Life Safety Code Program

The Life Safety Code Program page provides information about provider compliance with Life Safety Code (LSC) requirements and includes links to applicable laws, regulations, and compliance information.

Contact

Indiana Department of Health Division of Long Term Care 2 North Meridian Street, 4B Indianapolis, IN 46204	Program Supervisor Amy Kelley amkelley@health.IN.gov
Long Term Care Receptionist: 317-233-7442 IDOH Main Switchboard: 317-233-1325	317-234-8502 Fax: 317-233-7322

Information and Policies

Emergency Preparedness Information

Emergency Preparedness Resource Center
State Operations Manual Appendix Z
Forms

Ambulatory Surgical Center (ASC) and End Stage Renal Disease (ESRD) Life Safety Code (LSC) Entrance Conference Documentation Checklist
Battery Operated Smoke Detector Maintenance Log
Battery Operated Emergency Lights Test Log
CMS-2786M Worksheets for Determining Evacuation Capability, Intermediate Care Facilities for Individuals with Intellectual Disabilities. (Applicable to Existing Facilities Only)
CMS-2786R Fire Safety Survey Report 2012 Code - Health Care Medicare-Medicaid
CMS-2786U Fire Safety Survey Report 2012 Code – Ambulatory Surgical Centers & End Stage Renal Disease Medicare
CMS-2786V Fire Safety Survey Report 2012 Code- Intermediate Care Facilities for Individuals with Intellectual Disabilities, Small Facilities
CMS – 2786W Fire Safety Survey Report 2012 Code – Intermediate Care Facilities for Intellectual Disabilities, Large Facilities
Fire Drill Report A
Fire or Smoke Damper Maintenance Log
Fire Watch Log
Hospital Entrance Conference Checklist
ICF/DD Life Safety Code (LSC) Entrance Conference Documentation Checklist
Life Safety Code Initial / Recertification / PSR / Walk - Thru Survey Exit Conference
Life Safety Code Waiver Request
Monthly Generator Load Test Log
Nursing Home Life Safety Code Entrance Conference Documentation Checklist
Nursing Home Smoke Detector Status Report
Receptacle Testing Form #1
Receptacle Testing Form #2
Receptacle Testing Form #3
Sample Weekly Generator Test Log
Letters

Adoption of New Fire Safety Requirements for Long Term Care Facilities, Mandatory Sprinkler Installation Requirement
Corridor Width and Corridor Mounted Computer Touch Screens in Health Care Facilities – Clarification Effective Immediately
Definitions of Terms Used in the Life Safety Code (LSC) of the National Fire Protection Association (NFPA)
Evacuation Drills for Intermediate Care Facilities for the Mentally Retarded
Generators in Ambulatory Surgical Centers (ASCs)
Life Safety Code (LSC) Surveyor Reference Materials
Life Safety Code – Canopy and Overhang Sprinkler Requirements and the Use of the Fire Safety Evaluation System (FSES)
Life Safety Code - Clarification of the Amount of Air Movement Allowed Between Corridors and Resident Rooms and Plenum Waiver Requirements
Life Safety Code – Exit Discharge Requirements and the Fire Safety Evaluation System (FSES)
Multiple Providers - Hospitals, Ambulatory Surgical Centers, Nursing Homes, Religious Non-Medical Health Care Institutions, Programs of All-Inclusive Care for the Elderly (PACE) Facilities, Critical Access Hospitals, Intermediate Care Facilities for the Mentally Retarded – Medical Gas Storage and Usage Considerations
Multiple Providers - Hospitals, Ambulatory Surgical Centers, Nursing Homes, Religious Non-Medical Health Care Institutions, Programs of All-Inclusive Care for the Elderly (PACE) Facilities, Critical Access Hospitals, Intermediate Care Facilities for the Mentally Retarded – Permitted Gaps in Corridor Doors and Doors in Smoke Barriers
Natural Gas Five Criteria Template Letter
NFPA Safety Alert Regarding Antifreeze in Residential Sprinklers
Use of Alcohol-based Skin Preparations in Anesthetizing Locations
Links

Life Safety Code Requirements
Manuals

Emergency Evacuation Planning Guide for People with Disabilities
LSC Transition Course Glossary
NFPA Glossary of Terms
State Operations Manual, Appendix I - Life Safety Code

Life Safety Code Program

Contact

Information and Policies

About the Agency

Contact and Information

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