Free Community Based Residential Facility Completion Documents-F-00012 - Wisconsin

DEPARTMENT OF HEALTH SERVICES
Division of Quality Assurance F-00012 (12/08)

STATE OF WISCONSIN

COMMUNITY BASED RESIDENTIAL FACILITY COMPLETION DOCUMENTS
The documentation listed below shall be submitted prior to the final inspection for this project. Until such documentation is received and approved, no patients or facility employees are allowed to occupy or use the remodeled area or addition. I. Local Inspection Reports and Occupancy Permit Plumbing Electrical Building Fire Department II. Grab Bars Certification that grab bars are installed in accordance with disability and health code standards III. Carpet Carpet specification test report of flame-spread characteristics from the Manufacturer's testing laboratory (minimum class: 1 or 2) Letter from installer certifying that carpet that is installed is the same as that tested IV. Fire Protection Sprinkler System Sprinkler system installation Test report and certification that the sprinkler system is fully operative (Use NFPA 13.) Certification that sprinkler system is electrically supervised (NFPA 101 and NFPA 13) Fire Alarm System Installer certification that the fire alarm system has been tested, including the electrical testing of all devices and interconnections, and is fully operative as designed and approved (Use NFPA 72 form.) Certification that the fire alarm system is interconnected with the fire department or in accordance with NFPA 72 Fire Extinguishers Certification that all portable fire extinguishers (minimum size 2A ­ 10BC on each floor; maximum 150' apart) are in place and are fully operative V. Exits Certification that sidewalks or roads are in place from all exits VI. Compliance Statement Copy of the COMM 61.50 (SBD-9720) or Compliance Statement (DHS form F-62495) submitted to DHS or letter of completion from the architect, engineer, or designer