Skilled Healthcare Documentation Requirements Life Safety and Fire Protection
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1 DATE OF EVALUATION: FACILITY NAME: FACILITY ADDRESS: ADMINISTRATOR: MAINTENANCE DIRECTOR: All required documentation must be written and saved for at least 2 years and some documentation may be required to be saved for a longer period of time. The smoke detector sensitivity test must be saved for a minimum of 7 years. NFPA #101- LIFE SAFETY YES NO N/A Written Disaster Plans Written Fire Response Plans Written Smoking Policy Written Fire Watch Policy Documentation of Quarterly Fire Drills (All Shifts): Includes Scenario Description Includes Staff Sign-in Sheets Documentation of Staff Fire / Life Safety Training: P.A.S.S. Procedure R.A.C.E. Procedure Exit Signs-Battery Back-up: 30-Second Monthly Testing Exit Signs-Battery Back-up: 90-Minute Annual Testing Emergency Lights-Battery Back-up: 30-Second Monthly Testing Emergency Lights-Battery Back-up: 90-Minute Annual Testing Page 1 of 6
2 NFPA #25- AUTOMATIC FIRE SPRINKLER SYSTEMS YES NO N/A Documentation of Monthly Visual Inspections: Risers Fire Department Connections (FDC) Exterior Backflow Valve Installed Sprinkler Heads Documentation of Quarterly Inspector s Test: Includes Time in Seconds from Valve Opening to Alarm Activation Documentation of Annual Inspection of Entire Automatic Sprinkler System by Qualified Contractor Documentation of Annual Anti-Freeze System Testing Documentation of Annual Dry-Pipe Trip Test by Qualified Contractor Documentation of Fire Pump Testing: Weekly Test- Run: 10-minutes Annual Testing by Qualified Contractor Page 2 of 6
3 NFPA #72- AUTOMATIC FIRE ALARM SYSTEMS YES NO N/A Documentation of Monthly Visual Inspections: All System Devices (Detectors, Pull Stations, AV Devices, etc.) Fire Alarm Control Panel (FACP) Fire Alarm Annunciator Panel (FAAP) Documentation of Annual Testing: Documentation of Smoke Detector Sensitivity Testing: First Year of System Operation Third Year of System Operation Subsequent Years- Up to Five (5) Year Intervals Data is Maintained on File for at Least Seven (7) Years Page 3 of 6
4 NFPA #96- KITCHEN HOOD SYSTEM YES NO N/A Documentation of Semi-Annual Inspection of Kitchen Hood Fire Protection System: Current Inspection Tag on System Housing Current Inspection Tag on System Pull Station Documentation of Weekly Cleaning of Hood and Filters Documentation of Semi-Annual or Annual Cleaning by Qualified Contractor (Dependent on Use): Hoods Ducts Rooftop Fans Current Inspection Tag on Hood Page 4 of 6
5 NFPA #99 AND #110- EMERGENCY AND STANDBY POWER YES NO N/A Documentation of Weekly Emergency Generator Inspection: All fluids Battery General Condition Site Condition (No weeds, debris, etc. near unit) Documentation of Monthly Load Test: Conducted from Transfer Switch Documents Time in Seconds to Transfer Load Transfer Occurs in ten (10) Seconds or Less Documentation of Annual Testing by Qualified Contractors: Page 5 of 6
6 NFPA #10- PORTABLE FIRE EXTINGUISHERS YES NO N/A Documentation of Monthly Visual Inspection of All Fire Extinguishers: Monthly Inspection Log Sheet Sign-off on Back of FE s Inspection Tags Documentation of Annual Testing by a Qualified Contractor: Page 6 of 6
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