Get Cms-2786r. Cms-2786r; Fire Safety Survey Report; 2012 Life Safety Code; Healthcare

The CMS-2786R form is essential for documenting compliance with fire safety regulations in healthcare facilities as per the 2012 Life Safety Code. This guide provides step-by-step instructions to help users accurately fill out the form online.

Follow the steps to effectively complete the CMS-2786R form.

1. Press the ‘Get Form’ button to obtain the document and open it in your online editor.
2. Provide identifying information in Section 1. Fill in the provider number and Medicaid ID number as applicable. Ensure all changes are documented alongside their dates.
3. For Part I, indicate the facility name and address. Specify if the building is fully, partially, or not sprinklered at all.
4. In the survey section, mark whether the survey is for Medicare or Medicaid. Enter the date of the survey and plan approval.
5. Document the bed composition for the facility, including the total number of beds certified for Medicare and Medicaid. Note any distinct parts and whether the facility is accredited.
6. In each subsequent part, carefully address the specific Life Safety Code requirements. Mark whether each requirement is met, not met, or not applicable, and provide detailed remarks for any deficiencies.
7. Complete Part III, including justifications for any waivers sought. Be specific in explaining how strict adherence would cause unreasonable hardship and that patient safety is not compromised.
8. Finalize by signing the document in the designated sections for the surveyor and fire authority official.
9. Once all fields are completed, save your changes, then download or print the form. You may also share it as needed.

Complete your CMS-2786R form online today and ensure your facility meets fire safety standards.