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2012 LIFE SAFETY CODE DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Form Approved OMB Exempt FIRE SAFETY SURVEY REPORT - 2012 LIFE SAFETY CODE Intermediate Care.

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How to use or fill out the CMS-2786W online

The CMS-2786W form, known as the Fire Safety Survey Report, is an essential document used for assessing compliance with the 2012 Life Safety Code for large facilities. This guide provides clear and supportive steps to help you complete this form online accurately and efficiently.

Follow the steps to fill out the CMS-2786W online.

  1. Click 'Get Form' button to obtain the CMS-2786W form and open it in the form editor.
  2. Begin filling out the identifying information section. You will need to provide the provider number and Medicaid ID number along with the name and address of the facility.
  3. In Part I, refer to the instructions for completing the form. Make sure to follow the guidelines for your specific occupancy type, whether existing or new.
  4. For existing facilities, complete the required worksheets for evaluating resident evacuation capability, as instructed in the corresponding sections.
  5. In Part II, provide information regarding resident board and care occupancy compliance based on the NFPA 101 standards for prompt or slow evacuation.
  6. Complete the sections in Part III for new residential board and care occupancies, ensuring to check compliance with relevant building standards.
  7. Proceed to Parts IV and V to describe the building services and operating features essential for maintaining safety and compliance.
  8. Conclude your form by entering crucial data in Part VI, ensuring you capture all necessary details accurately.
  9. After filling in all required fields, make sure to review your entries for accuracy before finalizing the submission. You can then save changes, download, print, or share the form as needed.

Complete your CMS-2786W form online today for a streamlined compliance process.

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CMS 2786W | CMS
CMS 2786W. Form Title. Fire Safety Survey Report - ICF-IID (Large Facilities) 2012 Life...
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