Form Cms-2786r - Fire Safety Survey Report - Health Care 2012 Life Safety Code Page 14
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50Name of Facility
2012 LIFE SAFETY CODE
ID
NOT
MET
N/A
REMARKS
PREFIX
MET
K293
Exit Signage
2012 EXISTING
Exit and directional signs are displayed in accordance with 7.10 with
continuous illumination also served by the emergency lighting system.
19.2.10.1
(Indicate N/A in one-story existing occupancies with less than 30 occupants
where the line of exit travel is obvious.)
2012 NEW
Exit and directional signs are displayed in accordance with 7.10 with
continuous illumination also served by the emergency lighting system.
18.2.10.1
SECTION 3 – PROTECTION
K300
Protection – Other
List in the REMARKS section any LSC Section 18.3 and 19.3 Protection
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.
K311
Vertical Openings – Enclosure
2012 EXISTING
Stairways, elevator shafts, light and ventilation shafts, chutes, and other
vertical openings between floors are enclosed with construction having a
fire resistance rating of at least 1-hour. An atrium may be used in
accordance with 8.6.
19.3.1.1 through 19.3.1.6
If all vertical openings are properly enclosed with construction providing at
least a 2 hour fire resistance rating, also check this
box. ☐
2012 NEW
Stairways, elevator shafts, light and ventilation shafts, chutes, and other
vertical openings between floors are enclosed with construction having a
fire resistance rating of at least 2 hours connecting four or more stories. (1-
hour for single story building and buildings up to three stories in height.) An
atrium may be used in accordance with 8.6.7.
18.3.1 through 18.3.1.5
Form CMS-2786R (10/2016)
Page 14
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