Forms

Abortion Forms

• Informed Consent Form and Medical Emergency Abortion Form
  These forms are also referred to as Appendix A and B in the Abortion or Reproductive Health Centers Licensure Rules.
• Abortion Materials Order Form

Reporting Forms

• Health Care Facilities On-Line Reporting
• Fire Watch Procedure (below)

Fire Watch Procedure

The procedure for Assisted Living Facilities to follow when a fire alarm system or fire sprinkler system is out of service for more than four hours in a 24-hour period is based on the current Rules of the Alabama State Board of Health, Alabama Department of Public Health (ADPH), Chapters 420-5-4 and 420-5-20, and the 2000 edition of NFPA 101 (Life Safety Code) paragraphs 9-6.18 and 9-7.6, and includes the following:

1. Notify ADPH Assisted Living Facilities (ALF) Unit: If the situation is discovered during a survey, the facility is in a jeopardy situation until the administrator can give the surveyor or send to the ALF Unit ([email protected]) a written plan of action stating how and when the fire alarm or sprinkler system is expected to be back in service. If the situation occurs at other times, the facility must report the situation, with the written plan of action, to the ALF Unit via the online incident reporting system.
2. Notify Facility Staff: The administrator shall notify the staff by memo telling them how to handle the fire/alarm situation at the facility. The staff must be instructed to keep smoke and fire doors, including those normally held open with magnets, CLOSED until the fire alarm or sprinkler system has been made operational. The administrator shall send a copy of this fire/alarm memo to the ALF Unit via the online incident reporting system.
3. Fire Watch Approval: The Life Safety Code requires the evacuation of the facility or implementation of an approved fire watch. The administrator must implement a fire watch plan which has the approval of the local Fire Chief or the local Fire Marshall. The purpose of a fire watch is to watch for fires which would ordinarily be detected by the fire alarm or sprinkler systems.
4. Acceptable Plan: Once the plan has been received and approved by the ALF Unit or by the surveyor, the facility is no longer in jeopardy. If the surveyor is on-site, he/she may leave the facility once the fire watch has been implemented.
5. Fire Watch Activity: The administrator must use extra individuals to perform the fire watch. These individuals cannot be doing other work, such as housekeeping, resident care, or maintenance work. The fire watch person shall be assigned to do nothing other than performing fire watch activities, such as walking through the facility, checking all rooms and attic spaces for fire, and completing and signing a fire watch log every 15 to 30 minutes.
6. Fire Watch Log: The administrator shall send the ALF Unit a copy of the signed fire watch log every four to six hours via the online incident reporting system, until the fire/alarm issue has been corrected. Night and weekend logs may be sent during normal business hours.