Form Cms-2786v - Fire Safety Survey Report - Icf-Iid (Small Facilities) 2012 Life Safety Code Page 3
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41Name of Facility
2012 LIFE SAFETY CODE
PART II – EXISTING RESIDENT BOARD & CARE OCCUPANCIES
MET
NOT
N/A
REMARKS
ID
MET
PREFIX
(PROMPT EVACUATION)
GENERAL
K100
General Requirements – Other
List in the REMARKS section any LSC Section 33.1 or 33.2 General
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.
K111
Building Rehabilitation
Repair, Renovation, Modification, or Reconstruction
Any building undergoing repair, renovation, modification, or reconstruction
complies with both of the following:
Requirements of Chapter 33.
Requirements of the applicable Sections 43.3, 43.4, 43.5, and 43.6.
33.1.1.3, 4.6.7, 43.1.2.1
Change of Use or Change of Occupancy
Any building undergoing change of use or change of occupancy classification
complies with the requirements of Section 43.7.
33.1.1.3, 4.6.7, 43.1.2.2 (43.7)
Additions
Any building undergoing an addition shall comply with the requirements of
Section 43.8. If the building has a common wall with a nonconforming
building, the common wall is a fire barrier having at least a 2-hour fire
resistance rating constructed of materials as required for the addition.
Communicating openings occur only in corridors and are protected by
approved self-closing fire doors with at least a 1-1/2-hour fire resistance
rating. Additions comply with the requirements of Section 43.8.
33.1.1.3, 4.6.7, 43.1.2.3(43.8)
Form CMS-2786V (10/2016)
Page
3
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