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2000 to 2012 Hospital K-tag crosswalk matrix for hospitals Adhoc Health Care Committee 2000 to 2012 Hospital K-tag crosswalk matrix for hospitals June 19, 2017 Page 1 2000 Tag # 2000 P # 2000 Language 2012 Tag # 2012 P #r 20120 Language 2018 IBC/IFC Section Commentary N/A N/A N/A K100 2 General Requirements Other List in the REMARKS section, any LSC Section 18.1 and 19.1 General Requirements that are not addressed by the provided K- tags, but are deficient. This information, along with the applicable Life Safety Code or NFPA standard citation, should be included on Form CMS-2567. ? This is a “catch-all”. Until we either do a much more comprehensive review of 101, or we start seeing what gets cited out of this section, it tough to determine if there is a gap. I would argue this needs to be monitored closely, however but we could present this as substantially equivalent. N/A N/A N/A K111 2 Building Rehabilitation IEBC [A] 101.2 Scope. IEBC 301.1 General. IEBC 301.2 Repairs. IEBC 301.3 Alteration, change of occupancy, addition or relocation. IFC 1101.1 Scope. IFC 1101.2 Intent. Minimal work required. This is essentially a scoping document instructing surveryors to acknowledge the existing requirements (IFC), renovation scoping requirements (IEBC) and new construction requirements (IBC). Conceptually both code families are consistent. We should review and monitor the approaches. Update IEBC to address changes of function (storage in a hospital). Review nursing home application (group I-2, condition 1) Repair, Renovation, Modification, or Reconstruction Any building undergoing repair, renovation, modification, or reconstruction complies with both of the following: Requirements of Chapter 18 and 19 Requirements of the applicable Sections 43.3, 43.4, 43.5, and 43.6 18.1.1.4.3, 19.1.1.4.3, 43.1.2.1 IEBC 202 Definitions REPAIR. [A] ALTERATION. IEBC 401.1 Scope. (Repair) IEBC 501.1 Scope. (Prescriptive method) IEBC 701.1 Scope. (Level 1 alterations ) IEBC 801.1 Scope. (Level 2 alterations ) IEBC 901.1 Scope. (Level 3 alterations) IFC 1101.1 Scope. IFC 1101.2 Intent. IFC SECTION 1105 CONSTRUCTION REQUIREMENTS FOR EXISTING GROUP I-2 IFC 1105.1 General. See comment above Change of Use or Change of Occupancy Any building undergoing change of use or change of occupancy classification complies with the requirements of Section 43.7, unless permitted by 18.1.1.4.2 or 19.1.1.4.2 18.1.1.4.2 (4.6.7 and 4.6.11), 19.1.1.4.2 (4.6.7 and 4.6.11), 43.1.2.2 (43.7) IEBC 202 Definitions [A] CHANGE OF OCCUPANCY. IEBC 501.1 Scope. (Prescriptive method) IEBC 1001.1 Scope. (change of occupancy) IEBC SECTION 1002 SPECIAL USE AND OCCUPANCY IEBC 1002.1 Compliance with the building code. Minimal work needed. We addressed change of occupancy clearly and consistently with these concepts. High level review of scoping language needed. Change of use (actual use of space ie. Bedroom to storage room) is not consistent with these requirements. Additions Any building undergoing an addition shall comply with the requirements of Section 43.8. IEBC 202 Definitions ADDITION. IEBC 501.1 Scope. (Prescriptive method) IEBC 502.1 General. IEBC 1101.1 Scope. (addition) No work needed. If the building has a common wall with a nonconforming building, the common wall is a fire barrier having at least a 2-hour fire resistance rating constructed of materials as required for the addition. Communicating openings occur only in corridors and are protected by approved self-closing fire doors with at least a 1 1/2-hour fire resistance rating. Additions comply with the requirements of Section 43.8 (additions). 18.1.1.4.1 (4.6.7 and 4.6.11), 18.1.1.4.1.1 (8.3), 18.1.1.4.1.2, 18.1.1.4.1.3, 19.1.1.4.1 (4.6.7 and 4.6.11), 19.1.1.4.1.1 (8.3), 19.1.1.4.1.2, 19.1.1.4.1.3, 43.1.2.3(43.8) G148-15 (AMPC1) IBC 508.3.1.2 Group I-2, Condition 2 occupancies. Some work needed. This portion of the KTAG is worded in a challenging way. Conceptually, the Ktag tries to acknowledge that non- compliant buildings (ie other occupancies) that are not compliant with the bare minimum requirements for the occupancy (IFC chapter 11requirements) are separated from a new healthcare occupancy with a two hour separation. The building code works the same way if you add an I-2 to another occupancy you will get a minimum 2 hour separation. With non-separated mixed uses, its more difficult to state. We added a section into 2018 IBC 508 to deal with some of the opening protection issues but this needs to be added into the chapter 11 IFC. Review nursing home application (group I-2, condition 1) N/A N/A N/A K112 3 Sprinkler Requirements for Major Rehabilitation If a non-sprinklered smoke compartment has undergone major rehabilitation the automatic sprinkler requirements of 18.3.5 have been applied to the smoke compartment. In cases where the building is not protected throughout by a sprinkler system, the requirements of 18.4.3.2, 18.4.3.3, and 18.4.3.8 are also met. Note: Major rehabilitation involves the modification of more than 50 percent, or more than 4500 square feet of the area of the smoke compartment. 18.1.1.4.3.3,19.1.1.4.3.3 IFC 1105.9 Group I-2 automatic sprinkler system. No work. Because of the decision (2009) to retroactively sprinkler ALL group I-2 areas, and 2015 guidance to sprinkler all buildings containing group I-2 the concept of triggering sprinkler work as part of a rehab is moot. N/A N/A N/A K131 3 Multiple Occupancies Sections of Health Care Facilities Sections of health care facilities classified as other occupancies meet all of the following: IBC 202 Definitions 24-HOUR BASIS. CARE SUITE. CLINIC, OUTPATIENT. CUSTODIAL CARE. DETOXIFICATION FACILITIES. HOSPITALS AND PSYCHIATRIC HOSPITALS. INCAPABLE OF SELF-PRESERVATION. MEDICAL CARE. Some work needed. This portion of the KTAGs deal with multiple occupancies, mixed use. Conceptually, the approaches are now very similar. Ambulatory surgery is identified and is consistent with CMS rule. There may be additional detail needed when describing the movement of inpatients, however, this is arguably already covered in the rules. CMS heavily edits this concept.

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2000 to 2012 Hospital K-tag crosswalk matrix for hospitals

Adhoc Health Care Committee – 2000 to 2012 Hospital K-tag crosswalk matrix for hospitals – June 19, 2017 Page 1

2000 Tag #

2000 P #

2000 Language 2012 Tag #

2012 P #r

20120 Language 2018 IBC/IFC Section Commentary

N/A N/A N/A K100 2 General Requirements – Other

List in the REMARKS section, any LSC Section 18.1

and 19.1 General Requirements that are not

addressed by the provided K- tags, but are deficient.

This information, along with the applicable Life

Safety Code or NFPA standard citation, should be

included on Form CMS-2567.

? This is a “catch-all”. Until we either do a much more comprehensive review of 101, or we start seeing what gets cited out of this section, it tough to determine if there is a gap. I would argue this needs to be monitored closely, however but we could present this as substantially equivalent.

N/A N/A N/A K111 2 Building Rehabilitation IEBC [A] 101.2 Scope. IEBC 301.1 General. IEBC 301.2 Repairs. IEBC 301.3 Alteration, change of occupancy, addition or relocation. IFC 1101.1 Scope. IFC 1101.2 Intent.

Minimal work required. This is essentially a scoping document instructing surveryors to acknowledge the existing requirements (IFC), renovation scoping requirements (IEBC) and new construction requirements (IBC). Conceptually both code families are consistent. We should review and monitor the approaches. Update IEBC to address changes of function (storage in a hospital). Review nursing home application (group I-2, condition 1)

Repair, Renovation, Modification, or Reconstruction

Any building undergoing repair, renovation, modification, or reconstruction complies with both of the following:

• Requirements of Chapter 18 and 19

• Requirements of the applicable Sections 43.3,

43.4, 43.5, and 43.6 18.1.1.4.3, 19.1.1.4.3, 43.1.2.1

IEBC 202 Definitions REPAIR. [A] ALTERATION. IEBC 401.1 Scope. (Repair) IEBC 501.1 Scope. (Prescriptive method) IEBC 701.1 Scope. (Level 1 alterations ) IEBC 801.1 Scope. (Level 2 alterations ) IEBC 901.1 Scope. (Level 3 alterations) IFC 1101.1 Scope. IFC 1101.2 Intent. IFC SECTION 1105 CONSTRUCTION REQUIREMENTS FOR EXISTING GROUP I-2 IFC 1105.1 General.

See comment above

Change of Use or Change of Occupancy

Any building undergoing change of use or change of

occupancy classification complies with the

requirements of Section 43.7, unless permitted by

18.1.1.4.2 or 19.1.1.4.2

18.1.1.4.2 (4.6.7 and 4.6.11), 19.1.1.4.2 (4.6.7 and 4.6.11), 43.1.2.2 (43.7)

IEBC 202 Definitions [A] CHANGE OF OCCUPANCY. IEBC 501.1 Scope. (Prescriptive method) IEBC 1001.1 Scope. (change of occupancy) IEBC SECTION 1002 SPECIAL USE AND OCCUPANCY IEBC 1002.1 Compliance with the building code.

Minimal work needed.

We addressed change of occupancy clearly and consistently with these concepts. High level review of scoping language needed. Change of use (actual use of space ie. Bedroom to storage room) is not consistent with these requirements.

Additions

Any building undergoing an addition shall comply

with the requirements of Section 43.8.

IEBC 202 Definitions ADDITION. IEBC 501.1 Scope. (Prescriptive method) IEBC 502.1 General. IEBC 1101.1 Scope. (addition)

No work needed.

If the building has a common wall with a

nonconforming building, the common wall is a fire

barrier having at least a 2-hour fire resistance rating

constructed of materials as required for the addition.

Communicating openings occur only in corridors and

are protected by approved self-closing fire doors

with at least a 1 1/2-hour fire resistance rating.

Additions comply with the requirements of Section

43.8 (additions).

18.1.1.4.1 (4.6.7 and 4.6.11), 18.1.1.4.1.1 (8.3), 18.1.1.4.1.2, 18.1.1.4.1.3, 19.1.1.4.1 (4.6.7 and 4.6.11), 19.1.1.4.1.1 (8.3),

19.1.1.4.1.2, 19.1.1.4.1.3, 43.1.2.3(43.8)

G148-15 (AMPC1) IBC 508.3.1.2 Group I-2, Condition 2 occupancies. Some work needed.

This portion of the KTAG is worded in a challenging way. Conceptually, the Ktag tries to acknowledge that non-compliant buildings (ie other occupancies) that are not compliant with the bare minimum requirements for the occupancy (IFC chapter 11requirements) are separated from a new healthcare occupancy with a two hour separation. The building code works the same way – if you

add an I-2 to another occupancy you will get a minimum 2 hour separation. With non-separated mixed uses, it’s more difficult to state. We added a section into 2018 IBC 508 to deal with some of the opening protection issues – but this

needs to be added into the chapter 11 IFC. Review nursing home application (group I-2, condition 1)

N/A N/A N/A K112 3 Sprinkler Requirements for Major Rehabilitation

If a non-sprinklered smoke compartment has

undergone major rehabilitation the automatic

sprinkler requirements of 18.3.5 have been

applied to the smoke compartment.

In cases where the building is not protected throughout by a sprinkler system, the requirements of 18.4.3.2, 18.4.3.3, and 18.4.3.8 are also met.

Note: Major rehabilitation involves the

modification of more than 50 percent, or more

than 4500 square feet of the area of the smoke

compartment.

18.1.1.4.3.3,19.1.1.4.3.3

IFC 1105.9 Group I-2 automatic sprinkler system.

No work. Because of the decision (2009) to retroactively sprinkler ALL group I-2 areas, and 2015 guidance to sprinkler all buildings containing group I-2 – the concept of triggering

sprinkler work as part of a rehab is moot.

N/A N/A N/A K131 3 Multiple Occupancies – Sections of Health Care Facilities

Sections of health care facilities classified as other occupancies meet all of the following:

IBC 202 Definitions 24-HOUR BASIS. CARE SUITE. CLINIC, OUTPATIENT. CUSTODIAL CARE. DETOXIFICATION FACILITIES. HOSPITALS AND PSYCHIATRIC HOSPITALS. INCAPABLE OF SELF-PRESERVATION. MEDICAL CARE.

Some work needed. This portion of the KTAGs deal with multiple occupancies, mixed use. Conceptually, the approaches are now very similar. Ambulatory surgery is identified and is consistent with CMS rule. There may be additional detail needed when describing the movement of inpatients, however, this is arguably already covered in the rules. CMS heavily edits this concept.

2000 to 2012 Hospital K-tag crosswalk matrix for hospitals

Adhoc Health Care Committee – 2000 to 2012 Hospital K-tag crosswalk matrix for hospitals – June 19, 2017 Page 2

2000 Tag #

2000 P #

2000 Language 2012 Tag #

2012 P #r

20120 Language 2018 IBC/IFC Section Commentary

NURSING HOMES. PERSONAL CARE SERVICE. IBC SECTION 308 INSTITUTIONAL GROUP I IBC 308.1 Institutional Group I. IBC 308.2 Institutional Group I-1. IBC 308.2.1 Condition 1. IBC 308.2.2 Condition 2. IBC 308.2.3 Six to 16 persons receiving custodial care. IBC 308.2.4 Five or fewer persons receiving custodial care. IBC 308.3 Institutional Group I-2. IBC 308.3.1 Occupancy conditions. IBC 308.3.1.1 Condition 1. IBC 308.3.1.2 Condition 2. IBC 308.3.2 Five or fewer persons receiving medical care. IBC 308.5.3 Five or fewer persons receiving care. IBC 308.5.4 Five or fewer persons receiving care in a dwelling unit.

• They are not intended to serve four or more inpatients.

Needs significant review. In context this is stated, this would allow separated mixed uses if no more than 4 inpatients. This is different that the NFPA stipulation relating to patients capability of self-preservation.

• They are separated from areas of health care

occupancies by construction having a minimum 2-

hour fire resistance rating in accordance with

Chapter 8.

IBC SECTION 508 MIXED USE AND OCCUPANCY IBC 508.1 General.

Needs significant review This would imply that non-separated mixed occupancies are not acceptable. Needs significant clarity in both IBC and IFC.

• The entire building is protected throughout

by an approved, supervised automatic

sprinkler system in accordance with Section

9.7.

IFC 903.3 Installation requirements. IFC 903.3.1 Standards. IFC 903.3.1.1 NFPA 13 sprinkler systems.

Needs some review Recent action to retroactively sprinkler buildings contains an I-2 would cover other occupancies within the building. Not sure how this will be enforced, need to monitor and adjust if applies to buildings outside of the I-2.

Hospital outpatient surgical departments are

required to be classified as an Ambulatory Health

Care Occupancy regardless of the number of

patients served.

18.1.3.3, 19.1.3.3, 42 CFR 482.41, 42 CFR 485.623

IBC 202 DEFINITIONS 24-HOUR BASIS. AMBULATORY CARE FACILITY. CLINIC, OUTPATIENT. IBC 304.1 Business Group B. IBC 422.2 Separation.

No work needed. Current approach to Ambulatory care matches this requirement.

N/A N/A N/A K132 3 Multiple Occupancies – Contiguous Non-Health Care Occupancies

Non-health care occupancies that are located

immediately next to a Health Care Occupancy, but

are primarily intended to provide outpatient

services are permitted to be classified as Business

or Ambulatory Health Care Occupancies, provided

the facilities are separated by construction having

not less than 2-hour fire resistance-rated

construction, and are not intended to provide

services simultaneously for four or more inpatients.

Outpatient surgical departments must be classified

as Ambulatory Health Care Occupancy regardless

of the number of patients served.

18.1.3.4.1, 19.1.3.4.1

IBC 202 DEFINITIONS 24-HOUR BASIS. AMBULATORY CARE FACILITY. CLINIC, OUTPATIENT. IBC 304.1 Business Group B. IBC SECTION 302 OCCUPANCY CLASSIFICATION AND USE DESIGNATION IBC 302.1 Occupancy classification. IBC 302.2 Use designation. IBC 422.2 Separation. IBC TABLE 508.4

f REQUIRED SEPARATION OF OCCUPANCIES (HOURS)

Some work needed. There is a lack of context in the KTAG that would imply that a separated occupancy could have not more than 4 people incapable of self preservation. It’s more accurate to say that NFPA 101 says you must have no more than four before you become an ambulatory healthcare occupancy. Need to clarify intent of NFPA 10, because that is inconsistent. Also need to understand the overlap of CMS COPs to see if they are engineering a separation from a billing perspective.

K11 2 If building has a common wall with nonconforming

building, common wall is a fire barrier of at least a

two hour fire resistance rating constructed of

materials as required for the addition.

Communicating openings occur only in corridors

and shall be protected by approved self-closing fire

doors with at least 1½ hour fire resistance rating

(18.1.1.4.1-2, 18.2.3.2, and 19.1.1.4.1-2).

K133 4 Multiple Occupancies – Construction Type

Where separated occupancies are in

accordance with 18/19.1.3.2 or 18/19.1.3.4,

the most stringent construction type is

provided throughout the building, unless a 2-

hour separation is provided in accordance

with 8.2.1.3, in which case the construction

type is determined as follows:

• The construction type and supporting

construction of the health care occupancy is based

on the story in which it is located in the building in

accordance with 18/19.1.6 and Tables 18/19.1.6.1

• The construction type of the areas of

the building enclosing the other

occupancies shall be based on the

applicable occupancy chapters.

18.1.3.5, 19.1.3.5, 8.2.1.3

IBC SECTION 508 MIXED USE AND OCCUPANCY IBC 508.1 General. IFC 1105.2 Construction.

No work needed

K12 2 2000 EXISTING

Building construction type and height

meets one of the following: 19.1.6.2,

K161 4 Building Construction Type and Height 2012

EXISTING

Building construction type and stories

IFC 1105.2 Construction. IFC TABLE 1105.2 FLOOR LEVEL LIMITATIONS FOR GROUP I-2 CONDITION 2

Some work needed Look @2A and 3 sprinklered. IFC may be more restrictive. Not a problem per se, but may be issue for existing facility depending on implementation date of retro sprinklers.

2000 to 2012 Hospital K-tag crosswalk matrix for hospitals

Adhoc Health Care Committee – 2000 to 2012 Hospital K-tag crosswalk matrix for hospitals – June 19, 2017 Page 3

2000 Tag #

2000 P #

2000 Language 2012 Tag #

2012 P #r

20120 Language 2018 IBC/IFC Section Commentary

19.1.6.3, 19.1.6.4, 19.3.5.1 I (443), I

(332), II (222) Any Height

2 II (111) One story only (non-sprinklered)

3 II (111) Not over three stories with complete automatic sprinkler system

4 III (211) Not over two stories with complete automatic sprinkler system

5 V (111) Not over two stories with complete automatic sprinkler system

6 IV (2HH) Not over two stories with complete

automatic sprinkler system

7 7 II (000)

8 III (200) Not over one story with complete automatic sprinkler system

9 V (000) Not over one story with complete

automatic sprinkler system Building contains fire-

retardant-treated wood

Give a brief description, in REMARKS, of the

construction, the number of stories, including

basements, floors on which patients are located,

location of smoke or fire barriers and dates of

approval. Complete sketch or attach small floor

plan of the building as appropriate.

meets Table 19.1.6.1, unless otherwise

permitted by 19.1.6.2 through 19.1.6.7

19.1.6.4, 19.1.6.5

1 I (442), I (332), II (222) Any number of stories (non-sprinklered and sprinklered)

2 II (111) One story (non-sprinklered) ≤ 3 stories (sprinklered)

3 II (000) No stories (non-sprinklered) ≤ 2 stories (sprinklered)

4 III (211) No stories (non-sprinklered) ≤ 2 stories (sprinklered)

5 IV (2HH) No stories (non-sprinklered) ≤ 2 stories (sprinklered)

6 V (111) No stories (non-sprinklered) ≤ 2 stories (sprinklered)

7 III (200) No stories (non-sprinklered) ≤ 1 story (sprinklered)

8 V (000) No stories (non-sprinklered) ≤ 1 story (sprinklered)

Sprinklered stories must be sprinklered

throughout by an approved, supervised automatic

system in accordance with section 9.7. (See

19.3.5)

Give a brief description, in REMARKS, of the

construction, the number of stories, including

basements, floors on which patients are located,

location of smoke or fire barriers and dates of

approval. Complete sketch or attach small floor plan

of the building as appropriate.

K12 3 2000 NEW

Building construction type and height meets one of the following: 18.1.6.2, 18.1.6.3, 18.3.5.1

1 I (443), I (332), II (222) Any height with complete automatic sprinkler system

2 II (111) Not over three stories with complete automatic sprinkler system

3 III (211) Not over one story with complete automatic sprinkler system

4 V (111) Not over one story with complete automatic sprinkler system

5 IV (2HH) Not over one story with complete automatic sprinkler system

6 II (000) Not over one story with complete automatic sprinkler system

7 III (200) Not permitted

9 V (000) Not permitted

Building contains fire-retardant-treated wood

Give a brief description, in REMARKS, of the

construction, the number of stories, including

basements, floors on which patients are located,

location of smoke or fire barriers and dates of

approval. Complete sketch or attach small floor

plan of the building as appropriate.

K161 5 Building Construction Type and Height 2012 NEW

Building construction type and stories meets Table

18.1.6.1, unless otherwise permitted by 18.1.6.2

through 18.1.6.7. 18.1.6.4, 18.1.6.5

I (442), I (332), II (222) No stories (non-sprinklered),

Any number of stories (sprinklered) II (111) No

stories (non-sprinklered) ≤ 3 stories (sprinklered)

II (000) No stories (non-sprinklered) ≤ 1 story

(sprinklered) III (211) No stories (non-sprinklered) ≤

1 story (sprinklered) IV (2HH) No stories (non-

sprinklered) ≤ 1 story (sprinklered) V (111) No stories

(non-sprinklered) ≤ 1 story (sprinklered) III (200), V

(000) No stories permitted

Sprinklered stories must be sprinklered throughout

by an approved, supervised automatic system in

accordance with section 9.7. (See 18.3.5)

Give a brief description, in REMARKS, of the

construction, the number of stories, including

basements, floors on which patients are located,

location of smoke or fire barriers and dates of

approval. Complete sketch or attach small floor plan

of the building as appropriate.

IBC CHAPTER 5 GENERAL BUILDING HEIGHTS AND AREAS IBC Section 504 BUILDING HEIGHT AND NUMBER OF STORIES IBC Section 506 BUILDING AREA IBC Section 509 INCIDENTAL USES IBC Section 414 HAZARDOUS MATERIALS IBC Section 415 GROUPS H-1, H-2, H03, H-4 AND H-5 IBC Section 903.2.6 Group I (sprinklers required)

No work needed While the construction types are similar the taxonomy is slightly different. This is something we are familiar with and could be accommodated by just adopting the ICC approach to classification.

N/A N/A N/A K162 6 Roofing Systems Involving Combustibles 2012

NEW

Buildings of Type I (442), (332) or Type II (222), or

Type II (111) having roof systems employing

combustible roofing supports, decking or roofing

meet the following:

1. roof covering meets Class A requirements

2. roof is separated from occupied building portions

with 2-hour fire resistive noncombustible floor

assembly using not less than 2-1/2 inches concrete

or gypsum fill

3. the structural elements supporting the

rated floor assembly meet the required

fire resistance rating of the building

18.1.6.2, ASTM E108, ANSI/UL 790

IBC Chapter 15 Roof assemblies and rooftop structures Needs significant review This is a new KTAG and needs to be compared to the roofing requirements in Chapter 15. These construction types appear to allow class B roofing.

2000 to 2012 Hospital K-tag crosswalk matrix for hospitals

Adhoc Health Care Committee – 2000 to 2012 Hospital K-tag crosswalk matrix for hospitals – June 19, 2017 Page 4

2000 Tag #

2000 P #

2000 Language 2012 Tag #

2012 P #r

20120 Language 2018 IBC/IFC Section Commentary

K103 3 Interior walls and partitions in buildings of Type

I or Type II construction shall be

noncombustible or limited- combustible

materials 18.1.6.3, 19.1.6.3 (Indicate N/A for

existing buildings using listed fire retardant

treated wood studs within non-load bearing

one-hour rated partitions.).

K163 6 Interior Non-Bearing Wall Construction

Interior non-bearing walls in Type I or II

construction are constructed of noncombustible

or limited-combustible materials. Interior non-

bearing walls required to have a minimum 2-

hour fire resistance rating are fire-retardant-

treated wood enclosed within noncombustible or

limited-combustible materials, provided they are

not used as shaft enclosures.

18.1.6.4, 18.1.6.5, 19.1.6.4, 19.1.6.5

IBC CHAPTER 6 TYPES OF CONSTRUCTION IBC SECTION 602 CONSTRUCTION CLASSIFICATIONS IBC 602.2 Types I and II IBC COMBUSTIBLE MATERIALS IN TYPES I AND II CONSTRUCTION

Some work needed. Chapter 6 covers combustible and limited combustible material permitted in Types 1 and 2 construction. Some comparison needs to occur. There may be allowances in IBC that are not in 101 – however the point is that there is a mechanism to determine what is allowed. Note last sentence of KTAG is misleading – NFPA 101 does not require all 2 hour walls to be constructed out of FRT wood.

N/A N/A N/A K200 7 Means of Egress Requirements – Other

List in the REMARKS section any LSC Section 18.2

and 19.2 Means of Egress requirements that are not

addressed by the provided K-tags, but are deficient.

This information, along with the applicable Life

Safety Code or NFPA standard citation, should be

included on Form CMS-2567.

18.2, 19.2

? This is a “catch-all”. Until we either do a much more comprehensive review of 101, or we start seeing what gets cited out of this section, it tough to determine if there is a gap. I would argue this needs to be monitored closely, however but we could present this as substantially equivalent because the ICC family goes into much more detail about the arrangement of the means of egress.

K72 15 Means of egress shall be continuously maintained

free of all obstructions or impediments to full instant

use in the case of fire or other emergency. No

furnishings, decorations, or other objects shall

obstruct exits, access thereto, egress there from, or

visibility thereof shall be in accordance with 7.1.10.

18.2.1, 19.2.1

K211 7 Means of Egress – General

Aisles, passageways, corridors, exit discharges, exit

locations, and accesses are in accordance with

Chapter 7, and the means of egress is continuously

maintained free of all obstructions to full instant use

in case of emergency, unless modified by 18/19.2.2

through 18/19.2.11.

18.2.1, 19.2.1, 7.1.10.1

IBC [F] 1002.1 Maintenance. IBC 1003.3 Protruding objects IBC SECTION 1005 MEANS OF EGRESS SIZING IBC SECTION 1006 NUMBER OF EXITS AND EXIT ACCESS DOORWAYS IBC SECTION 1007 EXIT AND EXIT ACCESS DOORWAY CONFIGURATION IBC SECTION 1018 AISLES IBC SECTION 1020 CORRIDORS IBC SECTION 1024 EXIT PASSAGEWAYS IBC SECTION 1028 EXIT DISCHARGE

IFC SECTION 1031 MAINTENANCE OF THE MEANS OF EGRESS IFC 1031.1 General. IFC 1031.2 Reliability. IFC 1105.5 Means of egress.

Very minimal work needed. IFC 1031 covers this concept. Should check1031.3.1 (temporary obstructions) for consistency with CMS enforcement.

K43 14 Patient room doors are arranged such that the

patients can open the door from inside without

using a key. Special door locking arrangements are

permitted in facilities. 18.2.2.2.4, 18.2.2.2.5,

19.2.2.2.4, 19.2.2.2.5 If door locking arrangement

without delay egress is used indicate in REMARKS

18.2.2.2.2, 19.2.2.2.2

K221 7 Patient Sleeping Room Doors

Locks on patient sleeping room doors are not

permitted unless the key-locking device that

restricts access from the corridor does not

restrict egress from the patient room, or the

locking arrangement is permitted for patient

clinical, security or safety needs in accordance

with 18.2.2.2.5 or 19.2.2.2.5.

18.2.2.2, 19.2.2.2, TIA 12-4

IBC 407.4.1.1 Locking devices. IBC 1010.1.9.4 Locks and latches.

Work needed. The ICC does not specifically address the patient room door condition. The referenced allowance for egress restrictions are similar to the IBC - these should be validated. There is no mention of delayed or restricted egress conditions in IFC 1104 or 1105, one would assume it default to code at time of construction. This may not be a good enough tool for the fire inspector.

N/A N/A N/A K222 8 Egress Doors

Doors in a required means of egress shall not be

equipped with a latch or a lock that requires the use

of a tool or key from the egress side unless using

one of the following special locking arrangements:

IFC 1031.2.1 Security devices and egress locks.

Some work needed See previous comments on K221. The past two cycles have seen significant work to resolve inconsistences and make these systems realistic, safe, and buildable. In some cases the ICC is now more stringent than some of these requirements. In most cases it is certainly more comphrehensive. The NFPA code changed significantly from the last KTAG. These requirements should be compared to 2012 KTAG to see if differences are significant. K222 is long – some comments are below.

CLINICAL NEEDS OR SECURITY THREAT LOCKING

Where special locking arrangements for the clinical

security needs of the patient are used, only one

locking device shall be permitted on each door and

provisions shall be made for the rapid removal of

occupants by: remote control of locks; keying of all

locks or keys carried by staff at all times; or other

such reliable means available to the staff at all times.

18.2.2.2.5.1, 18.2.2.2.6, 19.2.2.2.5.1, 19.2.2.2.6

IBC 10101.1.9.7 Controlled egress doors in Groups I-1 and I-2. The KTAG makes it sounds simplier than the code, review 18.2.2.2 in detail, plus all options available in the ICC. Note the exception condition apply to this condition is most similar to the option in 18.2.2.2.6 Should check and see if we need to limit device to one per door.

SPECIAL NEEDS LOCKING ARRANGEMENTS

Where special locking arrangements for the safety

needs of the patient are used, all of the Clinical or

Security Locking requirements are being met. In

addition, the locks must be electrical locks that fail

safely so as to release upon loss of power to the

device; the building is protected by a supervised

automatic sprinkler system and the locked space is

protected by a complete smoke detection system

(or is constantly monitored at an attended location

within the locked space); and both the sprinkler and

IBC 10101.1.9.7 Controlled egress doors in Groups I-1 and I-2. The base condition (without exception) is most comparable.

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detection systems are arranged to unlock the doors

upon activation.

18.2.2.2.5.2, 19.2.2.2.5.2, TIA 12-4

DELAYED-EGRESS LOCKING ARRANGEMENTS

Approved, listed delayed-egress locking systems

installed in accordance with 7.2.1.6.1 shall be

permitted on door assemblies serving low and

ordinary hazard contents in buildings protected

throughout by an approved, supervised automatic

fire detection system or an approved, supervised

automatic sprinkler system.

18.2.2.2.4, 19.2.2.2.4

IBC 1010.1.9.8 Delayed egress. IBC 1010.1.9.8.1 Delayed egress locking system.

Need to review, it should be very close.

ACCESS-CONTROLLED EGRESS LOCKING ARRANGEMENTS

Access-Controlled Egress Door assemblies installed

in accordance with 7.2.1.6.2 shall be permitted.

18.2.2.2.4, 19.2.2.2.4

IBC 10101.1.9.7 Controlled egress doors in Groups I-1 and I-2. IBC 1010.1.9.9 Sensor release of electrically locked egress doors.

Needs review

ELEVATOR LOBBY EXIT ACCESS LOCKING ARRANGEMENTS 0

Elevator lobby exit access door locking in

accordance with 7.2.1.6.3 shall be permitted on door

assemblies in buildings protected throughout by an

approved, supervised automatic fire detection

system and an approved, supervised automatic

sprinkler system.

18.2.2.2.4, 19.2.2.2.4

IBC 1016.2 Egress through intervening spaces. IBC 3006.4 Means of egress. (Elevator lobbies) IFC 1031.2.1 Security devices and egress locks.

Concept is similar

K21 7 Doors in an exit passageway, stairway enclosure, horizontal exit, smoke barrier or hazardous area enclosure are self-closing and kept in the closed position, unless held open by a release device complying with 7.2.1.8.2 that automatically closes all such doors throughout the smoke compartment or entire facility upon activation of: The required manual fire alarm system and Local smoke detectors designed to detect smoke passing through the opening or a required smoke detection system and The automatic sprinkler system, if installed 18.2.2.2.6, 18.3.1.2

K223 9 Doors with Self-Closing Devices

Doors in an exit passageway, stairway enclosure, or

horizontal exit, smoke barrier, or hazardous area

enclosure are self- closing and kept in the closed

position, unless held open by a release device

complying with 7.2.1.8.2 that automatically closes

all such doors throughout the smoke compartment

or entire facility upon activation of:

• Required manual fire alarm system; and

• Local smoke detectors designed to detect smoke passing through the opening or a required smoke detection system; and

• Automatic sprinkler system, if installed; and

• Loss of power

18.2.2.2.7, 18.2.2.2.8, 19.2.2.2.7, 19.2.2.2.8

IBC 716.2.6.6 Smoke-activated doors. F253-16 (AS) IFC 1105.5.2 Group I-2 occupancies.

Review Significant work was done to align these two. Not sure why we are not listing loss of power, although that may be implied.

N/A N/A N/A K224 9 Horizontal Sliding Doors

Horizontal-sliding doors permitted by 7.2.1.14 that

are not automatic-closing are limited to a single

leaf and shall have a latch or other mechanism to

ensure the door will not rebound.

Horizontal-sliding doors serving an occupant

load fewer than 10 shall be permitted, providing

all of the following criteria are met:

• Area served by the door has no hazards

• Door is operable from either side without special knowledge or effort

• Force required to operate the door in the direction

of travel is ≤ 30 lbf to set the door in motion and ≤

15 lbf to close or open to the required width

• Assembly is appropriately fire rated, and

where rated is self-or automatic-closing by

smoke detection per 7.2.1.8, and installed

per NFPA 80

• Where required to latch,

the door has a latch or

other mechanism to ensure

the door will not rebound.

18.2.2.2.10, 19.2.2.2.10

IBC 1010.1.2 Door swing. IBC 1010.1.4.3 Special purpose horizontal sliding, accordion or folding doors.

Some work needed. This is a new KTAG dealing with sliding doors. The current IBC language is misleading and needs review. A strict read would prohibit sliding doors in medical surgical patient rooms. The laundry list in item is narrow. Most patient rooms are not critical or intensive care as described in item 3. Practically MANY facilities have been built with sliding corridor doors that technically don’t meet all of the IBC

requirements. Also – there are some restrictions in the

KTAG that are good add to the ICC language (eg. ensuring no rebound)

K34 13 Stairways and smokeproof enclosures used as

exits are in accordance with 7.2. 18.2.2.3,

18.2.2.4, 19.2.2.3, 19.2.2.4

K225 9 Stairways and Smokeproof Enclosures

Stairways and Smokeproof enclosures used as exits

are in accordance with 7.2. 18.2.2.3, 18.2.2.4,

19.2.2.3, 19.2.2.4, 7.2

IBC 403.5.4 Smokeproof enclosures. IBC SECTION 1011 STAIRWAYS IBC SECTION 1019 EXIT ACCESS STAIRWAYS AND RAMPS IBC 1019.4 Group I-2 and I-3 occupancies. IBC SECTION 1023 INTERIOR EXIT STAIRWAYS AND RAMPS IBC 1023.11 Smokeproof enclosures. IBC 1023.11.1 Termination and extension. IBC 1023.11.2 Enclosure access.

Some work needed. Requirements are similar. Section 1023 states that were these are required they shall be constructed as follows. The KTAGs and 101 broadly permit them to be used as a strategy. We should also compare requirements.

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K44 14 Horizontal exits, if used, are in accordance with 7.2.4. 18.2.2.5, 19.2.2.5

K226 10 Horizontal Exits

Horizontal exits, if used, are in accordance with

7.2.4 and the provisions of 18.2.2.5.1 through

18.2.2.5.7, or 19.2.2.5.1 through 19.2.2.5.4.

18.2.2.5, 19.2.2.5

IBC Section 1026 Horizontal Exits Some review needed. While this is not a new requirement, there have been some changes to the basic horizontal exit concepts in 101. I do not think they apply to Healthcare, but we should review.

N/A N/A N/A K227 10 Ramps and Other Exits

Ramps, exit passageways, fire and slide escapes,

alternating tread devices, and areas of refuge are in

accordance with the provisions 7.2.5 through 7.2.12.

18.2.2.6 to 18.2.2.10 or 19.2.2.6 to 19.2.2.10

IBC [BE] 1009.6 Areas of refuge. IBC [BE] 1011.14 Alternating tread devices. IBC SECTION 1019 EXIT ACCESS STAIRWAYS AND RAMPS [BE] 1019.4 Group I-2 and I-3 occupancies. IBC SECTION 1023 INTERIOR EXIT STAIRWAYS AND RAMPS IBC SECTION 1024 EXIT PASSAGEWAYS IBC SECTION 1027 EXIT STAIRWAYS AND RAMPS IFC 1104.16 Fire escape stairways. IEBC SECTION 505 FIRE ESCAPES

Some review needed. This is a new KTAG, and to confirm consistency, we should review.

K35 13 The capacity of required mean of egress is based on its width, in accordance with 7.3.

K231 10 Means of Egress Capacity

The capacity of required means of egress is in

accordance with 7.3. 18.2.3.1, 19.2.3.1

No review needed.

K39 13, 14

2000 EXISTING

Width of aisles or corridors (clear and unobstructed) serving as exit access shall be at least 4 feet. 19.2.3.3

K232 10 Aisle, Corridor or Ramp Width 2012 EXISTING

The width of aisles or corridors (clear or

unobstructed) serving as exit access shall be at

least 4 feet and maintained to provide the

convenient removal of nonambulatory patients on

stretchers, except as modified by 19.2.3.4,

exceptions 1-5.

19.2.3.4, 19.2.3.5

IFC 1031.3.1 Group I-2. IFC 1104.15 Width of ramps. IFC 1105.5.3 Ramps. IFC 1105.5.4 Corridor width. IFC 1105.5.7 Aisles.

Some review needed. As noted above 2018 IFC language is significantly coordinated with the changes made to this KTAG. We should monitor compliance and application of this section to ensure concept is accurately/adequately reflected in IFC 1031.

K39 13, 14

2000 NEW

Width of aisles or corridors (clear and

unobstructed) serving as exit access in hospitals

and nursing homes shall be at least 8 feet.

In limited care facility and psychiatric

hospitals, width of aisles or corridors shall be

at least 6 feet. 18.2.3.3, 18.2.3.4

K232 10 Aisle, Corridor or Ramp Width 2012 NEW

The width of aisles or corridors (clear and

unobstructed) serving as exit access in hospitals

and nursing homes shall be at least 8 feet. In limited

care facility and psychiatric hospitals, width of aisles

or corridors shall be at least 6 feet, except as

modified by the 18.2.3.4 or 18.2.3.5 exceptions.

18.2.3.4, 18.2.3.5

IBC 407.4.3 Projections in nursing home corridors. IBC 1003.3.3 Horizontal projections. IBC 1003.4 Slip-resistant surface. IBC 1018.5 Aisles in other than assembly spaces and Groups B and M. IBC 1020.2 Width and capacity. IBC TABLE 1020.2 MINIMUM CORRIDOR WIDTH IBC 1020.3 Obstruction. IBC 1024.2 Width and capacity. IFC 1031.3 Obstructions.

Some work needed. IBC language may need link back to IFC 1031, to inform designers and enforcement agents. Item (6) in 18.2.3.4 is a good design clarification that really needs to be in the IBC. Perhaps we should clarify if there is an operational solution to IFC 1031.3, or at least a reasonable definition of accumulation.

K40 14 2000 EXISTING

Exit access doors and exit doors used by

health care occupants are of the swinging type

and are at least 32 inches in clear width. An

exception is provided for existing 34-inch

doors in existing occupancies. 19.2.3.5

K233 11 Clear Width of Exit and Exit Access Doors 2012

EXISTING

Exit access doors and exit doors are of the

swinging type and are at least 32 inches in clear

width. Exceptions are provided for existing 34-inch

doors and for existing 28-inch doors where the fire

plan does not require evacuation by bed, gurney, or

wheelchair.

19.2.3.6, 19.2.3.7

IBC 407.4.3 Projections in nursing home corridors. IBC 1003.3.3 Horizontal projections. IBC 1003.4 Slip-resistant surface.

Work needed. This concept was added into chapter 11 IFC last cycle. Needs review to compare scope of IFC (doors used for movement of beds) to KTAG (MOE doors and list locations). There may need to be further work for doors not seeing bed movement.

K40 14 2000 NEW

Exit access doors and exit doors used by health

care occupants are of the swinging type and are

at least 41.5 inches in clear width. Doors in exit

stairway enclosures shall be no less than 32

inches in clear width. In psychiatric hospitals or

limited care facilities (e.g.,ICF/MD providing

medical treatment) doors are at least 32 inches

wide. 18.2.3.5

K233 11 Clear Width of Exit and Exit Access Doors 2012

NEW

Exit access doors and exit doors are of the

swinging type and are at least 41-1/2 inches in

clear width. In psychiatric hospitals or limited care

facilities, doors are at least 32 inches wide. Doors

not subject to patient use, in exit stairway

enclosures, or serving newborn nurseries shall be

no less than 32 inches in clear width. If using a

pair of doors, the doors shall be provided with a

rabbet, bevel, or astragal at the meeting edge, at

least one of the doors shall provide 32 inches in

clear width, and the inactive leaf of the pair shall

be secured with automatic flush bolts.

18.2.3.6, 18.2.3.7

IBC 1010.1.1 Size of doors. Work needed. The scope of this requirement may need to be modified to specific uses (see 18.2.3.7). Also IBC does not address the use of pair of doors to meet requirement and the restrictions placed upon them by this (see 18.2.3.7)

N/A N/A N/A K241 11 Number of Exits – Story and Compartment

Not less than two exits, remote from each other, and

accessible from every part of every story are

provided for each story. Each smoke

compartment shall likewise be provided with two

distinct egress paths to exits that do not require the

entry into the same adjacent smoke compartment.

18.2.4.1-18.2.4.4, 19.2.4.1-19.2.4.4

IBC 407.4 Means of egress. G107-15 (AS) (G109-15 AMPC1) IBC 407.5.1 Smoke compartment size. G107-15 (AS) IBC 407.5.2 Exit access travel distance. IBC 1006.2.1 Egress based on occupant load and common path of egress travel distance. IFC 1104.20 Common path of egress travel. IFC 1105.5.6 Separation of exit access doors. IFC 1105.6 Smoke compartments. IFC 1105.6.1 Design. IFC 1105.6.1.1 Refuge areas. IFC 1105.7 Group I-2 care suites. IEBC 503.12 Refuge areas. IEBC 503.12.1 Smoke compartments.

Work needed This is a new KTAG. While the default for existing (IFC 1104) refers you to code at time of construction, this may be too obscure for these purposes. We need to look at this minimum standard for existing and reflect KTAG. Construction requirements for new are aligned. The last sentence relates to independent egress from smoke compartment. This was significantly modified from the previous KTAG – but the new 2018 language should meet this concept.

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IEBC 503.12.2 Ambulatory care. IEBC 802.3 Smoke compartments. IEBC 804.4.1.2 Group I-2.

K37 13 2000 EXISTING

Existing dead-end corridors shall be permitted to be

continued to be used if it is impractical and

unfeasible to alter them so that exists are accessible

in not less than two different directions from all

points in aisles, passageways, and corridors.

19.2.5.10

K251 11 Dead-End Corridors and Common Path of Travel

2012 EXISTING

Dead-end corridors shall not exceed 30 feet.

Existing dead-end corridors greater than 30 feet

shall be permitted to be continued to be used if it is

impractical and unfeasible to alter them.

19.2.5.2

IFC 1104.18 Dead end corridors. IFC TABLE 1104.18 COMMON PATH, DEAD-END AND TRAVEL DISTANCE LIMITS (by occupancy) IFC 1104.20 Common path of egress travel. IFC 1105.5.5 Dead-end corridors. IEBC 804.6 Dead-end corridors.

Some work needed. While the fire code requirement is more stringent than the KTAG, the KTAG has an open-ended acceptance of any condition. The IEBC language may be too permissive for existing conditions, but it is not as permissive as the KTAG. Regardless, the IEBC needs to be coordinated with Fire code.

K37 13 2000 NEW

Every exit and exit access shall be arranged so

that no corridor, aisle or passageway has a

pocket or dead-end exceeding 30 feet. 18.2.5.10

K251 12 Dead-End Corridors and Common Path of Travel

2012 NEW

Dead-end corridors shall not exceed 30 feet.

Common path of travel shall not exceed 100 feet.

18.2.5.2, 18.2.5.3

IBC 1006.2.1 Egress based on occupant load and common path of egress travel distance. IBC TABLE 1006.2.1 SPACES WITH ONE EXIT OR EXIT ACCESS DOORWAY IBC 1020.4 Dead ends.

Some review needed. The ICC codes are more restrictive in this regard:

20 ft max dead-ends vs 30ft.

75ft CPOT vs 100ft. However it applies to new construction only. CPOT is new to this KTAG, and should be reviewed. These difference were reviewed previously and because they are more restrictive, we believe it addressed the issue.

K32 12 Not less than two exits, remote from each other, are

provided for each floor or fire section of the building.

Not less than one exit from each floor or fire section

shall be a door leading outside, stair, smoke-proof

enclosure, ramp, or exit passageway. Only one of

these two exits may be a horizontal exit. Egress

shall not return through the zone of fire origin.

18.2.4.1, 18.2.4.2, 19.2.4.1, 19.2.4.2

K252 12 Number of Exits – Corridors

Every corridor shall provide access to not less than

two approved exits in accordance with Sections 7.4

and 7.5 without passing through any intervening

rooms or spaces other than corridors or lobbies.

18.2.5.4, 19.2.5.4

IBC 1020.6 Corridor continuity.

Review needed. The scope of this KTAG has changed significantly. It focuses on access to exits from a corridor and corridor continuity today, whereas previously it addressed general access to exits and limits to use of HEs. The IBC addresses corridor continuity for fire resistance rated corridors (1020.6) but does not address non-rated corridors which we have in hospitals.

K42 14 Any patient sleeping room or suite of rooms of

more than 1,000 sq. ft. has at least 2 exit

access doors remote from each other. 18.2.5.2,

19.2.5.2

K253 12 Number of Exits – Patient Sleeping and Non-Sleeping Rooms

Patient sleeping rooms of more than 1,000 square

feet or nonsleeping rooms of more than 2,500

square feet have at least two exit access doors

remotely located from each other.

18.2.5.5.1, 18.2.5.5.2, 19.2.5.5.1, 19.2.5.5.2

IBC 407.4 Means of egress. IBC 407.4.1 Direct access to a corridor. IBC 407.4.4 Group I-2 care suites. IBC 407.4.4.1 Exit access through care suites. IBC 407.4.4.2 Separation. IBC 407.4.4.3 Access to corridor. IBC 407.4.4.4 Doors within care suites. IBC 407.4.4.5 Care suites containing sleeping room areas. IBC 407.4.4.5.1 Area. IBC 407.4.4.5.2 Exit access. IBC 407.4.4.6 Care suites not containing sleeping rooms. IBC 407.4.4.6.1 Area. IBC 407.4.4.6.2 Exit access. IBC SECTION 1006 NUMBER OF EXITS AND EXIT ACCESS DOORWAYS

No review needed. Revisions last cycle aligned the codes appropriately

K41 14 All sleeping rooms have a door leading to a

corridor providing access to an exit or have a door

leading directly to grade. One room may intervene

in accordance with 18.2.5.1, 19.2.5.1 If doors lead

directly to grade from each room, check this box.

K254 12 Corridor Access

All habitable rooms not within suites have a door

leading directly outside to grade or have a door

leading to an exit access corridor. Patient sleeping

rooms with less than eight patient beds may have

one room intervening to reach an exit access

corridor provided the intervening room is equipped

with an approved automatic smoke detection

system.

18.2.5.6.1 through 18.2.5.6.4, 19.2.5.6.1 through 19.2.5.6.4

IBC 407.4.1 Direct access to a corridor. IBC 407.4.4 Group I-2 care suites. IBC 407.4.4.1 Exit access through care suites. IBC 407.4.4.2 Separation. IBC 407.4.4.3 Access to corridor. IBC 407.4.4.4 Doors within care suites. IBC 407.4.4.5 Care suites containing sleeping room areas. IBC 407.4.4.5.1 Area. IBC 407.4.4.5.2 Exit access. IBC 407.4.4.6 Care suites not containing sleeping rooms. IBC 407.4.4.6.1 Area. IBC 407.4.4.6.2 Exit access.

Some review needed. The corridor access concept is aligned in clear in both codes. The limitation of 8 sleeping beds is consistent as well, however the location of smoke detection differs. ICC monitors the condition of the sleeping room, KTAG monitors condition of the suite. This may be moot due to direct supervision Vs smoke detection requirements.

N/A N/A N/A K255 13 Suite Separation, Hazardous Content, and Subdivision

All suites are separated from the remainder of the

building (including from other suites) by

construction meeting the separation provisions for

corridor construction (18.3.6.2-18.3.6.5 or 19.3.6.2-

19.3.6.5). Existing approved barriers shall be

allowed to continue to be used provided they limit

the transfer of smoke. Intervening rooms have no

hazardous areas and hazardous areas within suites

comply with 18/19.2.5.7.1.3. Subdivision of suites

shall be by noncombustible or limited-combustible

construction.

18.2.5.7.1.2 through 18.2.5.7.1.4, 19.2.5.7.1.2, 19.2.5.7.1.3, 19.2.5.7.1.4

IBC 407.4.4.2 Separation.

Work needed Separation of suites is accomplished by a smoke partition, which is now consistent in both codes. Control over the walls subdividing suites is a new concept. This KTAG is misleading – 101 allows walls of FRT with non- or limited combustible covering.

N/A N/A N/A K256 14 Sleeping Suites

Occupants shall have exit access to a corridor or

direct access to a horizontal exit. Where ≥ 2 exits

are required, one exit access door may be to a

stairway, passageway or to the exterior. Suites shall

be provided with constant staff supervision. Staff

IBC 407.4 Means of egress. IBC 407.4.1 Direct access to a corridor. IBC 407.4.4 Group I-2 care suites. IBC 407.4.4.1 Exit access through care suites. IBC 407.4.4.2 Separation. IBC 407.4.4.3 Access to corridor. IBC 407.4.4.4 Doors within care suites.

Work needed. Access to corridor is implied, could be clearer, but not necessary. Option to access an exit as one of the options is new – doesn’t really support defend in place concept – needs some review. Need to review direct vs. constant visual supervision in new KTAG. Number of exits when <1000sf, access through adjacent

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shall have direct visual supervision of patient

sleeping rooms, from a constantly attended location

or the room shall be provided with an automatic

smoke detection system.

Suites more than 1,000 square feet shall have 2 or

more remote exits. One means of egress from the

suite shall be to a corridor and one may be into an

adjacent suite separated in accordance with corridor

requirements.

IBC 407.4.4.5 Care suites containing sleeping room areas. IBC 407.4.4.5.1 Area. IBC 407.4.4.5.2 Exit access. IBC 407.4.4.6 Care suites not containing sleeping rooms. IBC 407.4.4.6.1 Area. IBC 407.4.4.6.2 Exit access. IBC SECTION 1006 NUMBER OF EXITS AND EXIT ACCESS DOORWAYS

suite are aligned.

Suites shall not exceed the following size limitations:

• 5,000 square feet if the suite is not fully smoke detected or fully sprinklered

• 7,500 square feet if the suite is either fully smoke detected or fully sprinklered

• 10,000 square feet if the suite is both fully smoke

detected and fully sprinklered and the sleeping

rooms have direct supervision from a constantly

attended location

Travel distance between any point in a suite to exit

access shall not exceed 100 ft. and distance to an

exit shall not exceed 150 ft. (200 ft. if building is fully

sprinklered).

18.2.5.7.2, 19.2.5.7.2

IBC 407.4 Means of egress. IBC 407.4.1 Direct access to a corridor. IBC 407.4.4 Group I-2 care suites. IBC 407.4.4.1 Exit access through care suites. IBC 407.4.4.2 Separation. IBC 407.4.4.3 Access to corridor. IBC 407.4.4.4 Doors within care suites. IBC 407.4.4.5 Care suites containing sleeping room areas. IBC 407.4.4.5.1 Area. IBC 407.4.4.5.2 Exit access. IBC 407.4.4.6 Care suites not containing sleeping rooms. IBC 407.4.4.6.1 Area. IBC 407.4.4.6.2 Exit access. IBC SECTION 1006 NUMBER OF EXITS AND EXIT ACCESS DOORWAYS

Some review needed. Size aligned. Travel distance aligned. ICC still counts doors NFPA does not.

N/A N/A N/A K257 14 Non-Sleeping Suites

Occupants shall have exit access to a corridor or

direct access to a horizontal exit. Where ≥ 2 exits

are required, one exit access door may be to a

stairway, passageway or to the exterior.

Suites more than 2,500 square feet shall have 2 or

more remote exits. One means of egress from the

suite shall be to a corridor and one may be into an

adjacent suite separated in accordance with corridor

requirements.

Suites shall not exceed 10,000 square feet.

Travel distance between any point in a suite to exit

access shall not exceed 100 ft. and distance to an

exit shall not exceed 150 ft. (200 ft. if building is fully

sprinklered).

18.2.5.7.3, 19.2.5.7.3

IBC 407.4 Means of egress. IBC 407.4.1 Direct access to a corridor. IBC 407.4.4.6 Care suites not containing sleeping rooms. IBC 407.4.4.6.1 Area. IBC 407.4.4.6.2 Exit access. IBC SECTION 1006 NUMBER OF EXITS AND EXIT ACCESS DOORWAYS

See K256

K36 13 Travel distance (exit access) to exits are measured in accordance with 7.6.

• Room door to exit ≤ 100 ft. (≤ 150 ft. sprinklered)

• Point in room or suite to exit ≤ 150 ft. (≤ 200 ft. sprinklered)

• Point in room to room door ≤ 50 ft.

• Point in suite to suite door ≤ 100 ft. 18.2.6, 19.2.6

K261 15 Travel Distance to Exits

Travel distance (excluding suites) to exits are measured in accordance with 7.6.

• From any point in the room or suite to exit ≤ 150 feet (≤ 200 ft. if the building is fully sprinklered)

• Point in a room to room door ≤ 50 ft. 18.2.6,

19.2.6

IBC SECTION 1017 EXIT ACCESS TRAVEL DISTANCE IBC 1017.1 General. IBC 1017.2 Limitations. IBC TABLE 1017.2 EXIT ACCESS TRAVEL DISTANCE

a

IBC 407.4.2 Distance of travel. IFC 1104.19 Exit access travel distance. IFC Table 1104.18 COMMON PATH, DEAD-END AND TRAVEL DISTANCE LIMITS (by occupancy)

No work needed Concepts match.

K38 13 Exit access is so arranged that exits are readily accessible at all times in accordance with 7.1, 18.2.1, 19.2.1

K271 15 Discharge from Exits

Exit discharge is arranged in accordance with 7.7,

provides a level walking surface meeting the

provisions of 7.1.7 with respect to changes in

elevation and shall be maintained free of

obstructions. Additionally, the exit discharge shall

be a hard packed all- weather travel surface in

accordance with CMS Survey and Certification

Letter 05-38.

18.2.7, 19.2.7, S&C 05-38

IBC 1003.4 Floor surface. IBC 1003.5 Elevation change. IBC 1003.6 Means of egress continuity. IBC 1028.5 Access to a public way. IFC 1031.3 Obstructions.

Some review needed. KTAGS allow discharge to adjacent or adjoining roofs, should review

K45 15 Illumination of means of egress, including exit

discharge, is arranged so that failure of any single

lighting fixture will not leave the area in darkness.

Lighting system shall be either continuously in

operation or capable of automatic operation

without manual intervention. 18.2.8, 19.2.8, 7.8

K281 15 Illumination of Means of Egress

Illumination of means of egress, including exit

discharge, is arranged in accordance with 7.8 and

shall be either continuously in operation or capable

of automatic operation without manual intervention.

18.2.8, 19.2.8

IBC SECTION 1008 MEANS OF EGRESS ILLUMINATION IBC 1008.1 Means of egress illumination. IBC 1008.2 Illumination required. IBC 1008.2.1 Illumination level under normal power. IBC 1008.2.2 Group I-2. (E33-15 AM) IBC 1008.2.3 Exit Discharge. IBC 1008.3 Emergency power for illumination. IBC 1008.3.1 General. IBC 1008.3.2 Buildings. IBC 1008.3.3 Rooms and spaces. IEBC 805.7 Means-of-egress lighting. IEBC 805.7.1 Artificial lighting required. IEBC 805.7.2 Supplemental requirements for means-ofegress lighting. IEBC 905.2 Means-of-egress lighting. IFC 1104.5 Illumination emergency power.

Review only.

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K46 15 Emergency lighting of at least 1½

hour duration is provided

automatically in accordance with

7.9. 18.2.9.1, 19.2.9.1.

K291 15 Emergency Lighting

Emergency lighting of at least 1½-hour duration is

provided automatically in accordance with 7.9.

18.2.9.1, 19.2.9.1

IBC 1008.3.4 Duration. IFC 1104.5.1 Emergency power duration and installation.

No work needed.

K105 15 2000 NEW (INDICATE N/A FOR EXISTING)

Buildings equipped with or requiring the use of life

support systems (electro-mechanical or inhalation

anesthetics) have illumination of means of egress,

emergency lighting equipment, exit, and directional

signs supplied by the Life Safety Branch of the

electrical system described in NFPA 99. 18.2.9.2.,

18.2.10.2 (Indicate N/A if life support equipment is

for emergency purposes only).

K292 15 Life Support Means of Egress

2012 NEW (INDICATE N/A FOR EXISTING)

Buildings equipped with or requiring the use of life

support systems (electro-mechanical or inhalation

anesthetics) have illumination of means of egress,

emergency lighting equipment, exit, and directional

signs supplied by the life safety branch of the

electrical system described in NFPA 99.

(Indicate N/A if life support equipment is for

emergency purposes only.) 18.2.9.2, 18.2.10.5

IFC 1105.10 Essential electrical systems. IFC 1105.10.1 Where required. IFC 1105.10.2 Installation and duration. IBC 407.11 Electrical systems. G125-15 (AS) IBC 422.6 Electrical systems. IBC [F] 2702.1.7 Group I-2 occupancies. G125-15 (AS) IBC [F] 2702.2.1 Ambulatory care facilities. IBC [F] 2702.2.7 Group I-2 occupancies.

No work needed. Essentially, both the ICC and NFPA point to NFPA 99 for design of the Essential electrical system.

K47, K22

14, 12

K47

Exit and directional signs are displayed in

accordance with 7.10 with continuous illumination

also served by the emergency lighting system.

18.2.10.1, 19.2.10.1

(Indicate N/A in one story existing

occupancies with less than 30 occupants

where the line of exit travel is obvious.)

K22

Access to exits shall be marked by approved,

readily visible signs in all cases where the exit or

way to reach exit is not readily apparent to the

occupants. Doors, passages or stairways that are

not a way of exit that are likely to be mistaken for

an exit have a sign designating "No Exit". 7.10,

18.2.10.1, 19.2.10.1

K293 16 Exit Signage 2012 EXISTING Exit and directional signs are displayed in accordance with 7.10 with continuous illumination also served by the emergency lighting system. 19.2.10.1 (Indicate N/A in one-story existing occupancies with less than 30 occupants where the line of exit travel is obvious.)

IFC 1104.3 Exit sign illumination. IFC 1104.4 Power source. IFC 604.2.6 Exit signs. IFC [BE] 1031.4 Exit signs.

Minimal review needed. The ICC is more stringent on smaller buildings – however it is unlikely that many of these exist? F242 is a correlation between change E-90-15 that was approved in the 2015 hearings. Section 604 of the fire code details requirements for exist signage power (Section 604.2.5) and the use of NFPA 99 (by reference 604.2.6). These requirements are duplicative.

K47, K22

14, 12

K47

Exit and directional signs are displayed in

accordance with 7.10 with continuous illumination

also served by the emergency lighting system.

18.2.10.1, 19.2.10.1

(Indicate N/A in one story existing

occupancies with less than 30 occupants

where the line of exit travel is obvious.)

K22

Access to exits shall be marked by approved,

readily visible signs in all cases where the exit or

way to reach exit is not readily apparent to the

occupants. Doors, passages or stairways that are

not a way of exit that are likely to be mistaken for

an exit have a sign designating "No Exit". 7.10,

18.2.10.1, 19.2.10.1

K293 16 Exit Signage 2012 NEW Exit and directional signs are displayed in accordance with 7.10 with continuous illumination also served by the emergency lighting system. 18.2.10.1

IEBC 805.8 Exit signs. IEBC 805.8.1 Work areas. IEBC 805.8.2 Supplemental requirements for exit signs. IEBC 905.3 Exit signs. IBC 1013.3 Illumination. IBC 1013.5 Internally illuminated exit signs. IBC 1013.6 Externally illuminated exit signs. IBC 1013.6.3 Power source.

No review needed.

N/A N/A N/A K300 16 Protection – Other

List in the REMARKS section any LSC Section

18.3 and 19.3 Protection requirements that are not

addressed by the provided K-tags, but are

deficient. This information, along with the

applicable Life Safety Code or NFPA standard

citation, should be included on Form CMS-2567.

This is a “catch-all”. Until we either do a much more comprehensive review of 101, or we start seeing what gets cited out of this section, it tough to determine if there is a gap. I would argue this needs to be monitored closely, however but we could present this as substantially equivalent.

K20, K33

7, 12

2000 EXISTING

K20

Stairways, elevator shafts, light and ventilation

shafts, chutes, and other vertical openings

between floors are enclosed with construction

having a fire resistance rating of at least one hour.

An atrium may be used in accordance with 8.2.5,

8.2.5.6, 19.3.1.1 If all vertical openings are

properly enclosed with construction providing at

least a two hour fire resistance rating, also check

this box.

If enclosures are less than required, give a brief description and specific location in REMARKS.

K33

Exit enclosures (such as stairways) are enclosed

K311 16 Vertical Openings – Enclosure 2012 EXISTING

Stairways, elevator shafts, light and ventilation

shafts, chutes, and other vertical openings between

floors are enclosed with construction having a fire

resistance rating of at least 1 hour. An atrium may

be used in accordance with 8.6.

19.3.1.1, through 19.3.1.6

If all vertical openings are properly enclosed with

construction providing at least a 2-hour fire

resistance rating, also check this box.

IEBC 501.2 Fire resistance ratings. IEBC 802.2 Vertical openings. IEBC 802.2.1 Existing vertical openings. IEBC 802.2.2 Supplemental shaft and floor opening enclosure requirements. IEBC 802.2.3 Supplemental stairway enclosure requirements. IEBC 903.1 Existing shafts and vertical openings. IFC 1103.4 Vertical openings. IFC 1103.4.1 Group I-2 and I-3 occupancies.

Review IEBC Substantial revision was made to the IFC for existing vert openings, currently language is aligned. We may want to look at IEBC language to make sure it’s clear that IFC chapter 11 minimums are still met.

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with construction having a fire resistance rating of

at least one hour, are arranged to provide a

continuous path of escape, and provide protection

against fire or smoke from other parts of the

building. 7.1.3.2, 8.2.5.2, 8.2.5.4, 19.3.1.1

If all vertical openings are properly enclosed with

construction providing at least a two hour fire

resistance rating, also check this box □

K20, K33

7, 12

2000 NEW

K20

Stairways, elevator shafts, light and ventilation

shafts, chutes, and other vertical openings

between floors are enclosed with construction

having a fire resistance rating of at least two

hours connecting four stories or more. (One hour

for single story building and buildings up to three

stories in height.) An atrium may be used in

accordance with 8.2.5.6, 8.2.5, 18.3.1.1

If enclosures are less than required, give a brief description and specific location in REMARKS.

K33

Exit enclosures (such as stairways) in buildings four

stories or more are enclosed with construction

having a fire resistance rating of at least two hours,

are arranged to provide a continuous path of

escape, and provide a protection against fire and

smoke from other parts of the building. In all

buildings less than four stories, the enclosure is at

least one hour. 7.1.3.2, 8.2.5.2, 8.2.5.4, 18.3.1.1,

18.2.2.3

K311 15 Vertical Openings – Enclosures 2012 NEW

Stairways, elevator shafts, light and ventilation

shafts, chutes, and other vertical openings

between floors are enclosed with construction

having a fire resistance rating of at least 2 hours

connecting four or more stories. (1 hour for single

story building and buildings up to three stories in

height.) An atrium may be used in accordance

with 8.6.7.

18.3.1 through 18.3.1.5

IBC SECTION 712 VERTICAL OPENINGS IBC SECTION 713 SHAFT OPENINGS

Review only. Essentially the concepts are aligned. KTAG is misleading. One story building arguably do not have vertical openings. 101 allows convenience openings and 2 story partial enclosures in healthcare – similar to what ICC does in Chapter 7.

K29 10 2000 EXISTING

One hour fire rated construction (with 3/4 hour fire-

rated doors) or an approved automatic fire

extinguishing system in accordance with 8.4.1

and/or 19.3.5.4 protects hazardous areas. When the

approved automatic fire extinguishing system option

is used, the areas shall be separated from other

spaces by smoke resisting partitions and doors.

Doors shall be self-closing and non-rated or field-

applied protective plates that do not exceed 48

inches from the bottom of the door are permitted.

19.3.2.1

(See table on 2786R)

Describe the floor and zone locations of hazardous areas that are deficient in REMARKS.

K321 17 Hazardous Areas – Enclosure 2012 EXISTING

Hazardous areas are protected by a fire barrier

having 1-hour fire resistance rating (with 3/4-hour

fire rated doors) or an automatic fire extinguishing

system in accordance with 8.7.1. When the

approved automatic fire extinguishing system

option is used, the areas shall be separated from

other spaces by smoke resisting partitions and

doors in accordance with 8.4. Doors shall be self-

closing or automatic-closing and permitted to have

nonrated or field-applied protective plates that do

not exceed 48 inches from the bottom of the door.

Describe the floor and zone locations of hazardous

areas that are deficient in REMARKS. 19.3.2.1

Area, Automatic Sprinkler, Separation, N/A

a. Boiler and Fuel-Fired Heater Rooms

b. Laundries (larger than 100 square feet)

c. Repair, Maintenance, and Paint Shops

d. Soiled Linen Rooms (exceeding 64 gallons)

e. Trash Collection Rooms (exceeding 64 gallons)

f. Combustible Storage Rooms/Spaces (over 50 square feet)

g. Laboratories (if classified as Severe Hazard - see 0322)

IFC 1105.3 Incidental uses in existing Group I-2. IFC 1105.3.1 Occupancy classification. IFC 1105.3.2 Area limitations. IFC 1105.3.3 Separation and protection. IFC 1105.3.3.1 Separation. IFC 1105.3.3.2 Protection. IFC 1105.3.3.2.1 Protection limitation. IFC TABLE 1105.3 INCIDENTAL USES IN EXISTING GROUP I-2 OCCUPANCIES IEBC 902.2 Boiler and furnace equipment rooms.

Review only. Based on work last cycle these are aligned. Some of the numbers are slightly different (10 cu.ft. vs 64 gallons) but the concepts are the same. As mentioned previously we may want to address change of use to storage in the IEBC.

K29 10 2000 NEW

Hazardous areas are protected in accordance

with 8.4. The areas shall be enclosed with a one

hour fire-rated barrier, with a 3/4 hour fire-rated

door, without windows (in accordance with 8.4).

Doors shall be self-closing or automatic closing

in accordance with 7.2.1.8. Hazardous areas are

protected by a sprinkler system in accordance

with 9.7, 18.3.2.1, 18.3.5.1.

(See table on 2786R)

Describe the floor and zone locations of hazardous areas that are deficient in REMARKS.

K321 18 Hazardous Areas – Enclosure 2012 NEW

Hazardous areas are protected in accordance with

18.3.2.1. The areas shall be enclosed with a 1-hour

fire-rated barrier, with a 3/4-hour fire-rated door

without windows (in accordance with 8.7.1.1). Doors

shall be self-closing or automatic-closing in

accordance with 7.2.1.8. Hazardous areas are

protected by a sprinkler system in accordance with

9.7, 18.3.2.1, and 8.4.

Describe the floor and zone locations of hazardous areas that are deficient in REMARKS.

18.3.2.1, 7.2.1.8, 8.4, 8.7, 9.7

Area, Automatic Sprinkler, Separation, N/A

a. Boiler and Fuel-Fired Heater Rooms

b. Laundries (larger than 100 square feet)

IBC SECTION 509 INCIDENTAL USES IBC TABLE 509 INCIDENTAL USES

See above

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c. Repair, Maintenance, and Paint Shops

d. Soiled Linen Rooms (exceeding 64 gallons)

e. Trash Collection Rooms (exceeding 64 gallons)

f. Combustible Storage Rooms/Spaces (over 50 and less than 100 square feet)

g. Combustible Storage Rooms/Spaces (over 50 square feet)

h. Laboratories (if classified as Severe Hazard - see 0322)

K31, K131, K132,

K133,

K134,

K135,K136

23 K31

Laboratories employing quantities of flammable, combustible, or hazardous materials that are considered a severe hazard shall be protected in accordance with NFPA 99. (Laboratories that are not considered to be severe hazard shall meet the provision of K29.) 18.3.2.2, 19.3.2.2, Chapter 10 (NFPA 99) K131

Emergency procedures shall be established for

controlling chemical spills in accordance with 10-

2.1.3.2 (NFPA 99).

K132

Continuing safety education and supervision shall be

provided, incidents shall be reviewed monthly, and

procedures reviewed annually shall be in

accordance with 10-2.1.4.2 (NFPA 99).

K134

Where the eyes or body of any person can be

exposed to injurious corrosive materials, suitable

fixed facilities for quick drenching or flushing of the

eyes and body shall be provided within the work

area for immediate emergency use. Fixed eye baths

designed and installed to avoid injurious water

pressure shall be in accordance with 10-6 (NFPA

99).

K133

Fume hoods shall be in accordance with 5-4.3, 5-6.2 (NFPA 99). K135

Flammable and combustible liquids shall be used

from and stored in approved containers in

accordance with NFPA 30, Flammable and

Combustible Liquids Code, and NFPA 45, Standard

on Fire Protection for Laboratories Using

Chemicals.

Storage cabinets for flammable and combustible

liquids shall be constructed in accordance with NFPA

30, Flammable and Combustible liquids Code, 4-3

(NFPA 99), 10-7.2.1 (NFPA 99)

K136

Procedures for laboratory emergencies shall be

developed. Such procedures shall include alarm

actuation, evacuation, and equipment shutdown

procedures, and provisions for control of

emergencies that could occur in the laboratory,

including specific detailed plans for control

operations by an emergency control

group within the organization or a public fire department in accordance with 10-2.1.3.1 (NFPA 99), 18.3.2.2., 19.3.2.1

K322 19 Laboratories Laboratories employing quantities of flammable, combustible, or hazardous materials that are considered a severe hazard a r e protected by 1-hour fire resistance-rated separation, automatic sprinkler system, and are in accordance with 8.7 and with NFPA 99.

IFC 5003.8 Construction requirements. IFC 5003.8.1 Buildings. IFC 5003.8.2 Required detached buildings. IFC 5003.8.3 Control areas. Control areas shall comply with Sections 5003.8.3.1 through 5003.8.3.5. IFC 5003.8.3.1 Construction requirements. IFC 5003.8.3.2 Percentage of maximum allowable quantities. IFC 5003.8.3.3 Number. IFC 5003.8.3.4 Fire-resistance-rating requirements. IFC 5003.9 General safety precautions. IFC 5003.9.1 Personnel training and written procedures. IFC 5003.9.1.1 Fire department liaison. IFC 5003.9.2 Security. IFC 5704.3 Container and portable tank storage. IFC 5704.3.1 Design, construction and capacity of containers and portable tanks. IFC 5704.3.1.1 Approved containers. IFC 5704.3.2 Liquid storage cabinets. IFC 5704.3.2.1 Design and construction of storage cabinets. IFC 5704.3.2.1.1 Materials. IFC 5704.3.2.1.2 Labeling. IFC 5704.3.2.1.3 Doors. IFC 5704.3.2.1.4 Bottom. IFC 5704.3.2.2 Capacity. IMC SECTION 510 HAZARDOUS EXHAUST SYSTEMS IMC 510.1 General. IMC 510.2 Where required. IPC SECTION 411 EMERGENCY SHOWERS AND EYEWASH STATIONS IPC 411.1 Approval. IPC 411.2 Waste connection. IPC 411.3 Water supply.

Review. This KTAG is essentially covered in the ICC by the concept of incidental uses, hazardous materials and permit amounts. NFPA 99 moved away from prescribing laboratory requirements and left regulation to NFPA 45. We should review these and compare 2018 ICC changes for lab areas. The basic labs are consistent, with ICC possibly being more stringent. Larger educational or production labs may adequately be addressed in 2018. Unclear if it covers all teaching and production context that might be seen in a hospital. Gas appliance language is very specific and needs to be reviewed.

Laboratories not considered a severe hazard are protected as hazardous areas (see 0321).

IBC SECTION 509 INCIDENTAL USES IBC TABLE 509 INCIDENTAL USES

Laboratories using chemicals are in accordance with NFPA 45.

ICCPC 2201.3.10 Ventilation.

Gas appliances are of appropriate design and installed in accordance with NFPA 54. Shutoff valves are marked to identify material they control. Devices requiring medical grade oxygen from the piped distribution system meet the requirements under 11.4.2.2 (NFPA 99). 18.3.2.2, 19.3.2.2, 8.7, 8.7.4.1 (LSC) 9.3.1.2, 11.4.3.2, 15.4 (NFPA 99)

IFC SECTION 603 FUEL-FIRED APPLIANCES IFC 603.1 Installation. IFC 603.1.1 Manufacturer’s instructions.

K78 24 Anesthetizing locations shall be protected in accordance with NFPA 99, Standard for Health Care Facilities.

(a) Shutoff valves are located outside each

anesthetizing location and arranged so that

shutting off one room or location will not affect

others.

(b) Relative humidity is maintained equal to or

great than 35% 4-3.1.2.3(n) and 5-4.1.1 (NFPA

99), 18.3.2.3, 19.3.2.3

K323 20 Anesthetizing Locations

Areas designated for administration of general

anesthesia (i.e., inhalation anesthetics) are in

accordance with 8.7 and NFPA 99.

Zone valves are: located immediately outside

each anesthetizing location for medical gas or

vacuum; readily accessible in an emergency; and

arranged so shutting off any one anesthetizing

location will not affect others.

Area alarm panels are provided to monitor all

medical gas, medical-surgical vacuum, and piped

WAGD systems. Panels are at locations that

provide for surveillance, indicate medical gas

pressure decreases of 20% and vacuum decreases

of 12 inch gauge HgV, and provide visual and

IFC 5306.5 Medical gas systems.. The reference to NFPA 99 is adequate for this k-tag, and needs to be maintained.

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audible indication. Alarm sensors are installed

either on the source side of individual room zone

valve box assemblies or on the patient/use side of

each of the individual zone box valve assemblies.

The EES critical branch supplies power for task

illumination, fixed equipment, select receptacles,

and select power circuits, and EES equipment

system supplies power to ventilation system.

Heating, cooling, and ventilation are in

accordance with ASHRAE 170. Medical

supply and equipment manufacturer’s

instructions for use are considered before

reducing humidity levels to those allowed

by ASHRAE, per S&C 13-58.

Supply and exhaust systems for windowless

anesthetizing locations have smoke control

system(s) to automatically vent smoke, prevent

the recirculation of smoke originating within the

surgical suite, and prevent the circulation of smoke

entering the system intake, without interfering with

exhaust function, per 79 FR 21551.

18.3.2.3, 19.3.2.3 (LSC)

5.1.4.8.7, 5.1.4.8.7.2, 5.1.9.3, 5.1.9.3.4, 6.4.2.2.4.2 (NFPA 99)

K69 20 Cooking facilities shall be protected in accordance with 9.2.3, 18.3.2.6, and NFPA 96

K324 21 Cooking Facilities

Cooking equipment is protected in accordance with

NFPA 96, Standard for Ventilation Control and Fire

Protection of Commercial Cooking Operations ,

unless:

• residential cooking equipment (i.e., small

appliances such as microwaves, hot plates, toasters)

are used for food warming or limited cooking in

accordance with 18.3.2.5.2, 19.3.2.5.2

• cooking facilities open to the corridor in smoke

compartments with 30 or fewer patients comply with

the conditions under 18.3.2.5.3, 19.3.2.5.3, or

• Cooking facilities in smoke compartments with 30

or fewer patients comply with conditions under

18.3.2.5.4, 19.3.2.5.4. Cooking facilities protected

according to NFPA 96 per 9.2.3 are not required to

be enclosed as hazardous areas, but shall not be

open to the corridor.

18.3.2.5.1 through 18.3.2.5.4, 19.3.2.5.1 through 19.3.2.5.5, 9.2.3, TIA 12-2

F178-16 (AS), F179-16 (AS) IFC 904.13 Domestic cooking systems in Group I-2 Condition 1. This IMC section more clearly defines the difference in commercial cooking and ranges, and adequately covers the Hospital requirements for ADL kitchens, and cooking education. The IFC section was added to satisfy nursing home requirements, to allow open cooking serving multiple resident rooms.

K211 12 Where Alcohol Based Hand Rub (ABHR)

dispensers are installed: The corridor is at least 6

feet wide

The maximum individual fluid dispenser capacity shall be

1.2 liters (2 liters in suites of rooms)

The dispensers shall have a minimum spacing of 4 ft. from each other

Not more than 10 gallons are

used in a single smoke

compartment outside a storage

cabinet. Dispensers are not

installed over or adjacent to an

ignition source.

If the floor is carpeted, the building is fully sprinklered. 18.3.2.7, CFR 403.744, 418.110, 460.72, 482.41, 483.70,

485.623

K325 21 Alcohol Based Hand Rub Dispenser (ABHR)

ABHRs are protected in accordance with 8.7.3.1, unless all conditions are met:

• Corridor is at least 6 feet wide

• Maximum individual dispenser capacity is 0.32 gal. (0.53 gal. in suites) of fluid and 18 oz. of Level 1 aerosols

• Dispensers shall have a minimum of 4-foot horizontal spacing

• Not more than an aggregate of 10 gallons of fluid

or 135 oz. aerosol are used in a single smoke

compartment outside a storage cabinet, excluding

one individual dispenser per room

• Storage in a single smoke compartment greater than 5 gallons complies with NFPA 30

• Dispensers are not installed within 1 inch of an ignition source

• Dispensers over carpeted floors are in sprinklered smoke compartments

• ABHR does not exceed 95% alcohol

• Operation of the dispenser shall comply with Section 18.3.2.6(11) or 19.3.2.6(11)

• ABHR is protected against inappropriate access

18.3.2.6, 19.3.2.6, 42 CFR Parts 403, 418, 460, 482, 483, and 485

IFC 5705.5 Alcohol-based hand rubs classified as Class I or II liquids. IFC 5705.5.1 Corridor installations. IBC 407.4.3 Projections in nursing home corridors. IBC 1003.3.3 Horizontal projections. IBC 1003.4 Slip-resistant surface.

These requirements were found to match up to those in the Fire Code. No changes were needed.

K14, K15

4 2000 EXISTING

K14

Interior finish for means of egress, including

exposed interior surfaces of buildings such as fixed

or movable walls, partitions, columns, and ceilings

K331 22

Interior Wall and Ceiling Finish 2012 EXISTING

Interior wall and ceiling finishes, including

exposed interior surfaces of buildings such as

fixed or movable walls, partitions, columns, and

have a flame spread rating of Class A or Class B.

IFC 1031.6 Finishes, furnishings and decorations. IEBC 802.4 Interior finish. IEBC 802.4.1 Supplemental interior finish requirements. IEBC 903.3 Interior finish.

This is also covered in IFC table 803.3. Interior finishes remains a big issue with the I-2, Condition 1 (nursing home) group. More and more facilities are taking a consumer based approach, and need to be more upgraded and more like a home-environment, or higher end hotel.

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has a flame spread rating of Class A or Class B.

Interior finishes existing before December 17, 2010

that are applied directly to wall and ceilings with a

thickness of less than ½8 inch shall be permitted to

remain in use without flame spread rating

documentation. 10.2, 19.3.3.1, 19.3.3.2,

NFPA TIA 00-2

Indicate flame spread rating/s

K15

Interior finish for rooms and spaces not used for

corridors or exitways, including exposed interior

surfaces of buildings such as fixed or movable

walls, partitions, columns, and ceilings has a flame

spread rating of Class A or Class B. (In fully-

sprinklered buildings, flame spread rating of Class C

may be continued in use within rooms separated in

accordance with 19.3.6 from the exit access

corridors.) 19.3.3.1, 19.3.3.2

Indicate flame spread rating/s

The reduction in class of interior finish for a

sprinkler system as prescribed in 10.2.8.1 is

permitted.

10.2, 19.3.3.1, 19.3.3.2

Indicate flame spread rating(s).

K14, K15

4 2000 NEW

K14

Interior finish for means of egress, including

exposed interior surfaces of buildings such as

fixed or movable walls, partitions, columns, and

ceilings has a flame spread rating of Class A or

Class B. Lower half of corridor

walls, not exceeding 4ft in height, may have a Class

C flame spread rating. 10.2, 18.3.3.1, 18.3.3.2,

NFPA TIA 00- 2

Indicate flame spread rating/s

K15

Interior finish for rooms and spaces not used for

corridors or exitways, including exposed interior

surfaces of buildings such as fixed or movable

walls, partitions, columns, and ceilings has a flame

spread rating of Class A or Class B. (Rooms not

over

4 persons in capacity may have a flame

spread rating of Class A, Class B, or Class

C). 18.3.3.1, 18.3.3.2. Indicate flame spread

rating/s

K331 22 Interior Wall and Ceiling Finish 2012 NEW

Interior wall and ceiling finishes, including exposed

interior surfaces of buildings such as fixed or

movable walls, partitions, columns, and have a flame

spread rating of Class A. The reduction in class of

interior finish for a sprinkler system as prescribed in

10.2.8.1 is permitted.

Individual rooms not exceeding four persons may have a Class A or B finish.

Lower half of corridor walls, not exceeding 4 feet in

height, may have a Class A or B flame spread rating.

10.2, 18.3.3.1, 18.3.3.2

Indicate flame spread rating(s).

IFC 803.3 Interior finish requirements based on occupancy. IFC TABLE 803.3 INTERIOR WALL AND CEILING FINISH REQUIREMENTS BY OCCUPANCY

k

In terms of hospitals, these requirements are in line. Further work needs to be done in regard to nursing homes. There has been coordination with the nursing home advocates and the experts of the testing laboratories. At issue is the ‘homelike’ feel needed in the nursing home setting, particularly on walls.

N/A N/A N/A K332 22 Interior Floor Finish

2012 NEW (Indicate N/A for 2012 EXISTING)

Interior finishes shall comply with 10.2. Floor finishes

in exit enclosures and exit access corridors and

spaces not separated by walls that resist the

passage of smoke shall be Class I or II.

18.3.3.3.1, 18.3.3.3.2, 18.3.3.3.3, 10.2, 10.2.7.1, 10.2.7.2

IFC 804.3 New interior floor finish. IFC 804.3.1 Classification. IFC 804.3.3.2 Minimum critical radiant flux.

Same comment as in K331.

K51 16 A fire alarm system is installed with systems and

components approved for the purpose in

accordance with NFPA 70, National Electric Code

and NFPA 72, National Fire Alarm Code to provide

effective warning of fire in any part of the building.

Fire alarm system wiring or other transmission paths

are monitored for integrity. Initiation of the fire

alarm system is by manual means and by any

required sprinkler system alarm, detection device, or

detection system. Manual alarm boxes are provided

in the path of egress near each required exit.

Manual alarm boxes in patient sleeping areas shall

not be required at exits if manual alarm boxes are

located at all nurse’s stations.

Occupant notification is provided by audible and

visual signals. In critical care areas, visual alarms

are sufficient. The fire alarm system transmits the

alarm automatically to notify emergency forces in

the event of fire. The fire alarm automatically

activates required control functions. System

records are maintained and readily available.

K341 22 Fire Alarm System – Installation

A fire alarm system is installed with systems and

components approved for the purpose in

accordance with NFPA 70, National Electric Code,

and NFPA 72, National Fire Alarm Code to provide

effective warning of fire in any part of the building. In

areas not continuously occupied, detection is

installed at each fire alarm control unit. In new

occupancy, detection is also installed at notification

appliance circuit power extenders, and supervising

station transmitting equipment. Fire alarm system

wiring or other transmission paths are monitored for

integrity.

18.3.4.1, 19.3.4.1, 9.6, 9.6.1.8

IBC [F] 407.8 Fire alarm system. IBC [F] 422.5 Fire alarm systems. IFC 1103.7 Fire alarm systems. IFC 1103.7.2 Group I-1. IFC 1103.7.3 Group I-2. IFC 1105.9 Group I-2 automatic fire alarm system. IFC 907.4.2.1 Location. IFC 907.6.2 Power supply. IFC 907.6.6 Monitoring. IFC 907.6.6.1 Automatic telephone-dialing devices. IFC 907.6.6.2 Termination of monitoring service. IFC 907.8.5 Inspection, testing and maintenance. IEBC 803.4.1.3 Group I-2. IEBC 904.2.1 Manual fire alarm systems.

Generally, meets requirement. However, the IFC does not cover a new provision in 9.6.1.8.1 of the 2012 LSC to address areas that are not continuously occupied. It also effects where the notification reaches. This is important in hospitals at mechanical rooms, storage areas, and OR core areas.

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18.3.4, 19.3.4, 9.6

K60 18 Initiation of the required fire alarm systems

shall be by manual fire alarm initiation,

automatic detection, or extinguishing

system operation. 18.3.4.2, 19.3.4.2,

9.6.2.1

K342 23 Fire Alarm System – Initiation

Initiation of the fire alarm system is by manual

means and by any required sprinkler system

alarm, detection device, or detection system.

Manual alarm boxes are provided in the path of

egress near each required exit. Manual alarm

boxes in patient sleeping areas shall not be

required at exits if manual alarm boxes are located

at all nurse’s stations or other continuously

attended staff location, provided alarm boxes are

visible, continuously accessible, and 200 feet

travel distance is not exceeded.

18.3.4.2.1, 18.3.4.2.2, 19.3.4.2.1, 19.3.4.2.2, 9.6.2.5

IFC 907.2.6 Group I. IFC 907.2.6.2 Group I-2.

For new, this is now addressed in the IBC, per a change in the 2012 code.

N/A N/A N/A K343 23 Fire Alarm – Notification 2012 EXISTING

Positive alarm sequence in accordance with

9.6.3.4 are permitted in buildings protected

throughout by a sprinkler system. Occupant

notification is provided automatically in accordance

with 9.6.3 by audible and visual signals.

In critical care areas, visual alarms are sufficient.

The fire alarm system transmits the alarm

automatically to notify emergency forces in the

event of a fire.

19.3.4.3, 19.3.4.3.1, 19.3.4.3.2, 9.6.4, 9.7.1.1(1)

IFC 1103.7 Fire alarm systems. IFC 1103.7.3 Group I-2. IFC 1105.9 Group I-2 automatic sprinkler system.

.

This also addresses the Silent Mode issue, which we have covered in the 2012 cycle.

N/A N/A N/A K343 23 Fire Alarm – Notification 2012 NEW

Positive alarm sequence in accordance with

9.6.3.4 are permitted. Occupant notification is

provided automatically in accordance with 9.6.3 by

audible and visual signals.

In critical care areas, visual alarms are sufficient.

The fire alarm system transmits the alarm

automatically to notify emergency forces in the

event of a fire.

Annunciation and annunciation zoning for fire

alarm and sprinklers shall be provided by audible

and visual indicators and zones shall not be larger

than 22,500 square feet per zone.

18.3.4.3 through 18.3.4.3.3, 9.6.4

IBC [F] 407.9 Automatic fire detection. IFC 907.2.6.2 Group I-2. IFC 907.5.2 Alarm notification appliances. IFC 907.5.2.1 Audible alarms. IFC 907.5.2.2 Emergency voice/alarm communication systems. IFC 907.5.2.2.1 Manual override. IFC 907.5.2.2.2 Live voice messages. IFC 907.5.2.2.3 Alternate uses. IFC 907.5.2.3 Visible alarms. IFC 907.5.2.3.1 Public use areas and common use areas.

This requirement is adequately addressed in the IBC, but the expansion of spaces for I-2, Condition 1 (nursing homes) differs slightly from hospitals. Federal requirements particularly allow food prep areas, where nursing home residents can cook, but this is unlikely in a hospital. These requirements were successfully added in the 2012 cycle.

K107 25 Required alarm and detection systems are

provided with an alternative power supply in

accordance with NFPA 72.

9.6.1.4, 18.3.4.1, 19.3.4.1

K344 23 Fire Alarm – Control Functions

The fire alarm automatically activates required

control functions and is provided with an alternative

power supply in accordance with NFPA 72.

18.3.4.4, 19.3.4.4, 9.6.1, 9.6.5, NFPA 72

IFC 907.5.2.2.5 Emergency power. Also look at K51

K52 16 K52

A fire alarm system required for life safety shall be,

tested, and maintained in accordance with NFPA

70 National Electric Code and NFPA 72 National

Fire Alarm Code and records kept readily available.

The system shall have an approved maintenance

and testing program complying with applicable

requirement of NFPA 70 and 72.

9.6.1.4, 9.6.1.7

K345 24 Fire Alarm System – Testing and Maintenance

A fire alarm system is tested and maintained in

accordance with an approved program

complying with the requirements of NFPA 70,

National Electric Code, and NFPA 72, National

Fire Alarm and Signaling Code. Records of

system acceptance, maintenance and testing

are readily available.

9.7.5, 9.7.7, 9.7.8, and NFPA 25

IFC 907.6.5 Access. This requirement matches well, but the word “periodic” is likely to evolve in the future for I-2.

K155 18 K155

Where a required fire alarm system is out of

service for more than 4 hours in a 24-hour period,

the authority having jurisdiction shall be notified,

and the building shall be evacuated or an

approved fire watch shall be provided for all parties

left unprotected by the shutdown until the fire

alarm system has been returned to service. 9.6.1.8

K346 24 Fire Alarm – Out of Service

Where required fire alarm system is out of service

for more than 4 hours in a 24-hour period, the

authority having jurisdiction shall be notified, and

the building shall be evacuated or an approved fire

watch shall be provided for all parties left

unprotected by the shutdown until the fire alarm

system has been returned to service.

9.6.1.6

IFC 901.7 Systems out of service. Action needs to be taken on this topic. The question of ‘immediately’ in the IFC, and the 4-hour period over 24 hours in the LSC needs to be resolved.

K53, K54

16, 17

2000 NEW K53 (NURSING HOME AND EXISTING LIMITED CARE FACILITIES) An automatic smoke detection system is installed in all corridors. (As an alternative to the corridor smoke detection system on patient sleeping room floors, smoke detectors may be installed in each patient sleeping room and at smoke barrier or horizontal exit doors in the corridor.) Such detectors are electrically interconnected to the fire alarm system. 18.3.4.5.3

K347 24 Smoke Detection 2012 EXISTING Smoke detection systems are provided in spaces open to corridors as required by 19.3.6.1. 19.3.4.5.2

Action needs to be taken on this topic. New allowance for cooking facilities to be open to the corridor. Intent is kitchenettes used for residents of nursing homes, but spills over into the I-2, Condition 2 (Hospital) setting.

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K54 All required smoke detectors, including those activating door hold-open devices, are approved, maintained, inspected and tested in accordance with the manufacturer’s specifications. 9.6.1.3

K53, K54

16, 17

2000 NEW

K53

(NURSING HOME AND EXISTING LIMITED CARE FACILITIES)

An automatic smoke detection system is installed in

all corridors. (As an alternative to the corridor smoke

detection system on patient sleeping room floors,

smoke detectors may be installed in each patient

sleeping room and at smoke barrier or horizontal

exit doors in the corridor.) Such detectors are

electrically interconnected to the fire alarm system.

18.3.4.5.3

K54

All required smoke detectors, including those

activating door hold-open devices, are approved,

maintained, inspected and tested in accordance with

the manufacturer’s specifications. 9.6.1.3

K347 24 Smoke Detection 2012 NEW Smoke detection systems are provided in spaces open to corridors as required by 18.3.6.1

In nursing homes, an automatic smoke

detection system is installed in the corridors of

all smoke compartments containing resident

sleeping rooms, unless the resident sleeping

room has:

• smoke detection, or

• Automatic door closing devices with

integral smoke detectors on the room

side that provide occupant notification.

Such detectors are electrically

interconnected to the fire alarm

system.

18.3.4.5.2, 18.3.4.5.3

IFC 903.2.6 Group I. Seems to be adequately covered. This aligns with moving towards all hospital facilities required to be fully sprinklered. See K351 (old K56)

K56 18 2000 EXISTING Where required by section 19.1.6, Health care facilities shall be protected throughout by an approved, supervised automatic sprinkler system in accordance with section 9.7. Required sprinkler systems are equipped with water flow and tamper switches which are electrically interconnected to the building fire alarm. In Type I and II construction, alternative protection measures shall be permitted to be substituted for sprinkler protection in specific areas where State or local regulations prohibit sprinklers. 19.3.5, 19.3.5.1, NPFA 13

K351 25 Sprinkler System – Installation 2012 EXISTING

Nursing homes, and hospitals where required by

construction type, are protected throughout by an

approved automatic sprinkler system in accordance

with NFPA 13, Standard for the Installation of

Sprinkler Systems.

In Type I and II construction, alternative protection

measures are permitted to be substituted for

sprinkler protection in specific areas where State or

local regulations prohibit sprinklers.

In hospitals, sprinklers are not required in clothes

closets of patient sleeping rooms where the area of

the closet does not exceed 6 ft² and sprinkler

coverage covers the closet footprint as required by

NFPA 13, Standard for Installation of Sprinkler

Systems.

19.3.5.1, 19.3.5.2, 19.3.5.3, 19.3.5.4, 19.3.5.5, 19.4.2, 19.3.5.10, 9.7, 9.7.1.1(1)

IFC 1103.5 Sprinkler systems. IFC 1103.5.2 Group I-2. IFC 1103.5.3 Group I-2 Condition 2. IFC 1105.8 Group I-2 automatic sprinkler system.

Action needs to be taken on this topic. Monitoring of this requirement is crucial to track in future code cycles. This is a key new federal requirement, and must remain aligned in the codes to be effective.

K56 18 2000 NEW

There is an automatic sprinkler system installed in

accordance with NFPA13, Standard for the

Installation of Sprinkler Systems, with approved

components, device and equipment, to provide

complete coverage of all portions of the facility.

Systems are equipped with waterflow and tamper

switches, which are connected to the fire alarm

system. In Type I and II construction, alternative

protection measures shall be permitted to be

substituted for sprinkler protection in specific areas

where State or local regulations prohibit sprinklers.

18.3.5, 18. 3 . 5. 1 .

K351 25 2012 NEW

Buildings are to be protected throughout by an

approved automatic sprinkler system in accordance

with NFPA 13, Standard for the Installation of

Sprinkler Systems.

In Type I and II construction, alternative protection

measures are permitted to be substituted for

sprinkler protection in specific areas where State

and local regulations prohibit sprinklers.

Listed quick-response or listed residential sprinklers

are used throughout smoke compartments with

patient sleeping rooms. In hospitals, sprinklers are

not required in clothes closets of patient sleeping

rooms where the area of the closet does not exceed

6 ft² and sprinkler coverage covers the closet

footprint as required by NFPA 13, Standard for

Installation of Sprinkler Systems.

18.3.5.1, 18.3.5.4, 18.3.5.5, 18.3.5.6, 9.7, 9.7.1.1(1), 18.3.5.10

IBC [F] 407.7 Automatic sprinkler system. IFC 903.3 Installation requirements. IFC 903.3.1 Standards. IFC 903.3.1.1 NFPA 13 sprinkler systems.

This requirement is adequately represented, as part of the issues noted above.

K61 19 Automatic sprinkler system supervisory

attachments are installed and monitored for

integrity in accordance with NFPA 72, and provide

a signal that sounds and is displayed at a

continuously attended location or approved

remote facility when sprinkler operation is

impaired. 9.7.2.1,

NFPA 72

K352 25 Sprinkler System – Supervisory Signals

Automatic sprinkler system supervisory attachments

are installed and monitored for integrity in

accordance with NFPA 72, National Fire Alarm and

Signaling Code, and provide a signal that sounds

and is displayed at a continuously attended location

or approved remote facility when sprinkler operation

is impaired.

9.7.2.1, NFPA 72

IFC 903.4.1 Monitoring. IFC 903.4.2 Alarms.

This is a key provision, and needs to be closely monitored. The fire code considers more than just hospitals in this paragraph, so the scoping aspects of a committee dedicated to the healthcare type will be helpful in keeping it aligned with federal standards.

K62, K63

19 K62

Automatic sprinkler systems are continuously

maintained in reliable operating condition and

K353 26 Sprinkler System – Maintenance and Testing

Automatic sprinkler and standpipe systems are

inspected, tested, and maintained in accordance

IFC 903.5 Testing and maintenance. IFC 901.4 Installation.

This provision is adequately aligned.

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are inspected and tested periodically. 18.7.6,

19.7.6, 4.6.12, NFPA 13, NFPA 25, 9.7.5

K63

Required automatic sprinkler systems have an

adequate and reliable water supply which

provides continuous and automatic pressure.

9.7.1.1, NFPA 13

with NFPA 25, Standard for the Inspection, Testing,

and Maintaining of Water-based Fire Protection

Systems. Records of system design, maintenance,

inspection and testing are maintained in a secure

location and readily available.

a) Date sprinkler system last checked

b) Who provided system test

c) Water system supply source

Provide in REMARKS information on coverage for

any non-required or partial automatic sprinkler

system. 9.7.5, 9.7.7, 9.7.8, and NFPA 25

K154 19 Where a required automatic sprinkler system is out of service for more than 4 hours in a 24-hour period, the authority having jurisdiction shall be notified, and the building shall be evacuated or an approved fire watch system be provided for all parties left Unprotected by the shutdown until the sprinkler system has been returned to service. 9.7.6.1.

K354 26 Sprinkler System – Out of Service

Where the sprinkler system is impaired, the extent

and duration of the impairment has been

determined, areas or buildings involved are

inspected and risks are determined,

recommendations are submitted to management or

designated representative, and the fire department

and other authorities having jurisdiction have been

notified. Where the sprinkler system is out of service

for more than 10 hours in a 24-hour period, the

building or portion of the building affected are

evacuated or an approved fire watch is provided until

the sprinkler system has been returned to service.

18.3.5.1, 19.3.5.1, 9.7.5, 15.5.2 (NFPA 25)

IFC 901.7 Systems out of service. Action needs to be taken on this topic. Current federal standards allow for the syste to be out for 10 hours (or one shift) before formal notification. Work needs to be done to align.

K64 19 Portable fire extinguishers shall be

installed, inspected, and maintained in all

health care occupancies in accordance

with 9.7.4.1, NFPA 10.

18.3.5.6, 19.3.5.6

K355 26 Portable Fire Extinguishers

Portable fire extinguishers are selected, installed,

inspected, and maintained in accordance with NFPA

10, Standard for Portable Fire Extinguishers.

18.3.5.12, 19.3.5.12, NFPA 10

IFC 906.1 Where required. IFC 906.2 General requirements. IFC 906.2.1 Certification of service personnel for portable fire extinguishers.

Placement of fire extinguishers is well alighed, particulary with the reference to NFPA 10. However, as noted in exception 3 of 906.1, there will potentially be emerging exceptions coming as a result of trade-offs with other conditions (one could consider this exception a trade-off for food prep in open corridors in I-2, Condition 1. These aspects need to be monitored.

K30 11 Gift shops shall be protected as hazardous areas

when used for storage or display of combustibles in

quantities considered hazardous. Nonrated walls

may separate gift shops that are not considered

hazardous, have separate protected storage and

that are completely sprinklered. Gift shops may be

open to the corridor if they are not considered

hazardous, have separate protected storage, are

completely sprinklered and do not exceed 500

square feet. 18.3.2.5, 19.3.2.5

K361 26 Corridors – Areas Open to Corridor

Spaces (other than patient sleeping rooms,

treatment rooms and hazardous areas), waiting

areas, nurse’s stations, gift shops, and cooking

facilities, open to the corridor are in accordance

with the criteria under 18.3.6.1 and 19.3.6.1.

18.3.6.1, 19.3.6.1

IBC 407.2 Corridors continuity and separation. IBC 407.2.1 Waiting and similar areas. IBC 407.2.2 Care providers’ stations. IBC 407.2.3 Psychiatric treatment areas. IBC 407.2.4 Gift shops. IBC 407.2.5 Nursing home housing units. IBC 407.2.6 Nursing home cooking facilities.

Action needs to be taken on this topic. Although comprehensive, many of these requirements are based on older federal requirements (2000 LSC), particularly the one for gift shops. Code changes need to be developed to bring them to current standards, as the use of corridors evolves.

K17 5 2000 EXISTING

Corridors are separated from use areas by walls

constructed with at least ½ hour fire resistance

rating. In fully sprinklered smoke compartments,

partitions are only required to resist the passage of

smoke. In non-sprinklered buildings, walls extend

to the underside of the floor or roof deck above the

ceiling. (Corridor walls may terminate at the

underside of ceilings where specifically permitted

by Code. Charting and clerical stations, waiting

areas, dining rooms, and activity spaces may be

open to corridor under certain conditions specified

in the Code. Gift shops may be separated from

corridors by non-fire rated walls

if the gift shop is fully sprinklered.) 19.3.6.1, 19.3.6.2, 19.3.6.4, 19.3.6.5

If the walls have a fire resistance rating, give rating

if the walls terminate at the underside of a ceiling,

give a brief description in REMARKS, of the ceiling,

describing the ceiling throughout the floor area.

K362 27 Corridors – Construction of Walls 2012 EXISTING

Corridors are separated from use areas by walls

constructed with at least ½-hour fire resistance

rating. In fully sprinklered smoke compartments,

partitions are only required to resist the transfer of

smoke. In nonsprinklered buildings, walls extend

to the underside of the floor or roof deck above

the ceiling. Corridor walls may terminate at the

underside of ceilings where specifically permitted

by Code.

Fixed fire window assemblies in corridor walls are

in accordance with Section 8.3, but in sprinklered

compartments there are no restrictions in area or

fire resistance of glass or frames.

If the walls have a fire resistance rating, give the

rating if the walls terminate at the underside of the ceiling, give brief description in REMARKS, describing the ceiling throughout the floor area.

19.3.6.2, 19.3.6.2.7

IFC 1104.17 Corridor construction. IFC 1105.4 Corridor construction. IFC 1105.4.1 Materials. IFC 1105.4.2 Fire-resistance rating. IFC 1105.4.3 Corridor wall continuity.

Action needs to be taken on this topic. This is one of the larger issues dealing with corridors, and maintaining effective operations. We need to build the case to align the concept that the lay-in acoustic tile ceiling is effective for smoke control. The fire code has this in the retroactive requirements. Work is needed to bring it into the IBC.

K17 5 2000 NEW

Corridor walls shall form a barrier to limit the

transfer of smoke. Such walls shall be permitted to

terminate at the ceiling where the ceiling is

constructed to limit the transfer of smoke. No fire

resistance rating is required for the corridor walls.

18.3.6.1, 18.3.6.2, 18.3.6.4, 18.3.6.5

K362 27 Corridors – Construction of Walls 2012 NEW

Corridor walls shall form a barrier to limit the

transfer of smoke. Such walls shall be permitted to

terminate at the ceiling where the ceiling is

constructed to limit the transfer of smoke. No fire

resistance rating is required for the corridor walls.

18.3.6.2

IBC SECTION 407 GROUP I-2 IBC 407.1 General. IBC 407.3 Corridor wall construction. IBC 1020 Corridors IBC 1020.5 (IMC [BF] 601.2) Air movement in corridors.

Action needs to be taken on this topic. See above in K362

K18 6 2000 EXISTING

Doors protecting corridor openings in other than

required enclosures of vertical openings, exits, or

hazardous areas shall be substantial doors, such

as those constructed of 13/4 inch solid-bonded

K363 28 Corridor – Doors 2012 EXISTING

Doors protecting corridor openings in other than

required enclosures of vertical openings, exits, or

hazardous areas shall be substantial doors, such

as those constructed of 1¾ inch solid-bonded core

IBC 407.3.1 Corridor doors. IEBC 804.5.2 Transoms. IFC 1105.4.4.2 Doors.

Action needs to be taken on this topic. Work needs to be done regarding transoms are not expressly allowed, so work is needed in the IEBC on this one.

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core wood, or capable of resisting fire for at least

20 minutes. Clearance between bottom of door and

floor covering is not exceeding 1 inch. Doors in fully

sprinklered smoke compartments are only required

to resist the passage of smoke. There is no

impediment to the closing of the doors. Hold open

devices that release when the door is pushed or

pulled are permitted. Doors shall be provided with a

means suitable for keeping the door closed. Dutch

doors meeting 19.3.6.3.6 are permitted.

Door frames shall be labeled and made of steel or

other materials in compliance with 8.2.3.2.1. Roller

latches are prohibited by CMS regulations in all

health care facilities. 19.3.6.3

Show in REMARKS, details of doors, such as fire protection ratings, automatic closing devices, etc.

wood, or capable of resisting fire for at least 20

minutes. Doors in fully sprinklered smoke

compartments are only required to resist the

passage of smoke. Doors shall be provided with a

means suitable for keeping the door closed.

There is no impediment to the closing of the doors.

Clearance between bottom of door and floor

covering is not exceeding 1 inch. Roller latches are

prohibited by CMS regulations on corridor doors

and rooms containing flammable or combustible

materials. Powered doors complying with 7.2.1.9

are permissible. Hold open devices that release

when the door is pushed or pulled are permitted.

Nonrated protective plates of unlimited height are

permitted. Dutch doors meeting 19.3.6.3.6 are

permitted.

Door frames shall be labeled and made of steel or

other materials in compliance with 8.3, unless the

smoke compartment is sprinklered. Fixed fire

window assemblies are allowed per 8.3. In

sprinklered compartments there are no restrictions

in area or fire resistance of glass or frames in

window assemblies.

19.3.6.3, 42 CFR Parts 403, 418, 460, 482, 483, and 485

Show in REMARKS details of doors such as fire protection ratings, automatics closing devices, etc.

IFC 1105.4.4.2.1 Louvers. IFC 1105.4.4.2.2 Corridor doors. IFC 1105.4.4.2.3 Dutch doors. IFC 1105.4.4.2.4 Self- or automatic-closing doors. IFC 1105.4.4 Openings in corridor walls. IFC 1105.4.4.1 Windows. IFC 1105.4.4.3 Openings in corridor walls and doors. IFC 1105.4.5 Penetrations. IFC 1105.4.6 Joints. IFC 1105.4.7 Ducts and air transfer openings.

IFC, Chapter 11 Although many of the requirements were captured, this section needs monitoring to capture other requirements, and continual monitoring to make sure this chapter stays aligned with federal requirements. This is crucial for the retroactive requirements of this chapter.

K19 6 Vision panels in corridor walls or doors shall be

fixed window assemblies in approved frames. (In

fully sprinklered smoke compartments, there are no

restrictions in the area and fire resistance of glass

and frames.) In other than smoke compartments

containing patient bedrooms, miscellaneous

opening are permitted in vision panels or doors

provided the aggregate area of the opening per

room does not exceed 20 in.2 and the opening is

installed in bottom half of the wall (80 in.2 in fully

sprinklered buildings).

18.3.6.5, 19.3.6.2.3, 19.3.6.3.8, 19.3.6.5

K364 29 Corridor – Openings

Transfer grilles are not used in corridor walls or

doors. Auxiliary spaces that do not contain

flammable or combustible materials are permitted to

have louvers or be undercut.

In other than smoke compartments containing

patient sleeping rooms, miscellaneous openings are

permitted in vision panels or doors, provided the

openings per room do not exceed 20 in² and are at

or below half the distance from floor to ceiling. In

sprinklered rooms, the openings per room do not

exceed 80 in².

Vision panels in corridor walls or doors shall be fixed

window assemblies in approved frames. (In fully

sprinklered smoke compartments, there are no

restrictions in the area and fire resistance of glass

and frames.)

18.3.6.5.1, 19.3.6.5.2, 8.3

IEBC 804.5.2 Transoms. IFC 1105.4.4.2 Doors. IFC 1105.4.4.2.1 Louvers. IFC 1105.4.4.2.2 Corridor doors. IFC 1105.4.4.2.3 Dutch doors. IFC 1105.4.4.2.4 Self- or automatic-closing doors.

See above regarding Chapter 11 requirements.

K23, K24

8 2000 EXISTING

K23

Smoke barriers shall be provided to form at least

two smoke compartments on every sleeping room

floor for more than 30 patients. 19.3.7.1, 19.3.7.2

K24

The smoke compartments shall not exceed

22,500 square feet and the travel distance to and

from any point to reach a door in the required

smoke barrier shall not exceed 200 feet.

18.3.7.1, 19.3.7.1

Detail in REMARKS zone dimensions including length of zones and dead end corridors.

K371 29 Subdivision of Building Spaces – Smoke

Compartments 2012 EXISTING

Smoke barriers shall be provided to form at least two

smoke compartments on every sleeping floor with a

30 or more patient bed capacity. Size of

compartments cannot exceed 22,500 square feet or

a 200-foot travel distance from any point in the

compartment to a door in the smoke barrier.

19.3.7.1, 19.3.7.2

Detail in REMARKS zone dimensions including length of zones and dead-end corridors.

IFC 1105.6 Smoke compartments. IFC 1105.6.1 Design. IFC 1105.6.1.1 Refuge areas. IFC 1105.6.2 Smoke barriers. IFC 1105.6.3 Opening protectives. IFC 1105.6.4 Penetrations. IFC 1105.6.5 Joints. IFC 1105.6.6 Duct and air transfer openings.

Action needs to be taken on this topic. This is a critical piece of the future construction in healthcare. Strides are being made to align federal requirements to this. Next steps will include: Taking into account any provisions passed with the LSC Working with the occupant load for I-2. Due to space requirements and equipment, we need to increase the square footage per occupant to match contemporary standards. This will take a lot of collaboration and interface with fire and building officials to make sure we get things right.

K23, K24

8 2000 NEW

K23

Smoke barriers shall be provided to form at least

two smoke compartments on every floor used by

inpatients for sleeping or treatment, and on every

floor with an occupant load of 50 or more persons,

regardless of use. Smoke barriers shall also be

provided on floors that are usable, but unoccupied.

18.3.7.1, 18.3.7.2

K24

The smoke compartments shall not exceed

22,500 square feet and the travel distance to and

K371 29 Subdivision of Building Spaces – Smoke

Compartments 2012 NEW

Smoke barriers shall be provided to form at least two

smoke compartments on every floor used by

inpatients for sleeping or treatment, and on every

floor with an occupant load of 50 or more persons,

regardless of use.

Size of compartments cannot exceed 22,500 square

feet or a 200-foot travel distance from any point in

the compartment to a door in the smoke barrier.

Smoke subdivision requirements do not apply to any

of the stories or areas described in 18.3.7.2.

18.3.7.1, 18.3.7.2

Detail in REMARKS zone dimensions including

G107-15 (AS) IBC 407.5 Smoke barriers. G107-15 (AS) (G109-15 AMPC1) IBC 407.5.1 Smoke compartment size. G107-15 (AS) IBC 407.5.2 Exit access travel distance. IBC 407.5.3 Refuge area. IBC 407.5.4 Independent egress.

See comments above. These are key provisions to the Defend-In-Place concept, and must be monitored.

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from any point to reach a door in the required

smoke barrier shall not exceed 200 feet.

18.3.7.1, 19.3.7.1

Detail in REMARKS zone dimensions including length of zones and dead end corridors.

length of zones and dead-end corridors.

K25, K104

8, 10

K25: 2000 EXISTING Smoke barriers shall be constructed to provide at least a one half hour fire resistance rating and constructed in accordance with 8.3. Smoke barriers shall be permitted to terminate at an atrium wall. Windows shall be protected by fire-rated glazing or by wired glass panels and steel frames. 8.3, 19.3.7.3, 19.3.7.5 K104: Penetrations of smoke barriers by ducts are protected in accordance with 8.3.5. Dampers are not required in duct penetrations of smoke barriers in fully ducted HVAC systems where a sprinkler system in accordance with 18/19.3.5 is provided for adjacent smoke compartments. 18.3.7.3, 19.3.7.3. Hospitals may apply a 6-year damper testing interval conforming to NFPA 80 & NFPA 105. All other health care facilities must maintain a 4-year damper maintenance interval. 8.3.5 Describe any mechanical smoke control system in REMARKS.

K372 30 Subdivision of Building Spaces – Smoke Barrier

Construction 2012 EXISTING

Smoke barriers shall be constructed to a ½-hour fire

resistance rating per 8.5. Smoke barriers shall be

permitted to terminate at an atrium wall. Smoke

dampers are not required in duct penetrations in

fully ducted HVAC systems where an approved

sprinkler system is installed for smoke

compartments adjacent to the smoke barrier.

19.3.7.3, 8.6.7.1(1)

Describe any mechanical smoke control system in REMARKS.

IFC 1105.6.2 Smoke barriers. Action needs to be taken on this topic. It is important to make sure we monitor the retroactive requirements of Chapter 11, especially when it comes to smoke barriers, a key component of the Defend-In-Place concept.

K25, K104

8, 10

K25: 2000 EXISTING Smoke barriers shall be constructed to provide at least a one half hour fire resistance rating and constructed in accordance with 8.3. Smoke barriers shall be permitted to terminate at an atrium wall. Windows shall be protected by fire-rated glazing or by wired glass panels and steel frames. 8.3, 19.3.7.3, 19.3.7.5 K104: Penetrations of smoke barriers by ducts are protected in accordance with 8.3.5. Dampers are not required in duct penetrations of smoke barriers in fully ducted HVAC systems where a sprinkler system in accordance with 18/19.3.5 is provided for adjacent smoke compartments. 18.3.7.3, 19.3.7.3. Hospitals may apply a 6-year damper testing interval conforming to NFPA 80 & NFPA 105. All other health care facilities must maintain a 4-year damper maintenance interval. 8.3.5Describe any mechanical smoke control system in REMARKS.

K372 30 2012 NEW

Smoke barriers shall be constructed to provide at

least a 1-hour fire resistance rating and

constructed in accordance with 8.5. Smoke

barriers shall be permitted to terminate at an

atrium wall. Smoke dampers are not required in

duct penetrations of fully ducted HVAC systems.

18.3.7.3, 18.3.7.4, 18.3.7.5, 8.3

Describe any mechanical smoke control system in REMARKS.

IBC 407.5 Smoke barriers. IBC 709.8 Ducts and air transfer openings. IBC 717.5.5 Smoke barriers. IMC [BF] 607.5.4 Corridors/smoke barriers.

Action needs to be taken on this topic. Smoke dampers in smoke barriers remains a controversial issue, although not required in federal standards since the early 1990s. great strides have been made between the interested industry groups to focus these requirements on the science, so it is critical the healthcare industry stay at the table to engage on this issue.

K26 8 Space shall be provided on each side of

smoke barriers to adequately

accommodate the total number of

occupants in adjoining compartments.

18.3.7.4, 19.3.7.4

K373 30 Subdivision of Building Spaces – Accumulation Space

Space shall be provided on each side of smoke

barriers to adequately accommodate the total

number of occupants in adjoining compartments

18.3.7.5.1, 18.3.7.5.2, 19.3.7.5.1, 19.3.7.5.2

IBC 407.5.3 Refuge area. IFC 1105.6.1.1 Refuge areas.

Action needs to be taken on this topic. This is an evolving topic in emergency management (not just fire emergencies, but active shooter, biohazard, and other contemporary threats). It is important healthcare stay engaged on this issue.

K27, K28

9 2000 NEW K27 Doors in smoke barriers have at least a 20 minute fi protection rating or are at least 13/4 inch thick solid bonded core wood. Non- rated protective plates that do not exceed 48 inches from the bottom of the door are permitted. Horizontal sliding doors comply with 7.2.1.14. Swinging doors shall be arranged so that each door swings in an opposite direction. Doors shall be self- closing and rabbets, bevels or astragals are required at the meeting edges. Positive latching is not required. 18.3.7.5, 18.3.7.6, 18.3.7.8 K28 Door openings in smoke barriers are installed as swinging or horizontal doors shall provide a minimum clear width as follows: Provider Type Swinging Doors Horizontal Sliding Doors Hospitals and Nursing Facilities 41.5 inches (105 cm) 83 inches (211 cm) Psychiatric Hospitals and Limited Care Facilities 32 inches (81 cm) 64 inches (163 cm) 18.3.7.7

K374 31 Subdivision of Building Spaces – Smoke Barrier

Doors 2012 NEW

Doors in smoke barriers have at least a 20-minute

fire protection rating or are at least 1¾-inch thick

solid bonded core wood. Required clear widths are

provided per 18.3.7.6(4) and (5).

Nonrated protective plates that do not exceed 48

inches from the bottom of the door are permitted.

Horizontal-sliding doors comply with 7.2.1.14.

Swinging doors shall be arranged so that each door

swings in an opposite direction.

Doors shall be self-closing and rabbets, bevels, or

astragals are required at the meeting edges. Positive

latching is not required.

18.3.7.6, 18.3.7.7, 18.3.7.8

G112-15 (AS) IBC 407.6 Automatic closing doors. IBC 709.5 Openings. G112-15 (AS) IBC 709.5.1 Group I-2 and ambulatory care facilities IFC 909.5.3(IMC 513.5.3) Opening protection. IFC 909.5.3.1 (IMC 513.5.3.1) Group I-1 Condition 2, Group I-2 and ambulatory care facilities.

Action needs to be taken on this topic. Door issues become very complicated in the hospital setting, and are key to proper operatins. Although there is alignment on these now, they continually evolve and need maintenance in the future.

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K25 8 2000 EXISTING

Smoke barriers shall be constructed to provide at

least a one half hour fire resistance rating and

constructed in accordance with 8.3. Smoke

barriers shall be permitted to terminate at an

atrium wall. Windows shall be protected by fire-

rated glazing or by wired glass panels and steel

frames. 8.3, 19.3.7.3, 19.3.7.5

K379 31 Smoke Barrier Door Glazing 2012 EXISTING

Openings in smoke barrier doors shall be fire-rated

glazing or wired glass panels in steel frames.

19.3.7.6, 19.3.7.6.2, 8.5

IFC 1105.6.3 Opening protectives. Although aligned, these existing requirements need monitoring in the future.

K25 8 2000 NEW

Smoke barriers shall be constructed to

provide at least a one hour fire resistance

rating and constructed in accordance with

8.3. Smoke barriers shall be permitted to

terminate at an atrium wall. Windows shall be

protected by fire-rated glazing or by wired glass

panels in approved frames. 8.3, 18.3.7.3,

18.3.7.5

K379 31 2012 NEW

Windows in smoke barrier doors shall be installed in

each cross corridor swinging or horizontal-sliding

door protected by fire- rated glazing or by wired

glass panels in approved frames.

18.3.7.9

IBC 716.2.5.3 Glazing in door assemblies in corridors and smoke barriers. IBC 716.2.5.4 Fire door frames with transom lights and sidelights.

Action needs to be taken on this topic. The requirement was IF glass was in the door. Now, windows are required, so action is needed.

K55 17 K55:

2000 EXISTING

Every patient sleeping room shall have an

outside window or outside door. Except for

newborn nurseries and rooms intended for

occupancy for less than 24 hours.

19.3.8

2000 NEW

Every patient sleeping room shall have an outside

window or outside door. The allowable sill height

shall not exceed 36 inches (91 cm) above the floor.

Windows are not required for recovery rooms,

newborn nurseries, emergency rooms, and similar

rooms intended for occupancy for less than 24

hours. Window sill height for limited care facilities

shall not exceed 44 inches (112 cm) above the floor.

18.3.8

K381 31 Sleeping Room Outside Windows and Doors

Every patient sleeping room has an outside

window or outside door. In new occupancies, sill

height does not exceed 36 in. above the floor.

Windows in atrium walls are considered outside

windows. Newborn nurseries and rooms intended

for occupancy less than 24 hours have no outside

window or door requirements. Window sills in

special nursing care areas (e.g., ICU, CCU,

hemodialysis, neonatal) do not exceed 60 inches

above the floor.

42 CFR 403, 418, 460, 482, 483, and 485

Action needs to be taken on this topic. IBC or IFC do not currently address sill height. This is a large impact item, particularly for existing (IFC). Any restriction must not be in IFC Chapter 11 (retroactive).

N/A N/A N/A K400 31 Special Provisions – Other

List in the REMARKS section any LSC Section

18.4 and 19.4 Special Provisions requirements

that are not addressed by the provided K-tags,

but are deficient. This information, along with the

applicable Life Safety Code or NFPA standard

citation, should be included on Form CMS-2567.

N/A N/A N/A K421 32 High-Rise Buildings 2012 EXISTING High-rise buildings are protected throughout by an approved, supervised automatic sprinkler system in accordance with Section 9.7 within 12 years of LSC final rule effective date. 19.4.2

IBC 803.2 Automatic sprinkler systems. IBC 803.2.1 High-rise buildings. IBC 803.2.1.1 Supplemental automatic sprinkler system requirements. IBC 803.2.2 Groups A, B, E, F-1, H, I, M, R-1, R-2, R-4, S-1 and S-2. IBC 803.2.2.1 Mixed uses. F406-(AS) IFC K102.3.2 High rise buildings.

Action needs to be taken on this topic. Although adequately addressed, this item needs to be tracked in terms of implementation based on CMS adoption of the 2012 LSC. It will inform future code changes.

N/A N/A N/A K421 32 High-Rise Buildings 2012 NEW High-rise buildings comply with section 11.8. 18.4.2

IBC SECTION 403 HIGH-RISE BUILDINGS Most hospitals in urban areas are high-rises. All of these requirements must be monitored to ensure the concept of defend-in-place for patients is adequately recognized.

N/A N/A N/A K500 32 Building Services – Other

List in the REMARKS section any LSC Section 18.5

and 19.5 Building Services requirements that are not

addressed by the provided K-tags, but are deficient.

This information, along with the applicable Life

Safety Code or NFPA standard citation, should be

included on Form CMS-2567.

K108, K147

26 K108: 2000 NEW (INDICATE N/A FOR EXISTING) Power for Alarms, emergency communication systems, and illumination of generator set locations are in accordance with essential electrical system of NFPA 99. 18.5.1.2 K147: Electrical wiring and equipment shall be in accordance with National Electrical Code. 9-1.2 (NFPA 99) 18.9.1, 19.9.1

K511 32 Utilities – Gas and Electric

Equipment using gas or related gas piping

complies with NFPA 54, National Fuel Gas Code,

electrical wiring and equipment complies with

NFPA 70, National Electric Code. Existing

installations can continue in service provided no

hazard to life.

18.5.1.1, 19.5.1.1, 9.1.1, 9.1.2

IBC 2701.1 Scope.

IEBC 302.3 Additional codes. IFGC CHAPTER 4 GAS PIPING INSTALLATION

Action needs to be taken on this topic. The k-tag is largely a pointer to the relevant NFPA chapters. Work is needed to align the pointers. Gas: NFPA 54 Electrical: NFPA 70, National Electric Code (OK) Emergency Generators and Standby power: NFPA 110 Stored Electrical: NFPA 111

K67 20 Heating, ventilating, and air conditioning shall

comply with 9.2 and shall be installed in

accordance with the manufacturer’s

specifications.

18.5.2.1, 19.5.2.1, 9.2, NFPA 90A, 18.5.2.2, 19.5.2.2

K521 32 HVAC

Heating, ventilation, and air conditioning shall

comply with 9.2 and shall be installed in

accordance with the manufacturer’s

specifications.

IFC SECTION 603 FUEL-FIRED APPLIANCES IFC 603.1 Installation. IFC 603.1.1 Manufacturer’s instructions. IBC 1203.1 General.

Action needs to be taken on this topic. The k-tag is largely a pointer to the relevant NFPA chapters. Work is needed to align the pointers. HVAC ductwork and related equipment: NFPA 90A or 90B

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18.5.2.1, 19.5.2.1, 9.2 IMC 401.2 Ventilation required. IMC SECTION 407 AMBULATORY CARE FACILITIES AND GROUP I-2 OCCUPANCIES IMC 407.1 General.

Ventillating or Heat-Producing equipment: NFPA 211 chimneys, fireplaces, vents and solid fuel burning appliances NFPA 31 Oil Buring Equipment NFPA 54 Fuel gas Code NFPA 70 – NEC NFPA 96: Commercial Cooking Also, this K-tag is where NFPA 45 is referenced for laboratories using chemicals. Lots of work to be done with the multidisciplinary teams with code changes in the 2018 Cycle. Having the Ad-Hoc for Healthcare Committee is key participation

K68 20 Combustion and ventilation air for boiler,

incinerator and heater rooms is taken from and

discharged to the outside air.

18.5.2.2, 19.5.2.2

K522 32 HVAC – Any Heating Device

Any heating device, other than a central heating

plant, is designed and installed so combustible

materials cannot be ignited by device, and has a

safety features to stop fuel and shut down

equipment if there is excessive temperature or

ignition failure. If fuel fired, the device also:

• is chimney or vent connected

• takes air for combustion from outside

• combustion system separate from occupied area

atmosphere 18.5.2.2, 19.5.2.2

IMC CHAPTER 9 SPECIFIC APPLIANCES, FIREPLACES AND SOLID FUEL-BURNING EQUIPMENT No work needed

N/A N/A N/A K523 33 HVAC – Suspended Unit Heaters

Suspended unit heaters are permitted provided the following are met:

• Not located in means of egress or in patient rooms

• Located high enough to be out of reach of people in the area

• Has a safety feature to stop fuel and shut down

equipment if there is excessive temperature or

ignition failure. 18.5.2.3(1), 19.5.2.3(1)

IMC SECTION 920 UNIT HEATERS IMC 920.1 General. IMC 920.2 Support. IMC 920.3 Ductwork.

No language currently exists specific to the institutional (health care) installation as prescribed under NFPA 101-2012

N/A N/A N/A K524 33 HVAC – Direct-Vent Gas Fireplaces

Direct-vent gas fireplaces, as defined in NFPA 54,

inside of all smoke compartments containing

patient sleeping areas comply with the

requirements of 18.5.2.3(2), 19.5.2.3(2).

18.5.2.3(2), 19.5.2.3(2), NFPA 54

IMC CHAPTER 9 SPECIFIC APPLIANCES, FIREPLACES AND SOLID FUEL-BURNING EQUIPMENT No language currently exists specific to the institutional (health care) installation as prescribed under NFPA 101-2012

N/A N/A N/A K525 33 HVAC – Solid Fuel-Burning Fireplaces

Solid fuel-burning fireplaces are permitted in other than patient sleeping areas provided:

• Areas are separated by 1-hour fire resistance construction

• Fireplace complies with 9.2.2

• Fireplace enclosure resists breakage up to 650°F and has heat-tempered glass

• Room has supervised CO detection per 9.8

18.5.2.3(3) and 19.5.2.3(3)

IMC CHAPTER 9 SPECIFIC APPLIANCES, FIREPLACES AND SOLID FUEL-BURNING EQUIPMENT M12-15 (AS) IMC 901.4 Solid fuel-burning fireplaces and appliances in Group I-2 Condition 2.

No language currently exists specific to the institutional (health care) installation as prescribed under NFPA 101-2012

K160 21 2000 EXISTING

Elevators comply with the provision of 9.4.

Elevators are inspected and tested as specified in

A17.1, Safety Code for Elevators and Escalators.

Fire Fighter’s Service is operated monthly with a

written record.

Existing elevators conform to ASME/ANSI A17.3,

Safety Code for Existing Elevators & Escalators.

All existing elevators, having a travel distance of

25 ft. or more above or below the level that best

serves the needs of emergency personnel for

firefighting purposes, conform with Firefighter’s

Service Requirements of ASME/ANSI A17.3.

9.4.2, 9.4.3, 19.5.3

(Includes firefighters service phase I key recall and

smoke detector automatic recall, firefighters

service phase II emergency in-car key operation,

machine room smoke detectors, and elevator

lobby smoke detectors.)

K531 33 Elevators

2012 EXISTING

Elevators comply with the provision of 9.4. Elevators

are inspected and tested as specified in ASME

A17.1, Safety Code for Elevators and Escalators.

Firefighter’s Service is operated monthly with a

written record.

Existing elevators conform to ASME/ANSI A17.3,

Safety Code for Existing Elevators and Escalators.

All existing elevators, having a travel distance of 25

ft. or more above or below the level that best serves

the needs of emergency personnel for firefighting

purposes, conform with Firefighter’s Service

Requirements of ASME/ANSI A17.3. (Includes

firefighter’s service Phase I key recall and smoke

detector automatic recall, firefighter’s service Phase

II emergency in-car key operation, machine room

smoke detectors, and elevator lobby smoke

detectors.)

19.5.3, 9.4.2, 9.4.3

IBC 3001.3 Referenced standards. G194-15 (AM) IBC TABLE 3001.3 ELEVATORS AND CONVEYING SYSTEMS AND COMPONENTS IEBC 902.1.2 Elevators. IFC SECTION 606ELEVATOR OPERATION, MAINTENANCE AND FIRE SERVICE KEYS IFC 606.1 Emergency operation. IFC 606.2 Standby power. IFC 606.2.1 Manual transfer. IFC 606..2.2 One elevator. IFC 606.2.3 Two or more elevators. IFC 1103.3 Existing elevators. F236-16 (AS) IFC 1103.3.1 Elevators, escalators and moving walks. IFC 1103.3.2 Elevator emergency operation.

All language parallel.

K161 21 and 22

2000 EXISTING

Escalators, dumbwaiters, and moving walks comply with the provisions of 9.4.

All existing escalators, dumbwaiters, and moving walks conform to the requirements of ASME/ANSI A17.3,

K532 34 Escalators, Dumbwaiters, and Moving Walks 2012

EXISTING

Escalators, dumbwaiters, and moving walks comply with the provisions of 9.4.

All existing escalators, dumbwaiters, and

moving walks conform to the requirements of

ASME/ANSI A17.3, Safety Code for Existing

IFC 1103.3 Existing elevators. F236-16 (AS) IFC 1103.3.1 Elevators, escalators and moving walks.

All language parallel.

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Safety Code for Existing Elevators and Escalators. 19.5.3, 9.4.2.2

(Includes escalator emergency stop buttons

and automatic skirt obstruction stop. For power

dumbwaiters includes hoistway door locking to

keep doors closed except for floor where car is

being loaded or unloaded.)

Elevators and Escalators.

(Includes escalator emergency stop buttons and

automatic skirt obstruction stop. For power

dumbwaiters, includes hoistway door locking to

keep doors closed except for floor where car is

being loaded or unloaded.)

19.5.3, 9.4.2.2

K161 21 and 22

2000 NEW

Escalators, dumbwaiters, and moving walks

comply with the provisions of 9.4. All escalators

and conveyors comply with ASME/ANSI A17.1,

Safety Code for Elevators and Escalators. 18.5.3, 9.4.2.1

K532 34 Escalators, Dumbwaiters, and Moving Walks 2012

NEW

Escalators, dumbwaiters, and moving walks comply

with the provisions of 9.4. 18.5.3, 9.4.2.2

IBC SECTION 3004 CONVEYING SYSTEMS IBC 3004.1 General.

K71 20

Rubbish Chutes, Incinerators and Laundry

Chutes. 18.5.4, 19.5.4, 9.5, 8.4, NFPA 82

(1) Any existing linen and trash chute, including

pneumatic rubbish and linen systems, that

opens directly onto any corridor shall be sealed

by fire resistive construction to prevent further

use or shall be provided with a fire door

assembly having a fire protection rating of 1

hour. All new chutes shall comply with 9.5.

(2) Any rubbish chute or linen chute,

including pneumatic rubbish and linen

systems, shall be provided with automatic

extinguishing protection in accordance with

9.7.

(3) Any trash chute shall discharge into a

trash collection room used for no other

purpose and protected in accordance with

8.4

K541 35 Rubbish Chutes, Incinerators, and Laundry Chutes

2012 EXISTING

(1) Any existing linen and trash chute, including

pneumatic rubbish and linen systems, that opens

directly onto any corridor shall be sealed by fire

resistive construction to prevent further use or shall

be provided with a fire door assembly having a fire

protection rating of 1 hour. All new chutes shall

comply with 9.5.

(2) Any rubbish chute or linen chute, including

pneumatic rubbish and linen systems, shall be

provided with automatic extinguishing protection in

accordance with 9.7.

(3) Any trash chute shall discharge into a trash collection room used for no other purpose and protected in accordance with

8.4. (Existing laundry chutes permitted to discharge

into same room are protected by automatic

sprinklers in accordance with 19.3.5.9 or 19.3.5.7.)

(4) Existing fuel-fed incinerators shall be sealed by

fire resistive construction to prevent further use.

19.5.4, 9.5, 8.4, NFPA 82

IEBC 904.1.2 Rubbish and linen chutes. IFC 1103.4.9 Waste and linen chutes. IFC 1103.4.9.1 Enclosure. IFC 1103.4.9.2 Chute intakes. IFC 1103.4.9.2.1 Chute intake direct from corridor. IFC 1103.4.9.2.2 Chute intake via a chute-intake room. IFC 1103.4.9.3 Automatic sprinkler system. IFC 1103.4.9.4 Chute discharge rooms. IFC 1103.4.9.5 Chute discharge protection. IFC 1103.4.10 Flue-fed incinerators.

No language regarding chutes that are not in use and sealing those chutes.

K71 20 Rubbish Chutes, Incinerators and Laundry

Chutes. 18.5.4, 19.5.4, 9.5, 8.4, NFPA 82

(1) Any existing linen and trash chute, including

pneumatic rubbish and linen systems, that

opens directly onto any corridor shall be sealed

by fire resistive construction to prevent further

use or shall be provided with a fire door

assembly having a fire protection rating of 1

hour. All new chutes shall comply with 9.5.

(2) Any rubbish chute or linen chute,

including pneumatic rubbish and linen

systems, shall be provided with automatic

extinguishing protection in accordance with

9.7.

(3) Any trash chute shall discharge into a

trash collection room used for no other

purpose and protected in accordance with

8.4

K541 35 Rubbish Chutes, Incinerators, and Laundry Chutes

2012 NEW

Rubbish chutes, incinerators, and laundry chutes

shall comply with the provisions of Section 9.5,

unless otherwise specified in 18.5.4.2.

• The fire resistance rating of chute charging room shall not be required to exceed 1 hour.

• Any rubbish chute or linen chute shall be provided with automatic extinguishing protection in accordance with Section 9.7.

• Chutes shall discharge into a trash collection

room used for no other purpose and shall be

protected in accordance with 8.7. 18.5.4.2, 8.7,

9.5, 9.7, NFPA 82

IBC 713.13 Waste and linen chutes and incinerator rooms. IBC 713.13.1 Waste and linen. IBC 713.13.2 Materials. IBC 713.13.3 Chute access rooms. IBC 713.13.4 Chute discharge room. IBC 713.13.5 Incinerator room. IBC 713.13.6 Automatic sprinkler system. IFC 903.2.11.2 Rubbish and linen chutes.

N/A N/A N/A K700 36 Operating Features – Other

List in the REMARKS section any LSC Section

18.7 and 19.7 Operating Features requirements

that are not addressed by the provided K-tags, but

are deficient. This information, along with the

applicable Life Safety Code or NFPA standard

citation, should be included in Form CMS-2567.

K48 15 There is a written plan for the protection of all

patients and for their evacuation in the event of

an emergency. 18.7.1.1, 19.7.1.1

K711 36 Evacuation and Relocation Plan

There is a written plan for the protection of all patients and for their evacuation in the event of an emergency.

Employees are periodically instructed and kept

informed with their duties under the plan, and a

copy of the plan is readily available with

telephone operator or with security. The plan

addresses the basic response required of staff

per 18/19.7.2.1.2 and provides for all of the fire

safety plan components per 18/19.2.2.

18.7.1.1 through 18.7.1.3, 18.7.2.1.2, 18.7.2.2,

IBC [F] 1002.2 Fire safety and evacuation plans. IFC 403.8 Group I occupancies. IFC 403.8.1 Group I-1 occupancies. IFC 403.8.1.1 Fire safety and evacuation plan. IFC 403.8.1.1.1 Fire evacuation plan. IFC 403.8.1.1.2 Fire safety plans. IFC 403.8.1.2 Employee training. IFC 403.8.1.3 Resident training. IFC 403.8.1.4 Drill frequency. IFC 403.8.1.5 Drill times. IFC 403.8.1.6 Resident participation in drills. IFC 403.8.1.7 Emergency evacuation drill deferral.

If the IBC continues to maintain chapter 4 (s. 407) should this requirement exist under that section? Understandably the IBC is “building” code and IFC is fire prevention and maintenance…emergency response or evacuation is more operational than building…but,? Definitely need to align the language in 18.7.2.1.1 through 18.7.2.3.2.

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18.7.2.3, 19.7.1.1 through 19.7.1.3, 19.7.2.1.2, 19.7.2.2, 19.7.2.3

IFC 403.8.2 Group I-2 occupancies. IFC 403.8.2.1 Fire evacuation plans. IFC 403.8.2.2 Fire safety plans. IFC 403.8.2.3 Emergency evacuation drills.

K50 15 Fire drills include the transmission of a fire alarm

signal and simulation of emergency fire conditions.

Fire drills are held at unexpected times under

varying conditions, at least quarterly on each shift.

The staff is familiar with procedures and is aware

that drills are part of established routine.

Responsibility for planning and conducting drills is

assigned only to competent persons who are

qualified to exercise leadership. Where drills are

conducted between 9:00 PM and 6:00 AM a coded

announcement may be used instead of audible

alarms.

18.7.1.2, 19.7.1.2

K712 36 Fire Drills

Fire drills include the transmission of a fire alarm

signal and simulation of emergency fire

conditions. Fire drills are held at unexpected

times under varying conditions, at least quarterly

on each shift. The staff is familiar with procedures

and is aware that drills are part of established

routine. Responsibility for planning and

conducting drills is assigned only to competent

persons who are qualified to exercise leadership.

Where drills are conducted between 9:00 PM and

6:00 AM, a coded announcement may be used

instead of audible alarms.

18.7.1.4 through 18.7.1.7, 19.7.1.4 through 19.7.1.7

IFC 403.8.2.3 Emergency evacuation drills. IFC 405.2 Frequency. IFC TABLE 405.2 FIRE AND EVACUATION DRILL FREQUENCY AND PARTICIPATION IFC 405.3 Leadership. IFC 405.4 Time. IFC 406.1 General.

Align language regarding specific hours in lieu of “visiting hours”

K66 19 Smoking regulations shall be adopted and shall include not less than the following provisions: 18.7.4, 19.7.4, 8-

6.4.2 (NFPA 99)

(1) Smoking shall be prohibited in any room, ward,

or compartment where flammable liquids,

combustible gases, or oxygen is used or stored

and in any other hazardous location, and such area

shall be posted with signs that read NO SMOKING

or shall be posted with the international symbol for

no sm ok i ng .

Exception: In facilities where smoking is

prohibited and signs are prominently placed at

all major entrances, secondary signs that

prohibit smoking in use areas are not required.

(Note: This exception is not applicable to

medical gas storage areas.)

8-3.1.11.3 (NFPA 99)

K741 37 Smoking Regulations

Smoking regulations shall be adopted and shall include not less than the following provisions:

(1) Smoking shall be prohibited in any room, ward,

or compartment where flammable liquids,

combustible gases, or oxygen is used or stored

and in any other hazardous location, and such

area shall be posted with signs that read NO

SMOKING or shall be posted with the international

symbol for no smoking.

(2) In health care occupancies where smoking is

prohibited and signs are prominently placed at all

major entrances, secondary signs with language

that prohibits smoking shall not be required.

(3) Smoking by patients classified as not responsible shall be prohibited.

(4) The requirement of 18.7.4(3) shall not apply where the patient is under direct superv ision.

(5) Ashtrays of noncombustible material and safe design shall be provided in all areas where smoking is permi t ted.

(6) Metal containers with self-closing cover

devices into which ashtrays can be emptied shall

be readily available to all areas where smoking is

permitted.

18.7.4, 19.7.4

IFC SECTION 310 SMOKING IFC 310.1 General. IFC 310.2 Prohibited areas. IFC 310.3 “No Smoking” signs. IFC 310.4 Removal of signs prohibited. IFC 310.5 Compliance with “No Smoking” signs. IFC 310.6 Ash trays. IFC 310.7 Burning objects. IFC 310.8 Hazardous environmental conditions.

Additional language required specific to patient care.

K74 22 Draperies, curtains, including cubicle curtains, and

other loosely hanging fabrics and films serving as

furnishings or decorations are flame resistant in

accordance with NFPA 701 except for shower

curtains. Sprinklers in areas where cubical curtains

are installed shall be in accordance with NFPA 13

to avoid obstruction of the sprinkler.

10.3.1, 18.3.5.5, 19.3.5.5, 18.7.5.1,

19.7.5.1, NFPA 13

Newly introduced upholstered furniture shall meet

the char length and heat release criteria specified

when tested in accordance with the methods cited

in 10.3.2 (2) and 10.3.3, 18.7.5.2, 19.7.5.2.

Newly introduced mattresses shall meet the

char length and heat release criteria

specified when tested in accordance with

the method cited in 10.3.2 (3) and 10.3.4.

18.7.5.3,

19.7.5.3

Newly introduced upholstered furniture and mattresses means purchased since March, 2003.

K751 37 Draperies, Curtains, and Loosely Hanging Fabrics

Draperies, curtains including cubicle curtains and

loosely hanging fabric or films shall be in

accordance with 10.3.1. Excluding curtains and

draperies: at showers and baths; on windows in

patient sleeping room located in sprinklered

compartments; and in non-patient sleeping rooms

in sprinklered compartments where individual

drapery or curtain panels do not exceed 48 square

feet or total area does not exceed 20% of the wall.

18.7.5.1, 18.3.5.11, 19.7.5.1, 19.3.5.11, 10.3.1

IFC 807.6 Occupancy-based requirements. IFC 807.6.3 Groups I-1 and I-2. IFC 807.6.3.1 Group I-1 and I-2 Condition 1 within units. IFC 807.6.3.2 In Group I-1 and I-2 Condition 1 for areas other than within units. IFC 807.6.3.3 In Group I-2 Condition 2. IFC 807.6.3.4 Other areas in Groups I-1 and I-2.

Align language based on percentage of cover as well as 48 square foot max…

N/A N/A N/A K752 38 Upholstered Furniture and Mattresses

Newly introduced upholstered furniture meets

Class I or char length, and heat release criteria in

accordance with 10.3.2.1 and 10.3.3, unless the

building is fully sprinklered.

Newly introduced mattresses shall meet char

length and heat release criteria in accordance

with 10.3.2.2 and 10.3.4, unless the building is

fully sprinklered.

F127-16 (AM) IFC 805.2 Group I-2 and Group B ambulatory care facilities. IFC 805.2.1 Upholstered furniture. IFC 805.2.1.1 Ignition by cigarettes. IFC 805.2.1.2 Heat release rate. IFC 805.2.1.3 Identification. IFC 805.2.2 Mattresses. IFC 805.2.2.1 Ignition by cigarettes. IFC 805.2.2.2 Heat release rate. IFC 805.2.2.3 Identification.

Align language specific to newly introduced definition.

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Upholstered furniture and mattresses

belonging to nursing home residents do not

have to meet these requirements as all

nursing homes are required to be fully

sprinklered.

Newly introduced upholstered furniture

and mattresses means purchased on or

after the LSC final rule effective date.

18.7.5.2, 18.7.5.4, 19.7.5.2, 19.7.5.4

IEBC 904.1.3 Upholstered furniture or mattresses.

K73 22 Combustible decorations shall be prohibited

unless they are flame-retardant or in such

limited quantity that hazard of fire

development or spread is not present.

18.7.5.4, 19.7.5.4

K753 38 Combustible Decorations

Combustible decorations shall be prohibited unless one of the following is met:

• Flame retardant or treated with approved fire-retardant coating that is listed and labeled for p r o d u c t .

• Decorations meet NFPA 701

• Decorations exhibit heat release less than 100 kilowatts in accordance with NFPA 289.

• Decorations, such as photographs, paintings and

other art are attached to the walls, ceilings and non-

fire-rated doors in accordance with 18.7.5.6 or

19.7.5.6.

• The decorations in existing occupancies are in

such limited quantities that a hazard of fire is not

present. 18.7.5.6, 19.7.5.6

IFC SECTION 807 DECORATIVE MATERIALS OTHER THAN NATURAL DECORATIVE VEGETATION IN NEW AND EXISTING BUILDINGS IFC 807.1 General. IFC 807.2 Limitations. IFC 807.6.3 Groups I-1 and I-2. IFC 807.6.3.1 Group I-1 and I-2 Condition 1 within units. IFC 807.6.3.2 In Group I-1 and I-2 Condition 1 for areas other than within units. IFC 807.6.3.3 In Group I-2 Condition 2. IFC 807.6.3.4 Other areas in Groups I-1 and I-2.

Align language regarding all percentages… Decorations do not exceed 20 percent of the wall, ceiling, and door areas inside any room or space of a smoke compartment that is not protected throughout by an approved automatic sprinkler system in accordance with Section 9.7.

K75 22, 23

Soiled linen or trash collection receptacles shall

not exceed 32 gal (121 L) in capacity. The

average density of container capacity in a room

or space shall not exceed .5 gal/ft2 (20.4 L/m2). A

capacity of 32 gal (121 L) shall not be exceeded

within any 64-ft2 (5.9-m2) area. Mobile soiled

linen or trash collection receptacles with

capacities greater than 32 gal (121 L) shall be

located in a room protected as a hazardous area

when not attended.

18.7.5.5, 19.7.5.5

K754 39 Soiled Linen and Trash Containers

Soiled linen or trash collection receptacles shall not

exceed 32 gallons in capacity. The average density

of container capacity in a room or space shall not

exceed 0.5 gallons/square feet. A total container

capacity of 32 gallons shall not be exceeded within

any 64 square feet area. Mobile soiled linen or trash

collection receptacles with capacities greater than 32

gallons shall be located in a room protected as a

hazardous area when not attended.

Containers used solely for recycling are permitted to

be excluded from the above requirements where

each container is ≤ 96 gal. unless attended, and

containers for combustibles are labeled and listed as

meeting FM Approval Standard 6921 or equivalent.

18.7.5.7, 19.7.5.7

IFC SECTION 808 FURNISHINGS OTHER THAN UPHOLSTERED FURNITURE AND MATTRESSES OR DECORATIVE MATERIALS IN NEW AND EXISTING BUILDINGS

F137-16 (AM) IFC 808.1 Wastebaskets and linen containers in Group I-1, I-2 and I-3 occupancies and Group B ambulatory care facilities. F138-16 (AM) IFC 808.1 Wastebaskets and linen containers in Group I-1, I-2 and I-3 occupancies. IFC 808.1.1 Capacity density. IFC 808.1.2 Recycling clean waste containers.

IFC only addresses container size but not density of .5 gallons per square foot.

N/A N/A N/A K771 39 Engineer Smoke Control Systems 2012 EXISTING When installed, engineered smoke control systems are tested in accordance with established engineering principles. Test documentation is maintained on the premises. 19.7.7

NFPA 92 referenced standard.

N/A N/A N/A K771 39 Engineer Smoke Control Systems 2012 NEW When installed, engineered smoke control systems are tested in accordance with NFPA 92, Standard for Smoke Control Systems. Test documentation is maintained on the premises. 18.7.7

IFC SECTION 909 SMOKE CONTROL SYSTEMS NFPA 92 referenced standard.

K70 20 Portable space heating devices shall be prohibited

in all health care occupancies. Except it shall be

permitted to be used in non-sleeping staff and

employee areas where the heating elements of

such devices do not exceed 212°F (100°C).

18.7.8, 19.7.8

K781 39 Portable Space Heaters Portable space heating devices shall be prohibited in all health care occupancies. Except, unless used in nonsleeping staff and employee areas where the heating elements do not exceed 212 degrees Fahrenheit (100 degrees Celsius). 18.7.8, 19.7.8

F73-16 (AMPC1) IFC 605.10 604.10 Portable, electric space heaters. IFC 605.10.1 Listed and labeled. IFC 605.10.2 Power supply. IFC 605.10.3 Extension cords. IFC 605.10.4 Prohibited areas. F73-16 (AMPC1) IFC 604.10.5Group I-2 occupancies and ambulatory care facilities.

Proposed IFC amendment aligns the language.

N/A N/A N/A K791 39 Construction, Repair, and Improvement Operations

Construction, repair, and improvement

operations shall comply with 4.6.10. Any means

of egress in any area undergoing construction,

repair, or improvements shall be inspected daily

to ensure its ability to be used instantly in case

of emergency and compliance with NFPA 241.

18.7.9, 19.7.9, 4.6.10, 7.1.10.1

IBC CHAPTER 33 SAFEGUARDS DURING CONSTRUCTION Comprehensive parallel.

N/A N/A N/A K900 40 Health Care Facilities Code - Other

List in the REMARKS section, any NFPA 99

requirements (excluding Chapter 7, 8, 12, and 13)

that are not addressed by the provided K-Tags,

but are deficient. This information, along with the

applicable Health Care Facilities Code or NFPA

standard citation, should be included on Form

CMS-2567.

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K145 25 The Type I EES is divided into the critical branch, life safety

branch and the emergency system and

Type II EES is divided into the emergency

and critical systems in accordance with 3-

4.2.2.2, 3-5.2.2 (NFPA 99)

K901 40 Fundamentals – Building System Categories

Building systems are designed to meet Category 1

through 4 requirements as detailed in NFPA 99.

Categories are determined by a formal and

documented risk assessment procedure performed

by qualified personnel.

Chapter 4 (NFPA 99)

IFC 1105.10 Essential electrical systems. F255-16 (AS) IFC 1105.10.1 Where required. IFC 1105.10.2 Installation and duration. IBC 407.11 Electrical systems. G125-15 (AS) IBC 422.6 Electrical systems. IBC [F] 2702.1.7 Group I-2 occupancies. G125-15 (AS) IBC [F] 2702.2.1 Ambulatory care facilities. IBC [F] 2702.2.7 Group I-2 occupancies.

Risk assessment in accordance with NFPA 99-2012 Risk assessment should follow procedures such as those outlined in ISO/IEC 31010, Risk Management — Risk Assessment Techniques, NFPA 551, Guide for the Evaluation of Fire Risk Assessments, Guide for the Evaluation of Fire Risk Assessments, SEMI S10-0307E, Safety Guideline for Risk Assessment and Risk Evaluation Process, or other formal process. The results of the assessment procedure should be documented and records retained.

K77 24 Piped in medical gas, vacuum and waste anesthetic gas disposal systems comply with NFPA 99, Chapter 4.

K902 40 Gas and Vacuum Piped Systems – Other

List in the REMARKS section, any NFPA 99

Chapter 5 Gas and Vacuum Systems requirements

that are not addressed by the provided K-Tags, but

are deficient. This information, along with the

applicable Life Safety Code or NFPA standard

citation, should be included on Form CMS-2567.

Chapter 5 (NFPA 99)

N/A N/A N/A K903 40 Gas and Vacuum Piped Systems – Categories

Medical gas, medical air, surgical vacuum, WAGD,

and air supply systems in which failure is likely to

cause major injury or death are designated

Category 1. Systems in which failure is likely to cause minor injury to patients are designated

Category 2. Systems in which failure is not likely to cause injury, but can cause discomfort is designated

Category 3. Deep sedation and general anesthesia

are not administered when using a Category 3

medical gas system. 5.1.1.1, 5.2.1, 5.3.1.1, 5.3.1.5

(NFPA 99)

IPC [A] 101.2 Scope. IPC 292 Definitions MEDICAL GAS SYSTEM.

IPC SECTION 1202 MEDICAL GASES IPC [F] 1202.1 Nonflammable medical gases. IEBC 1010.5 Group I-2.

IPC cross reference to NFPA 99.

K140 24 Medical gas warning systems shall be in accordance with NFPA 99, Standard for Health Care Facilities.

(a) Master alarm panels are in two separate locations and have audible and visible signals.

(b) There are high/low alarms for +/- 20% operating pressure.

This section shall be in accordance with NFPA 99, 4-3.1.2.2

(c) Where a level 2 gas system is used, one

alarm panel that complies with 4-3.1.2.2(b)

3a,b,c,d and with 4- 3.1.2.2(c)2,5 shall be

permitted. 4-4.1 (NFPA 99) exception No. 4.

4-3.1.2.2 (NFPA 99)

K904 40 Gas and Vacuum Piped Systems – Warning Systems

All master, area, and local alarm systems used for

medical gas and vacuum systems comply with

appropriate Category warning system requirements,

as applicable.

5.1.9, 5.2.9, 5.3.6.2.2 (NFPA 99)

IFC 5306.5 Medical gas systems. IPC cross reference to NFPA 99.

N/A N/A N/A K905 41 Gas and Vacuum Piped Systems – Central Supply System Identification and Labeling

Containers, cylinders and tanks are designed,

fabricated, tested, and marked in accordance with

5.1.3.1.1 through 5.1.3.1.7. Locations containing

only oxygen or medical air have doors labeled with

"Medical Gases, NO Smoking or Open Flame".

Locations containing other gases have doors labeled

"Positive Pressure Gases, NO Smoking or Open

Flame, Room May Have Insufficient Oxygen, Open

Door and Allow Room to Ventilate before opening.

5.1.3.1, 5.2.3.1, 5.3.10 (NFPA 99)

IFC 1103.10 Medical gases. IFC 5303.4.3 Piping systems.

IFC 1103.10 speaks to storage and transfer, IFC ch 53 does not address labeling but parallels safeguards including room construction and quantities.

K77 24 Piped in medical gas, vacuum and waste anesthetic gas disposal systems comply with NFPA 99, Chapter 4.

K906 41 Gas and Vacuum Piped Systems – Central Supply System Operations

Adaptors or conversion fittings are prohibited.

Cylinders are handled in accordance with 11.6.2.

Only cylinders, reusable shipping containers, and

their accessories are stored in rooms containing

central supply systems or cylinders. No flammable

materials are stored with cylinders. Cryogenic

liquid storage units intended to supply the facility

are not used to transfill.

Cylinders are kept away from sources of heat. Valve

protection caps are secured in place, if supplied,

unless cylinder is in use. Cylinders are not stored in

tightly closed spaces. Cylinders in use and storage

are prevented from exceeding 130°F, and nitrous

oxide and carbon dioxide cylinders are prevented

from reaching temperatures lower than manufacture

recommendations or 20°F. Full or empty cylinders,

when not connected, are stored in locations

complying with 5.1.3.3.2 through 5.1.3.3.3, and are

IFC 5303.1 Containers, cylinders and tanks. IFC 5303.2 Design and construction.

IFC circles back to NFPA 99.

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not stored in enclosures containing motor-driven

machinery, unless for instrument air reserve

headers.

5.1.3.2, 5.1.3.3.17, 5.1.3.3.1.8, 5.1.3.3.4, 5.2.3.2, 5.2.3.3, 5.3.6.20.4, 5.6.20.5, 5.3.6.20.7, 5.3.6.20.8, 5.3.6.20.9 (NFPA 99)

N/A N/A N/A K907 41 Gas and Vacuum Piped Systems – Maintenance Program

Medical gas, vacuum, WAGD, or support gas

systems have documented maintenance programs.

The program includes an inventory of all source

systems, control valves, alarms, manufactured

assemblies, and outlets. Inspection and

maintenance schedules are established through risk

assessment considering manufacturer

recommendations. Inspection procedures and

testing methods are established through risk

assessment. Persons maintaining systems are

qualified as demonstrated by training and

certification or credentialing to the requirements of

AASE 6030 or 6 0 4 0 .

5.1.14.2.1, 5.1.14.2.2, 5.1.15, 5.2.14, 5.3.13.4.2 (NFPA 99)

IFC 5306.5 Medical gas systems.

IFC circles back to NFPA 99.

N/A N/A N/A K908 42 Gas and Vacuum Piped Systems – Inspection and Testing Operations

The gas and vacuum systems are inspected and

tested as part of a maintenance program and

include the required elements. Records of the

inspections and testing are maintained as

required.

5.1.14.2.3, B.5.2, 5.2.13, 5.3.13, 5.3.13.4 (NFPA 99)

IFC 5306.5 Medical gas systems.

IFC circles back to NFPA 99.

K141 24 Medical gas storage areas shall have a

precautionary sign, readable from a distance of 5

ft.,that is conspicuously displayed on each door or

gate of the storage room or enclosure. The sign

shall include the following wording as a minimum:

CAUSION, OXIDIZING GAS(ES) STORED WITHIN, NO SMOKING. 18.3.2.4, 19.3.2.4, 8-3.1.11.3 (NFPA 99)

K909 42 Gas and Vacuum Piped Systems – Information and Warning Signs

Piping is labeled by stencil or adhesive markers

identifying the gas or vacuum system, including the

name of system or chemical symbol, color code

(Table 5.1.11), and operating pressure if other than

standard. Labels are at intervals not more than 20

ft., are in every room, at both sides of wall

penetrations, and on every story traversed by riser.

Piping is not painted. Shutoff valves are identified

with the name or chemical symbol of the gas or

vacuum system, room or area served, and caution

to not use the valve except in emergency.

5.1.14.3, 5.1.11.1, 5.1.11.2, 5.2.11, 5.3.13.3, 5.3.11 (NFPA 99)

IFC Chapter 63 portions are not applicable to the context of this K-tag.

N/A N/A N/A K910 42 Gas and Vacuum Piped Systems – Modifications

Whenever modifications are made that breach

the pipeline, any necessary installer and

verification test specified in 5.1.2 is conducted

on the downstream portion of the medical gas

piping system. Permanent records of all tests

required by system verification tests are

maintained.

5.1.14.4.1, 5.1.14.4.6, 5.2.13, 5.3.13.4.3 (NFPA 99)

IFC 5306.5 Medical gas systems.

I believe the medical gases reference in the IFC to be per NFPA 99 would be applicable here.

N/A N/A N/A K911 42 Electrical Systems – Other

List in the REMARKS section, any NFPA 99

Chapter 6 Electrical Systems requirements that are

not addressed by the provided K-Tags, but are

deficient. This information, along with the applicable

Life Safety Code or NFPA standard citation, should

be included on Form CMS-2567.

Chapter 6 (NFPA 99)

IFC 1105.10 Essential electrical systems. F255-16 (AS) IFC 1105.10.1 Where required. IFC 1105.10.2 Installation and duration. IFC 1203.1.3 Installation. IFC 1203.1.8 Group I-2 occupancies. IFC 1203.2.7 Group I-2 occupancies. F76-16 (AM) IFC 1203.4.1 Group I-2.

IBC 407.11 Electrical systems. IBC [F] 2702.1.7 Group I-2 occupancies. IBC [F] 2702.2.6 2702.2.7 Group I-2 occupancies.

IEBC 1008.1 Special occupancies.

Although these references do apply they only cover the Essential Electrical Systems and a change in occupancy. This is only part of the K-tag requirement since it is referring to the entire electrical system for new and renovated facilities. We may need to do something to properly expand these requirements to include the entire electrical system covered in NFPA 99.

N/A N/A N/A K912 42 Electrical Systems – Receptacles

Power receptacles have at least one, separate,

highly dependable grounding pole capable of

maintaining low-contact resistance with its mating

plug. In pediatric locations, receptacles in patient

rooms, bathrooms, play rooms, and activity rooms,

other than nurseries, are listed tamper-resistant or

IEBC 407.1.4 Group I-2 receptacles. This section of the IEBC doesn’t totally cover the

requirements since it applies to only repairs – this needs to

cover new and renovations as well. We may need to do something to properly expand these requirements to include all receptacles covered by NFPA 99.

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employ a listed cover.

If used in patient care room, ground-fault circuit

interrupters (GFCI) are listed. 6.3.2.2.6.2 (F),

6.3.2.4.2 (NFPA 99)

N/A N/A N/A K913 43 Electrical Systems – Wet Procedure Locations

Operating rooms are considered wet procedure

locations, unless otherwise determined by a risk

assessment conducted by the facility governing

body. Operating rooms defined as wet locations are

protected by either isolated power or ground-fault

circuit interrupters. A written record of the risk

assessment is maintained and available for

inspection.

6.3.2.2.8.4, 6.3.2.2.8.7, 6.4.4.2

IFC 1203.4 Maintenance. F76-16 (AM) IFC 1203.4.1 Group I-2.

These references in the IFC do not cover the context of the K-tag. We will need to look at doing something to address this.

K144 25 Generators inspected weekly and exercised under

load for 30 minutes per month and shall be in

accordance with NFPA 99 and NFPA 110.

3-4.4.1 and 8-4.2 (NFPA 99), Chapter 6 (NFPA 110)

K914 43 Electrical Systems – Maintenance and Testing

Hospital-grade receptacles at patient bed locations

and where deep sedation or general anesthesia is

administered, are tested after initial installation,

replacement or servicing. Additional testing is

performed at intervals defined by documented

performance data. Receptacles not listed as

hospital-grade at these locations are tested at

intervals not exceeding 12 months. Line isolation

monitors (LIM), if installed, are tested at intervals of

≤ 1 month by actuating the LIM test switch per

6.3.2.6.3.6, which activates both visual and audible

alarm. For, LIM circuits with automated self-testing,

this manual test is performed at intervals ≤ 12

months. LIM circuits are tested per 6.3.3.3.2 after

any repair or renovation to the electric distribution

system.

Records are maintained of required tests and

associated repairs or modifications, containing date,

room or area tested, and results.

6.3.4 (NFPA 99)

IFC 1203.4 Maintenance. F76-16 (AM) IFC 1203.4.1 Group I-2. IFC 1203.1.9 Maintenance. IFC 1203.5 Operational inspection and testing. F76-16 (AM) IFC 1203.5.1 Group I-2.

These references in the IFC do not cover the context of the K-tag. We will need to look at doing something to address this

K106, K146

25, 26

K106:

Hospitals and inpatient hospices with life support

equipment have an Type I Essential Electric

System, and nursing homes have a Type II ESS that

are powered by a generator with a transfer switch

and separate power supply in accordance with

NFPA 99. 12-3.3.2, 13-3.3.2.1, 16-3.3.2 (NFPA 99)

K146:

The nursing home/hospice with no life support

equipment shall have an alternate source of

power separate and independent from the normal

source that will be effective for minimum of 1 1/2

hour after loss of the normal source 3-6. (NFPA

99)

K915 43 Electrical Systems – Essential Electric System Categories

Critical care rooms (Category 1) in which electrical

system failure is likely to cause major injury or death

of patients, including all rooms where electric life

support equipment is required, are served by a Type

1 EES.

General care rooms (Category 2) in which electrical

system failure is likely to cause minor injury to

patients (Category 2) are served by a Type 1 or

Type 2 EES.

Basic care rooms (Category 3) in which electrical

system failure is not likely to cause injury to patients

and rooms other than patient care rooms are not

required to be served by an EES. Type 3 EES life

safety branch has an alternate source of power that

will be effective for 1 1/2 hours.

3.3.138, 6.3.2.2.10, 6.6.2.2.2, 6.6.3.1.1 (NFPA 99), TIA 12-3

IFC 1105.10.1 Where required. IFC 1105.10.2 Installation and duration. IFC 1203.4 Maintenance. F76-16 (AM)IFC 1203.4.1 Group I-2.

Need to add the two IFC Sections on essential electrical systems as noted in other column.

N/A N/A N/A K916 44 Electrical Systems – Essential Electric System Alarm Annunciator

A remote annunciator that is storage battery

powered is provided to operate outside of the

generating room in a location readily observed by

operating personnel. The annunciator is hard-wired

to indicate alarm conditions of the emergency power

source. A centralized computer system (e.g.,

building information system) is not to be substituted

for the alarm annunciator.

6.4.1.1.17, 6.4.1.1.17.5 (NFPA 99)

IFC 1206.2.10 Storage batteries and equipment. IFC 1206.2.10.3 Energy management system.

These references in the IFC do not cover the context of the K-tag. We will need to look at doing something to address this

N/A N/A N/A K917 44 Electrical Systems – Essential Electric System Receptacles

Electrical receptacles or cover plates supplied

from the life safety and critical branches have a

distinctive color or marking. 6.4.2.2.6,

6.5.2.2.4.2, 6.6.2.2.3.2 (NFPA 99)

IEBC 407.1.4 Group I-2 receptacles.

Repair requirement This reference in the IEBC does not cover the context of the K-tag. We will need to look at doing something to address this

N/A N/A N/A K918 44 Electrical Systems – Essential Electric System Maintenance and Testing

The generator or other alternate power source and

IFC 1203.4 Maintenance. F76-16 (AM) IFC 1203.4.1 Group I-2.

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associated equipment is capable of supplying

service within 10-seconds. If the 10-second criterion

is not met during the monthly test, a process shall be

provided to annually confirm this capability for the

life safety and critical branches. Maintenance and

testing of the generator and transfer switches are

performed in accordance with NFPA 110.

Generator sets are inspected weekly, exercised

under load 30 minutes 12 times a year in 20-40 day

intervals, and exercised once every 36 months for 4

continuous hours. Scheduled test under load

conditions include a complete simulated cold start

and automatic or manual transfer of all EES loads,

and are conducted by competent personnel.

Maintenance and testing of stored energy power

sources (Type 3 EES) are in accordance with NFPA

111. Main and feeder circuit breakers are inspected

annually, and a program for periodically exercising

the components is established according to

manufacturer requirements.

Written records of maintenance and testing are

maintained and readily available. EES electrical

panels and circuits are marked and readily

identifiable. Minimizing the possibility of damage of

the emergency power source is a design

consideration for new installations.

6.4.4, 6.5.4, 6.6.4 (NFPA 99), NFPA 110, NFPA 111, 700.10 (NFPA 70)

N/A N/A N/A K919 45 Electrical Equipment – Other

List in the REMARKS section, any NFPA 99

Chapter 10, Electrical Equipment, requirements

that are not addressed by the provided K-Tags,

but are deficient. This information, along with

the applicable Life Safety Code or NFPA

standard citation, should be included on Form

CMS-2567.

Chapter 10 (NFPA 99)

We will need to discuss if something to address this type of K-tag (general purpose) is needed.

N/A N/A N/A K920 45 Electrical Equipment – Power Cords and Extension Cords

Power strips in a patient care vicinity are only used

for components of movable patient-care-related

electrical equipment (PCREE) assembles that have

been assembled by qualified personnel and meet

the conditions of 10.2.3.6. Power strips in the patient

care vicinity may not be used for non-PCREE (e.g.,

personal electronics), except in long-term care

resident rooms that do not use PCREE. Power

strips for PCREE meet UL 1363A or UL 60601-1.

Power strips for non-PCREE in the patient care

rooms (outside of vicinity) meet UL 1363. In non-

patient care rooms, power strips meet other UL

standards. All power strips are used with general

precautions. Extension cords are not used as a

substitute for fixed wiring of a structure. Extension

cords used temporarily are removed immediately

upon completion of the purpose for which it was

installed and meets the conditions of 10.2.4.

10.2.3.6 (NFPA 99), 10.2.4 (NFPA 99), 400-8 (NFPA 70), 590.3(D) (NFPA 70), TIA 12-5

F82-16 (AS) 604.5 Extension cords. This references in the IFC does not cover the context of the K-tag. We will need to look at doing something to address this

N/A N/A N/A K921 46 Electrical Equipment – Testing and Maintenance Requirements

The physical integrity, resistance, leakage current,

and touch current tests for fixed and portable

patient-care related electrical equipment (PCREE)

is performed as required in 10.3. Testing intervals

are established with policies and protocols. All

PCREE used in patient care rooms is tested in

accordance with 10.3.5.4 or 10.3.6 before being put

into service and after any repair or modification.

Any system consisting of several electrical

appliances demonstrates compliance with NFPA 99

as a complete system. Service manuals,

instructions, and procedures provided by the

manufacture include information as required by

IFC 604.7 Equipment and fixtures Although close this references in the IFC does not really cover the context of the K-tag. We will need to look at doing something to address this

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10.5.3.1.1 and are considered in the development

of a program for electrical equipment maintenance.

Electrical equipment instructions and maintenance

manuals are readily available, and safety labels

and condensed operating instructions on the

appliance are legible. A record of electrical

equipment tests, repairs, and modifications is

maintained for a period of time to demonstrate

compliance in accordance with the facility's policy.

Personnel responsible for the testing, maintenance

and use of electrical appliances receive continuing

trained.

10.3, 10.5.2.1, 10.5.2.1.2, 10.5.2.5, 10.5.3, 10.5.6, 10.5.8

N/A N/A N/A K922 46 Gas Equipment – Other

List in the REMARKS section, any NFPA 99

Chapter 11 Gas Equipment requirements that are

not addressed by the provided K-Tags, but are

deficient. This information, along with the

applicable Life Safety Code or NFPA standard

citation, should be included on Form CMS-2567.

Chapter 11 (NFPA 99)

IMC [F] 502.9 Hazardous materials—requirements for specific materials. IMC [F] 502.9.1 Compressed gases—medical gas systems. IFC COMBUSTIBLE GAS DETECTOR. IFC COMPRESSED GAS. IFC COMPRESSED GAS CONTAINER. IFC COMPRESSED GAS SYSTEM.

Chapter 11 of NFPA 99 is really about cylinders and their use in healthcare facilities. These references in the IMC & IFC do not cover the context of the K-tag. We will need to discuss if something to address this type of K-tag (general purpose) is needed.

K76 24 K76:

Medical gas storage and administration areas

shall be protected in accordance with NFPA

99, Standard for Health Care Facilities.

(a) Oxygen storage locations of greater than 3,000 cu. ft. are enclosed by a one-hour separation.

(b) Locations for supply

systems of greater than

3,000 cu. ft. are vented to

the outside. 4-3.1.1.2

(NFPA 99), 8-3.1.11.1

(NFPA 99), 18.3.2.4,

19.3.2.4

K923 47 Gas Equipment – Cylinder and Container Storage

≥ 3,000 cubic feet

Storage locations are designed, constructed, and ventilated in accordance with 5.1.3.3.2 and 5.1.3.3.3.

> 300 but <3,000 cubic feet

Storage locations are outdoors in an enclosure or

within an enclosed interior space of non- or limited-

combustible construction, with door (or gates

outdoors) that can be secured. Oxidizing gases are

not stored with flammables, and are separated from

combustibles by 20 feet (5 feet if sprinklered) or

enclosed in a cabinet of noncombustible

construction having a minimum 1/2 hr. fire protection

rating.

≤ 300 cubic feet

In a single smoke compartment, individual cylinders

available for immediate use in patient care areas

with an aggregate volume of ≤ 300 cubic feet are not

required to be stored in an enclosure. Cylinders

must be handled with precautions as specified in

11.6.2

A precautionary sign readable from 5 feet is on each

door or gate of a cylinder storage room, where the

sign includes the wording as a minimum "CAUTION:

OXIDIZING GAS (ES) STORED WITHIN NO

SMOKING".

Storage is planned so cylinders are used in order of

which they are received from the supplier. Empty

cylinders are segregated from full cylinders. When

facility employs cylinders with integral pressure

gauge, a threshold pressure considered empty is

established. Empty cylinders are marked to avoid

confusion. Cylinders stored in the open are

protected from weather. 11.3.1, 11.3.2, 11.3.3,

11.3.4, 11.6.5 (NFPA 99)

IFC 1103.10 Medical gases. IFC 5303.16 Vaults. IFC 5303.16.2 Design and construction. IFC SECTION 5306 MEDICAL GASES F367-16 (AS) IFC 5306.1 General. IFC 5306.2 Interior supply location. IFC 5306.2.1 One-hour exterior rooms. F368-16 (AS) IFC 5306.2.2 One-hour interior room. IFC 5306.2.3 Gas cabinets. IFC 5306.3 Exterior supply locations. IBC (G127-15 AMPC1) SECTION 427 MEDICAL GAS SYSTEMS IBC 427.1 General. IBC 427.2 Interior supply location. IBC 427.2.1 One-hour exterior room. IBC 427.2.2 One-hour interior room. IBC 427.2.3 Gas cabinets.

IFC Sections 5306.2 through 5306.4 and IBC 427.1 through 427.2.3 are very close in context of the K-tag. We will need to look at improving the proper application to the quantities of cubic feet allowed within the standard

N/A N/A N/A K924 47 Gas Equipment – Testing and Maintenance Requirements

Anesthesia apparatus are tested at the final path

to patient after any adjustment, modification or

repair. Before the apparatus is returned to

service, each connection is checked to verify

proper gas and an oxygen analyzer is used to

verify oxygen concentration. Defective equipment

is immediately removed from service. Areas

designated for servicing of oxygen equipment are

clean and free of oil, grease, or other flammables.

Manufacturer service manuals are used to

maintain equipment and a scheduled maintenance

program is followed.

11.4.1.3, 11.5.1.3, 11.6.2.5, 11.6.2.6 (NFPA 99)

IFC 5306.5 Medical gas systems. This references in the IFC does not cover the context of the K-tag since an apparatus is not the same as a system (NFPA 99 Chapter 5 vs Chapter 11). We will need to look at doing something to address this

N/A N/A N/A K925 48 Gas Equipment – Respiratory Therapy Sources of IFGC [M] APPLIANCE. These references in the IFGC do not cover the context of

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Ignition

Smoking materials are removed from patients

receiving respiratory therapy. When a nasal cannula

is delivering oxygen outside of a patient’s room, no

sources of ignition are within in the site of intentional

expulsion (1-foot). When other oxygen deliver

equipment is used or oxygen is delivered inside a

patient’s room, no sources of ignition are within the

area are of administration (15-feet). Solid fuel-

burning appliances is not in the area of

administration. Nonmedical appliances with hot

surfaces or sparking mechanisms are not within

oxygen-delivery equipment or site of intentional

expulsion.

11.5.1.1, TIA 12-6 (NFPA 99)

IFGC 303.3 Prohibited locations. IFC 6303.1.3 Ignition source control. IFC 5003.7.1 Smoking.

the K-tag. We will need to look at doing something to address this

N/A N/A N/A K926 48 Gas Equipment – Qualifications and Training of Personnel

Personnel concerned with the application,

maintenance and handling of medical gases and

cylinders are trained on the risk. Facilities provide

continuing education, including safety guidelines and

usage requirements. Equipment is serviced only by

personnel trained in the maintenance and operation

of equipment.

11.5.2.1 (NFPA 99)

IFC 5303.7.6 Heating. This references in the IFC does not cover the context of the K-tag. We will need to look at doing something to address this

K143 25 Transferring of liquid oxygen from one

container to another shall be accomplished

at a location specifically designated for the

transferring that is as follows:

(a) separated from any portion of a facility wherein

patients are housed, examined, or treated by a

separation of a fire barrier of 1-hour fire-resistive

construction; and

(b) the area that is mechanically ventilated, sprinklered, and has ceramic or concrete flooring; and

(c) in an area that is posted with signs

indicating that transferring is occurring,

and that smoking in the immediate area

is not permitted in accordance with

NFPA 99 and Compressed Gas

Association.

8-6.2.5.2 (NFPA 99)

K927 48 Gas Equipment – Transfilling Cylinders

Transfilling of oxygen from one cylinder to

another is in accordance with CGA P-2.5,

Transfilling of High Pressure Gaseous Oxygen

Used for Respiration. Transfilling of any gas

from one cylinder to another is prohibited in

patient care r o o m s .

Transfilling to liquid oxygen containers or to

portable containers over 50 psi comply with

conditions under 11.5.2.3.1 (NFPA 99).

Transfilling to liquid oxygen containers or to

portable containers under 50 psi comply with

conditions under 11.5.2.3.2 (NFPA 99).

11.5.2.2 (NFPA 99)

IFC 5306.4 Transfilling.

N/A N/A N/A K928 49 Gas Equipment – Labeling Equipment and Cylinders

Equipment listed for use in oxygen-enriched

atmospheres are so labeled. Oxygen metering

equipment and pressure reducing regulators are

labeled "OXYGEN-USE NO OIL". Flowmeters,

pressure reducing regulators, and oxygen-

dispensing apparatus are clearly and permanently

labeled designating the gases for which they are

intended. Oxygen-metering equipment, pressure

reducing regulators, humidifiers, and nebulizers are

labeled with name of manufacturer or supplier.

Cylinders and containers are labeled in accordance

with CGA C-7. Color coding is not utilized as the

primary method of determining cylinder or

container contents. All labeling is durable and

withstands cleaning or disinfecting.

11.5.3.1 (NFPA 99)

IFC 5303.1 Containers, cylinders and tanks. IFC 5303.4 Marking. IFC 5303.4.1 Stationary compressed gas containers, cylinders and tanks. IFC 5303.4.2 Portable containers, cylinders and tanks.

These references in the IFC cover a portion of the context of the K-tag. We will need to look at doing something to address the other requirements such as labeling of equipment and apparatuses and the signage

N/A N/A N/A K929 49 Gas Equipment – Precautions for Handling Oxygen Cylinders and Manifolds

Handling of oxygen cylinders and manifolds is

based on CGA G-4, Oxygen. Oxygen cylinders,

containers, and associated equipment are

protected from contact with oil and grease, from

contamination, protected from damage, and

handled with care in accordance with precautions

provided under 11.6.2.1 through 11.6.2.4 (NFPA

99)

11.6.2 (NFPA 99)

IFC 5303.5 Security. IFC 5303.5.1 Security of areas. IFC 5303.5.2 Physical protection. IFC 5303.5.3 Securing compressed gas containers, cylinders and tanks.

These references in the IFC do address a portion of the context of the K-tag. We will need to look at doing something to address the issues not addressed such as protection from contact with oil or grease, protection from contamination, and proper handling

N/A N/A N/A K930 49 Gas Equipment – Liquid Oxygen Equipment The storage and use of liquid oxygen in base

IFC CHAPTER 63 OXIDIZERS, OXIDIZING GASES AND OXIDIZING CRYOGENIC FLUIDS IFC SECTION 6301 GENERAL

These references in the IFC do not cover the context of the K-tag.

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reservoir containers and portable containers comply with sections 11.7.2 through 11.7.4 (NFPA 99). 11.7 (NFPA 99)

IFC 6301.1 Scope. We will need to look at doing something to address this

K142 25 All occupancies containing hyperbaric facilities

shall comply with NFPA 99, Standard for Health

Care Facilities, Chapter 19.

K931 49 Hyperbaric Facilities

All occupancies containing hyperbaric facilities

comply with construction, equipment, administration,

and maintenance requirements of NFPA 99.

Chapter 14 (NFPA 99)

IFC SECTION 609 HYPERBARIC FACILITIES IFC 609.1 General. IFC 609.2 Records. IBC SECTION 425 HYPERBARIC FACILITIES IBC 425.1 Hyperbaric facilities.

Comparable to CMS 2000 Code K-Tag 142

N/A N/A N/A K932 49 Features of Fire Protection – Other

List in the REMARKS section, any NFPA 99 Chapter

15 Features of Fire Protection requirements that are

not addressed by the provided K-Tags, but are

deficient. This information, along with the applicable

Life Safety Code or NFPA standard citation, should

be included on Form CMS-2567.

Chapter 15 (NFPA 99)

F33-16 (AS) IFC 404.2.3 Lockdown plans. IFC 404.2.3.1 Lockdown plan contents. IFC 404.2.3.2 Drills.

Chapter 15 of NFPA 99 is about fire protection systems within healthcare facilities. These references in the IFC do not cover the context of the K-tag. We will need to discuss if something to address this type of K-tag (general purpose) is needed

N/A N/A N/A K933 50 Features of Fire Protection – Fire Loss Prevention in Operating Rooms

Periodic evaluations are made of hazards that could

be encountered during surgical procedures, and fire

prevention procedures are established. When

flammable germicides or antiseptics are employed

during surgeries utilizing electrosurgery, cautery or

lasers:

• packaging is non-flammable

• applicators are in unit doses

• Preoperative "time-out" is conducted prior the

initiation of any surgical procedure to verify: o

application site is dry prior to draping and use of

surgical equipment

o pooling of solution has not occurred or has been corrected

o solution-soaked materials have been removed from the OR prior to draping and use of surgical devices

o policies and procedures are established outlining

safety precautions related to the use of flammable

germicide or antiseptic use.

Procedures are established for operating room

emergencies including alarm activation, evacuation,

equipment shutdown, and control operations.

Emergency procedures include the control of

chemical spills, and extinguishment of drapery,

clothing and equipment fires. Training is provided to

new OR personnel (including surgeons), continuing

education is provided, incidents are reviewed

monthly, and procedures are reviewed annually.

15.13 (NFPA 99)

We will need to look at doing something to address this

K130 26 Miscellaneous

List in the REMARKS sections, any items that are

not listed previously, but are deficient. This

information, along with the applicable Life Safety

Code or NFPA standard citation, should be

included on Form CMS-2567.

N/A N/A N/A

Not in matrix for new hospitals - No K-tags No relevant K-tags. IBC [BS] WIND-BORNE DEBRIS REGION. IBC 407.10 Secured yards. provided safe dispersal areas shall be located not less than 50 feet (15 240 mm) from the building they serve. Although this could be applicable to academic medical centers there are no relevant K-tags to associate this with

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(F340-16) AMPC IBC SECTION 428 HIGHER EDUCATION LABORATORIES Accessibility is not addressed in the K-tags so although an issue that needs to be addressed by healthcare facilities there are no relevant K-tags to associate with IBC 1104.4 Multistory buildings and facilities. IBC 1106.3 Hospital outpatient facilities. IBC 1106.4 Rehabilitation facilities and outpatient physical therapy facilities.

IBC 1106.7.2 Medical facilities. IBC 1107.5.2 Group I-2 nursing homes.

IBC 1107.5.2.1 Accessible units. IBC 1107.5.2.2 Type B units. IBC 1107.5.3 Group I-2 hospitals. IBC 1107.5.3.1 Accessible units. IBC 1107.5.3.2 Type B units. IBC 1107.5.4 Group I-2 rehabilitation facilities. IBC E106.4.6 Hospitals.

Although addressed in S&C Letter 17-14-LSC this issue is not specifically addressed in any K-tag and not relevant to the matrix. IBC 1202.3 Unvented attic and unvented enclosed rafter assemblies. This issue is not specifically addressed in any K-tag and not relevant to the matrix. IBC TABLE 1607.1 MINIMUM UNIFORMLY DISTRIBUTED LIVE LOADS, L0, AND MINIMUM CONCENTRATED LIVE LOADSg Section 806.1 & 806.2 are relevant to K753 – Combustible Decorations and could be added there IFC SECTION 806 NATURAL DECORATIVE VEGETATION IN NEW AND EXISTING BUILDINGS IFC 806.1 Natural cut trees.

IFC 806.1.1 Restricted occupancies. (F130-16 AS, F132-16 AM, F133-16 AS) IFC 806.2 Artificial vegetation. F130-16 (AS) IFC 806.3 Obstruction of means of egress. No relevant K-tag. F3-16 (AS) IFC CARBON MONOXIDE ALARM. F3-16 (AS) IFC CARBON MONOXIDE DETECTOR. IFC SECTION 915 CARBON MONOXIDE DETECTION IFC 915.1 General.

IFC 915.1.1 Where required. IFC 915.1.2 Fuel-burning appliances and fuel-burning fireplaces.

(Note: There is also IFC Section 915.1.3 through 915.6.1) No relevant K-tag. IFC 5706.6.2.1 Parking near residential, educational and institutional occupancies and other high-risk areas. IFC 6111.2.1 Near residential, educational and institutional occupancies and other high-risk areas.

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K-tag K923 is somewhat relevant and this reference could be included there although K923 is more for all cylinder storage interior and exterior and is not specific to LP-gas containers – My recommendation is to not include this due to its specificity to LP-gas containers. IFC 6109.12 Location of storage outside of buildings. IFC TABLE 6109.12 SEPARATION FROM EXPOSURES OF LP-GAS CONTAINERS AWAITING USE, RESALE OR EXCHANGE STORED OUTSIDE OF BUILDINGS No relevant K-tag. IPC 403.1 (IBC [P] TABLE 2902.1)- MINIMUM NUMBER OF REQUIRED PLUMBING FIXTURES IPC 405.7 Plumbing in mental health centers. (FYI - Entire existing Section 422 deleted) IPC SECTION 422 HEALTH CARE FIXTURES AND EQUIPMENT No relevant K-tag. (P149-15 AM) IPC 608.3 Devices, appurtenances, appliances and apparatus.

IPC 608.3.1 Special equipment, water supply protection. IPC 608.4 Potable water handling and treatment equipment. No relevant K-tag. IPC SECTION 609 HEALTH CARE PLUMBING (FYI - The entire Section 713 deleted.) IPC SECTION 713 HEALTH CARE PLUMBING IPC 802.1 Where required.

IPC 1003.3.1 Grease interceptors and automatic grease removal devices required. No relevant K-tag. IPSDC 604.1 General. IPSDC TABLE 604.1(2) CONVERSION FACTOR

IPSDC 802.7.2 Other buildings. IPSDC TABLE 802.7.2 ADDITIONAL CAPACITY FOR OTHER BUILDINGS No relevant K-tag. IMC 1103.2 Occupancy classification. No relevant K-tag. IECC C403.8.1.1 Allowable fan motor horsepower (Mandatory). IECC C405.3.2 Interior lighting power allowance. IECC TABLE C405.4.2(1) INTERIOR LIGHTING POWER ALLOWANCES:BUILDING AREA METHOD IECC TABLE C405.4.2(2) INTERIOR LIGHTING POWER ALLOWANCES: SPACE-BY-SPACE METHOD IECC C403.8.1.1 Allowable fan motor horsepower (Mandatory IECC C406.7 Reduced energy use in service water heating.

2000 to 2012 Hospital K-tag crosswalk matrix for hospitals

Adhoc Health Care Committee – 2000 to 2012 Hospital K-tag crosswalk matrix for hospitals – June 19, 2017 Page 33

No relevant K-tag. IZC CONGREGATE RESIDENCE. IZC GROUP CARE FACILITY. IZC HOSPITAL. No relevant K-tag. (Do we want to look at hospitals in the ICCPC? Below are just a few of the references) ICCPC [BG] A103.1.6.2 I-2. ICCPC [BG] TABLE 303.1 PERFORMANCE GROUP CLASSIFICATIONS FOR BUILDINGS AND FACILITIES

Not included for existing hospitals - No K-tags No relevant K-tag. IEBC 502.7 Carbon monoxide alarms in existing portions of a building. IEBC 503.11 Carbon monoxide alarms. IEBC SECTION 805 CARBON MONOXIDE DETECTION IEBC 805.1 Carbon monoxide alarms. IEBC SECTION 1105 CARBON MONOXIDE ALARMS IN GROUPS I-1, I-2, I-4 AND R IEBC 1105.1 Carbon monoxide alarms in existing portions of a building No relevant K-tag. IFC 1103.9 Carbon monoxide alarms. IFC 1104.25 Egress path markings. No relevant K-tag. IEBC 305.8.6 Accessible dwelling or sleeping units. IEBC 305.8.7 Type A dwelling or sleeping units. IEBC 305.8.8 Type B dwelling or sleeping units. K-tag K111 addresses Building Rehabilitation – These references (IEBC 1301.2 & 1301.6) could be included with this K-tag IEBC 1301.2 Applicability. IEBC 1301.6 Evaluation process.

IEBC 1301.6.2 Building area. IEBC 1301.6.4 Tenant and dwelling unit separations. IEBC 1301.6.7 HVAC systems. IEBC 1301.6.8 Automatic fire detection. IEBC 1301.6.16 Mixed occupancies. IEBC 1301.6.17 Automatic sprinklers. IEBC 1301.6.20 Smoke compartmentation.

2000 to 2012 Hospital K-tag crosswalk matrix for hospitals

Adhoc Health Care Committee – 2000 to 2012 Hospital K-tag crosswalk matrix for hospitals – June 19, 2017 Page 34

IEBC TABLE 1301.6.20 SMOKE COMPARTMENTATION VALUES

IEBC 1301.6.20.1 Categories. IEBC 1301.6.21 Patient ability, concentration, smoke compartment location and ratio to attendant. IEBC 1301.6.21.1 Patient ability for self-preservation. IEBC TABLE 1301.6.21.1 PATIENT ABILITY VALUES

IEBC 1301.6.21.1.1 Categories. IEBC 1301.6.21.2 Patient concentration. IEBC TABLE 1301.6.21.2 PATIENT CONCENTRATION VALUES

IEBC 1.3 1301.6.21.3 Attendant-to-patient ratio. IEBC TABLE 1301.6.21.3 ATTENDANT-TO-PATIENT RATIO VALUES

IEBC 1301.6.21.3.1 Categories.