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PRINTED: 02×26/2014 FORM APPROVED OMB NO. 09380391 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER×SUPPLIER×CIA
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How to fill out a life safety survey:

01
Begin by carefully reviewing the survey form and any accompanying instructions. Familiarize yourself with the specific requirements and guidelines provided.
02
Gather all the necessary information and documentation required for the survey. This may include building plans, permits, occupancy records, maintenance logs, and any previous inspection reports.
03
Start filling out the survey form, answering each question accurately and honestly. Pay close attention to details and provide clear, concise information.
04
If you come across a question that you are unsure about or don't have the necessary information to answer, make a note and prioritize resolving these gaps in knowledge.
05
Provide any additional supporting documents or evidence as required, such as photographs, certificates, or compliance records.
06
Double-check your answers and review the completed survey form for any errors or omissions. Ensure the information provided is consistent and accurate.
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Seek assistance if needed. If certain aspects of the survey are beyond your expertise, consult with professionals or specialists who can provide guidance and help ensure the survey is completed correctly.
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Finally, sign and date the survey form, acknowledging that the information provided is true and accurate to the best of your knowledge.

Who needs a life safety survey?

01
Property owners: Life safety surveys are typically required for owners of commercial buildings, multi-unit residential properties, educational institutions, healthcare facilities, and other establishments where public safety is paramount.
02
Authorities having jurisdiction: Governments, fire departments, and other regulatory bodies impose the need for life safety surveys to ensure compliance with safety codes, regulations, and standards. These surveys help identify potential hazards and ensure preventive measures are in place to protect occupants.
03
Insurance companies: Some insurance providers may require a life safety survey before issuing coverage or determining premiums. These surveys help assess the level of risk associated with the property and ensure appropriate measures are in place to mitigate potential hazards.
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A life safety survey is an assessment conducted to evaluate the safety measures implemented in a building to protect occupants in case of emergencies.
Building owners or managers are typically required to file a life safety survey.
Life safety surveys can typically be filled out online or through a designated form provided by the relevant authority or regulatory agency.
The purpose of a life safety survey is to ensure that a building meets the necessary safety standards and is equipped to protect occupants in case of emergencies.
Information such as emergency exits, fire suppression systems, evacuation plans, and other safety measures implemented in the building must be reported on a life safety survey.
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