUIREMENTS –
EXISTING NURSING HOMES
Containment
Extinguishment
People Movement
Zone Location
(Sa)
(Sb)
(Sc)
1
st
story
0
10
0
nd
2
story
2
10
2
rd
3
story
6
14
2
th
4
story or higher
8
16
2
WORKSHEET 4.7.8C - MANDATORY SAFETY REQUIREMENTS –
MAJOR REHABILITATION IN NONSPRINKLERED EXISTING HOSPITALS
Containment
Extinguishment
People Movement
Zone Location
(Sa)
(Sb)
(Sc)
1
st
story
13
17(14)*
8(5)*
nd
rd
2
or 3
story
17
19(16)*
10(7)*
th
4
story or higher
18
19(16)*
11(8)*
*Use ( ) in zones that do not contain patient sleeping rooms.
Form
CMS-2786T (10/2016)
Page
5
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