Life Safety Code (LSC) Program

About the Life Safety Code (LSC) Program

The Consumer Services and Healthcare Regulation (CSHCR) Commission at the Indiana Department of Health (IDOH) promotes healthcare quality by coordinating the licensure and certification of health facilities, clinics, centers, and providers; supporting quality initiatives of patient care; ensuring radiation safety among clinical staff; and confirming state standards for weights, measures, and metrology.

Life Safety Code (LSC) is a set of fire protection requirements designed to provide a reasonable degree of safety from fire. LSC covers construction, protection, and operational features designed to provide safety from fire, smoke, and panic. The National Fire Protection Association (NFPA) 99 Healthcare Facilities Code (HCFC) is a set of requirements intended to provide minimum requirements for the installation, inspection, testing, maintenance, performance, and safe practices for facilities, material, equipment, and appliances.

The LSC and HCFC, which are revised periodically, are publications of the NFPA, which was founded in 1896 to promote the science and improve the methods of fire protection. The basic life safety from fire requirement for facilities participating in the Medicare and Medicaid programs is compliant with the 2012 edition of the NFPA LSC and HCFC. The Centers for Medicare and Medicaid Services (CMS) partners with state agencies to assess facilities for compliance with LSC requirements.

Program Resources

Manuals

Access	Resource/Topic Title
Click to View	Emergency Evacuation Planning Guide for People with Disabilities
Click to View	National Fire Protection Association, Glossary of Terms
Click to View	State Operations Manual, Appendix I - Life Safety Code

Forms

Templates

Access	Resource/Topic Title
Click to View	Battery-Operated Smoke Detector Maintenance Log/Record
Click to View	Battery-Operated Emergency Light Test Log/Record
Click to View	Fire/Smoke Damper Maintenance Log/Record
Click to View	Fire Watch Log/Record
Click to View	Weekly Emergency Generator Inspection Log/Record
Click to View	Monthly Emergency Generator Test Log/Record

Checklists

Access	Resource/Topic Title
Click to View	Ambulatory Surgery Center (ASC) and End-Stage Renewal Disease (ESRD) Entrance Conference Documentation Checklist
Click to View	Hospital/Critical Access Hospital (CAH) Entrance Conference Checklist
Click to View	Intermediate Care Facilities for Individuals with Intellectual Disabilities Entrance Conference Checklist
Click to View	Long-Term Care (LTC) Entrance Conference Checklist

Reports

Access	Resource/Topic Title
Click to View	Fire Drill Report Template
Click to View	Nursing Home Smoke Detector Status Report (State Form 55004)
Click to View	Receptacle Testing Report Template
Click to View	Receptacle Testing Report Template (Annual)
Click to View	Receptacle Testing Report Template (Annual)
Click to View	Life Safety Code (LSC) Waiver Request (State Form 54147)
Click to View	Life Safety Code (LSC)/Emergency Preparedness/Initial/Recertification/Post-Survey Revisit (PSR)/Walk-Through Survey Exit Conference (State Form 55060)

Centers for Medicare and Medicaid Services (CMS) Forms

Access	Resource/Topic Title
CMS-2786M	Determining Evacuation Capability: Intermediate Care Facilities for Individuals with Intellectual Disabilities
CMS-2786R	Fire Safety Survey Report, 2012: Healthcare
CMS-2786U	Fire Safety Survey Report, 2012: Ambulatory Surgical Centers (ASCs) and End Stage Renal Disease (ESRD)
CMS-2786V	Fire Safety Survey Report, 2012: Intermediate Care Facilities for Individuals with Intellectual Disabilities, Small Facilities
CMS-2786W	Fire Safety Survey Report, 2012: Intermediate Care Facilities for Individuals with Intellectual Disabilities, Large Facilities

Letters

Access	Resource/Topic Title
Click to View	Natural Gas Five Criteria Template Letter
Click to View	Safety Alert Regarding Antifreeze in Residential Sprinklers, National Fire Protection Association
Click to View	Use of Alcohol-Based Skin Preparations in Anesthetizing Locations

Emergency Preparedness Resources

Access	Resource/Topic Title
Click to View	Emergency Preparedness Resource Center
Click to View	State Operations Manual, Appendix Z

Contact
Division of Long-Term Care 2 North Meridian Street #4B Indianapolis, Indiana 46204	Program Supervisor Amy Kelley AmKelley@health.in.gov
Main Switchboard 317-233-1325	Commission Switchboard 317-233-7442

Last Updated: Apr. 16, 2026