Ilsm form 2026

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  1. Click ‘Get Form’ to open the ilsm form in the editor.
  2. Begin by answering the three initial questions regarding patient care areas and life safety systems. Circle 'Y' for Yes or 'N' for No as applicable.
  3. Proceed to fill in the general project/task information, including today's date, building name, start and completion dates, project location, manager, name, and work order number.
  4. Review the criteria section carefully. Check all applicable ILSM measures that relate to your project’s impairments lasting more than 8 hours.
  5. Complete the implementation measures section by selecting appropriate actions based on your assessment. Ensure you provide necessary details about inspections and notifications.
  6. Finally, enter the names and dates for both the person completing and reviewing this assessment at the end of the form.

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Interim Life Safety Measures (ILSM) are essential protocols that healthcare facilities implement to ensure the safety and well-being of patients, staff, and visitors when normal life safety systems are compromised or under maintenance.
The ILSM consist of one or more of the following actions: A. The hospital notifies the fire department and initiates a fire watch when a fire alarm or fire suppression system is out of service more than 4 hours in a 24-hour period in an occupied building. Notification and fire watch times are documented.
In ASHEs Life Safety Risk Assessment Tool, the user can follow the matrix to identify the risk tolerance for the specific issue by plotting the Impact of Deficiency and the Severity of Occurrence. The table on the bottom page shows examples of common life safety deficiencies to use for reference.
ILSM is about protecting patients and all others who might be unable to easily evacuate. The intent is to provide a safe environment for all occupants in the hospital at all times, and especially during times of construction or repair.
Each Hospital implements the life safety management plan and performance improvement standards, including all features described in the Joint Commission Elements of Performance for LS. 01.02.

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In order to evaluate and implement an effective plan for Life Safety code deficiency mitigation, an Interim Life Safety Measure. (ILSM) policy must consist of the following: State that the process is applicable to construction related situations and situations of non-compliance with the Life Safety Code.

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