09.00.01 Operations Plan 11.07.01 09.00.02 Hazard Vulnerablity Analysis (HVA) 09.01.01 Safety & Security 11.00.02 New Name 09.01.02 Supplies 09.01.03 482.41(a)(2) Utilities 11.03.21; 11.03.22 09.01.04 Decontamination 11.05.03 09.01.05 Personal Protective Equipment (PPE) 09.01.06 Nutritional Services 24.00.12 Score under 09.01.06 09.01.07 Communication 11.07.04 09.01.08 Incident Command Center 09.01.09 Triage 11.07.02 09.01.10 Evacuation 09.01.11 Volunteer Management 09.01.12 Business Continuity 09.02.01 Exercises 11.07.03; 11.07.08 Chapter 9 Management Page 1
09.02.02 Education 11.07.01; 11.07.07 Chapter 9 Management Page 2
11.00.01 482.41 Condition of Participation: Physical Environment 11.00.01 Condition of Participation 11.00.02 Required Plans & Performance s 11.00.02 11.01.01 Periodic Monitoring for Safety Issues 11.02.01 11.01.02 Building Safety 11.02.02 11.01.03 Safety Team / Committee 11.02.03 11.01.04 Safety Team / Committee Facilitator 11.02.04 11.01.05 Safety Officer 11.02.05 11.01.06 Teams Appinted for Specific Areas 11.02.06 11.01.07 Safety Team / Committee Functions 11.02.07 11.01.08 11.01.09 Review of Safety Policies & Procedures Smoking / Tobacco Products 11.02.08 11.04.01 11.02.01 Building Security 11.01.01 11.02.02 Security Management 11.01.02 Chapter 11 Physical Environment Page 3
11.02.03 Local Security Support 11.01.03 11.02.04 Security Sensitive Areas 11.02.05 Security Incident Procedures 11.03.01 Hazardous Materials & Waste Program 11.05.02 11.03.02 482.41(b)(6) Storage & Disposal of Trash 11.05.01 11.03.03 Program Minimizes Exposure 11.05.03 11.03.04 Labels, Inventory & MSDS 11.05.04 11.03.05 Personal Protective Equipement 11.05.05 11.03.06 Hazardous Materials Routine Monitoring 11.05.06 11.04.01 482.41(b)(7) Written Fire Control Plans 11.06.01 11.04.02 Fire Drill - Quarterly 11.06.03 11.04.03 Fire Drill - Critique 11.06.04 11.04.04 482.41(b)(8) Approval by State & Local Fire Agencies 11.06.05 11.04.05 Minimize the Risk of Danger from Fire Chapter 11 Physical Environment Page 4
11.05.01 Medical Equipment & Systems - Maintenance 11.08.06 11.05.02 Medical Equipment Inventory 11.05.03 Patient Call System 11.02.09 11.05.04 Safe Medical Device Act (SMDA) 11.12.01 11.05.05 Medical Equipment Procurement 11.06.01 482.41(a)(1) Power & Lighting 11.03.01 11.06.02 Power Electrical System 11.03.02; 11.03.04 11.06.03 Generator Inspection 11.03.03; 11.03.19 11.06.04 Generator Monthly Load Test 11.03.03; 11.03.20 11.06.05 Generator 3-Year Load Test 11.03.16; 11.03.17; 11.03.18 11.06.06 Automatic Transfer Switch Test 11.06.07 Potable Water 11.03.23 11.06.08 Medical Gas Shut- Off Valves 11.03.26 Chapter 11 Physical Environment Page 5
11.06.09 Plant Equipment & Systems - Maintenance 11.03.25; 11.08.07 11.06.10 Plant Equipment Inventory 11.06.11 Medical Gas Systems - Maintenance 11.08.07 11.06.12 Water Temperature Control 11.09.03 11.07.01 482.41(c); 482.41(c)(2); 482.41(c)(3) Adequate Facilities and Supplies 11.09.01 11.07.02 482.41(c)(1) Facilities Located for Safety of Patients 11.08.02 11.07.03 482.41(c)(4) Ventilation, Light, & Temperature Control 11.09.02 11.07.04 Americans with Disabilities Act 11.10.01 11.07.05 Occupational Safety & Health Act (OSHA) 11.11.01 11.07.06 Assessing Risk Prior to Construction 11.07.07 Monitoring the Physical Environment 11.08.01 Fire Response - Staff Training 11.06.02 Chapter 11 Physical Environment Page 6
Crosswalk of 2014 HFAP s against 2012-2013 HFAP s 13.00.01 482.41(b)(1)(i); 482.41(b)(2); 482.41(b)(3) Life Safety Code Compliance 11.04.02; 11.04.09; 11.04.15 13.00.02 Alternative Life Safety Measures - Policy 11.04.10 13.00.03 Alternative Life Safety Measures - Implementation January 13.00.04 Notification of Response Forces January 13.00.05 Facility Demographic Report (FDR) 11.04.11; 11.04.12 13.00.06 Testing & Inspection - Definition of Time 13.00.07 Testing & Inspection - Documentation 13.01.01 Corridor Door Latching 11.04.08; 11.04.17 13.01.02 Door Locks January 13.01.03 Corridor Width 11.04.07 13.01.04 Suites 13.01.05 Exit Signs 13.01.06 Exit Discharge 13.01.07 Corridor Projections January January January January Chapter 13 Life Safety Code Page 7
Crosswalk of 2014 HFAP s against 2012-2013 HFAP s 13.01.08 Path of Egress Obstructions 11.04.05 13.02.01 Fire Alarm System - Installation 11.04.05 13.02.02 Fire Alarm System - Testing 11.04.05 13.02.03 Fire Alarm Systems - Transmitting Signal January 13.02.04 Fire Alarm Systems - Technician Qualifications January 13.03.01 Water-Based Fire Protection System - Installation 13.03.02 Water-Based Fire Protection System - Testing & Inspection 11.05.03 13.03.03 Water-Based Fire Protection System - Control Valves, Piping and Hangers January 13.03.04 Fire Pumps - Weekly Test January 13.03.05 Fire Pumps - Annual Test January 13.03.06 Alternative Fire Suppression systems - Installation & Testing January Chapter 13 Life Safety Code Page 8
Crosswalk of 2014 HFAP s against 2012-2013 HFAP s 13.03.07 13.03.08 13.03.09 13.04.01 Water-Based Standpipes & Hoses - Inspection & Testing Water-Based Fire Department Connections - Inspection Portable Fire Extinguishers - Installation. Inspection and Maintenance Fire Rated Barriers 11.04.04 January January January 13.04.02 Smoke Compartment Barriers 11.04.04 13.04.03 Fire & Smoke Damper - Testing January 13.04.04 Overhead Rolling / Horizontal Sliding Fire Doors - Testing January 13.04.05 Construction Types January 13.04.06 Separation of Occupancies January 13.04.07 Fire Rated Door Assemblies January 13.04.08 Hazardous Areas 13.04.09 Ceilings 13.04.10 Corridor Walls January January January Chapter 13 Life Safety Code Page 9
Crosswalk of 2014 HFAP s against 2012-2013 HFAP s 13.05.01 Fireplaces 13.05.02 Elevator Recall January January 13.05.03 Trash & Linen Chutes January 13.06.01 Decorations January 13.06.02 Trash Receptacles January 13.06.03 Portable Heaters To be Scored January 13.06.04 Life Safety Drawings 13.06.05 482.41(b)(9)(ii) Alcohol Based Hand-Rub Dispensers 11.13.01; 11.13.02; 11.13.03 13.06.06 Definition of New Construction and Existing Conditions January 13.07.01 482.41(b)(2) CMS Waiver of Life Safety Code 11.04.13 13.07.02 Fire Safety Evaluation System January Chapter 13 Life Safety Code Page 10