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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES11/01/2011FORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 09380391STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION

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What is k0000 a life safety?

K0000 a life safety is a form used to report on the safety measures in place to protect individuals in a residential care setting.

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Administrators of residential care facilities are required to file k0000 a life safety.

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Information such as fire safety measures, emergency evacuation plans, and staff training on safety procedures must be reported on k0000 a life safety.

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