Form Cms-2786r - Fire Safety Survey Report - Health Care 2012 Life Safety Code Page 38
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50Name of Facility
2012 LIFE SAFETY CODE
ID
NOT
MET
N/A
REMARKS
PREFIX
MET
PART II – HEALTH CARE FACILITIES CODE REQUIREMENTS
K900
Health Care Facilities Code - Other
List in the REMARKS section any NFPA 99 requirements (excluding
Chapter 7, 8, 12, and 13) that are not addressed by the provided K-Tags,
but are deficient. This information, along with the applicable Health Care
Facilities Code or NFPA standard citation, should be included on Form
CMS-2567.
K901
Fundamentals – Building System Categories
Building systems are designed to meet Category 1 through 4 requirements
as detailed in NFPA 99. Categories are determined by a formal and
documented risk assessment procedure performed by qualified personnel.
Chapter 4 (NFPA 99)
K902
Gas and Vacuum Piped Systems – Other
List in the REMARKS section any NFPA 99 Chapter 5 Gas and Vacuum
Systems 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 5 (NFPA 99)
K903
Gas and Vacuum Piped Systems – Categories
Medical gas, medical air, surgical vacuum, WAGD, and air supply systems
in which failure is likely to cause major injury or death are designated:
☐ Category 1. Systems in which failure is likely to cause minor injury to
patients are designated.
☐ Category 2. Systems in which failure is not likely to cause injury, but can
cause discomfort is designated.
☐ Category 3. Deep sedation and general anesthesia are not administered
when using a Category 3 medical gas system.
5.1.1.1, 5.2.1, 5.3.1.1, 5.3.1.5 (NFPA 99)
K904
Gas and Vacuum Piped Systems – Warning Systems
All master, area, and local alarm systems used for medical gas and vacuum
systems comply with appropriate Category warning system requirements,
as applicable.
5.1.9, 5.2.9, 5.3.6.2.2 (NFPA 99)
Form CMS-2786R (10/2016)
Page 38
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Cms-2786x - Fire Safety Survey Report - Icf-iid (apartment House) 2012 Life Safety Code
Medical
Form Cms-2786w - Fire Safety Survey Report - Icf-iid (large Facilities) 2012 Life Safety Code
Medical
Form Cms-2786v - Fire Safety Survey Report - Icf-iid (small Facilities) 2012 Life Safety Code
Medical
Form Cms-2786y - Fire Safety Evaluation System - Icf-iid (small Facilities) 2012 Life Safety Code
Medical
Related Categories
Parent category: Medical