How to Fill Out Form STD 850: Fire Clearance Inspection and Reinspection

The California STD 850 Fire Safety Inspection Request is completed by the state licensing agency, not by the facility operator. If you run or are opening a residential care facility for the elderly, a community care facility, a child daycare center, or certain licensed health care operations, your role is to give the licensing agency (usually the Department of Social Services or the Department of Public Health) accurate information about your building, identify the right local fire authority, and be ready when the inspector calls to schedule the visit.¹

Who Actually Fills Out the STD 850

A common misconception is that the facility operator downloads the form, fills in the 19 sections, and mails it to the fire department. That is not how it works. The licensing agency completes the STD 850 and sends it to the fire authority with jurisdiction over your address. That authority is usually your local city or county fire department. In unincorporated areas or areas without local fire protection, the State Fire Marshal takes the role.²

What you supply is the underlying data. The Department of Social Services collects most of it through a separate form, the LIC 9054, which asks you to identify the correct local fire authority so the STD 850 gets routed properly.³ Naming the wrong fire authority is one of the fastest ways to lose weeks: the form arrives at an office that has no jurisdiction, and the process restarts.

Once the correct fire authority receives the STD 850, an inspector contacts the person listed as the facility contact and schedules a site visit. After the inspection, the fire authority marks Section 19 with either a clearance (code 1) or a denial (code 2) and returns the form to the licensing agency.¹

Facilities That Need a Fire Clearance

Any state-licensed facility that houses or cares for vulnerable populations needs a fire clearance before its license is issued. Community care facilities must secure and keep a fire clearance from the local fire enforcing agency or the State Fire Marshal, whichever has primary jurisdiction over the property.⁴ Residential care facilities for the elderly face the same rule: the Department of Social Services cannot issue or modify an RCFE license without a granted fire clearance.

The requirement applies to more than new applications. Capacity changes and changes in the type of residents served also trigger a new inspection. At initial contact, the licensing agency is required to tell you that fire clearance is a prerequisite and that the clearance must comply with both state and local fire safety regulations.⁴ Knowing this early lets you budget time and money for building modifications before an inspector is standing in your hallway.

What You Need to Give the Licensing Agency

Because the licensing agency transfers your information onto the STD 850, mismatches between what you tell them and what appears on your license application will stall your clearance. The two biggest trouble spots are capacity numbers and the facility name. Anything you send needs to match exactly.

Here is what each section of the form covers so you know which pieces of information are yours to provide correctly.¹

Sections 1 through 5 are handled internally by the licensing agency: its contact person, phone number, program, request date, and evaluator.
Section 6 records the facility number assigned to your application by the licensing agency.
Section 7 is a request code identifying whether the inspection is for a new facility, a renewal, a capacity change, a name change, or another reason. If you are changing the facility’s name, the previous name goes here.
Section 8 is the name and address of the licensing office requesting the inspection.
Section 9 breaks capacity into three categories: ambulatory, nonambulatory, and bedridden. Use actual numbers, not letter codes. For renewals or capacity changes, the previous clearance capacity and the new total licensed capacity across all three categories also go here.
Section 10 is the facility name exactly as it will appear on your license. If you operate under a parent company, include the sub-name (for example, “Hacienda Corp / Medina Lodge”).
Section 11 is the license category, worded the way it will appear on the certificate.
Section 12 is the street address and city. A P.O. box will not be accepted, since the fire authority needs a physical building to inspect.
Section 13 is the total number of buildings that will house occupants covered by the license.
Section 14 asks whether physical restraint (locking a resident in a room or the building) will be used. This changes the egress and exit hardware standards the inspector applies.
Section 15 is the facility contact person’s name and phone number. This is who the inspector will call to schedule the visit and who needs to grant building access.
Section 16 records whether occupants are housed for less than 24 hours or for 24 hours or more. Overnight facilities face stricter requirements.
Section 17 captures anything unique about the request, such as an inspection covering only one building on a multi-building campus.
Sections 18 and 19 are completed by the fire authority: its name and address, and its clearance or denial decision.

If the capacity numbers on the STD 850 do not line up with your license application, the licensing agency will have to reconcile the discrepancy before the clearance is valid. The same is true for even small differences in the facility name.

Getting the Facility Ready for the Inspector

The inspector will measure your building against the fire and life safety standards that apply to your specific occupancy. Residential care facilities in California face detailed requirements for exits, alarms, extinguishers, and building separation. Fixing the common failure points before the visit is far cheaper than a reinspection.

Exits: at least two, each at least three feet wide by six feet eight inches tall with a 32-inch clear opening. Exit doors need single-action hardware, meaning anyone can open them from the inside without a key, special knowledge, or extra effort. Deadbolts must release automatically when the primary knob or lever is turned. Secondary locks, latches, and broomsticks in sliding-door tracks are not allowed.⁵
Smoke alarms: installed outside each sleeping area, in each sleeping room, on every story, and in enclosed common stairwells. Residential care facilities also need alarms throughout all habitable areas except kitchens. In new construction or newly classified facilities, the alarms must be hardwired with battery backup.⁵
Fire extinguishers: at least one rated 2-A:10-B:C, mounted with the top between three and five feet off the floor and at least four inches of clearance from the ground. Additional extinguishers are required within 30 feet of commercial cooking equipment and in areas where flammable liquids are stored or used.⁵
Garage separation: if an attached garage connects to the residence, the connecting door must be self-closing, self-latching, and either fire-rated or solid wood at least 1⅜ inches thick. No additional openings from the garage into the residence are permitted.⁵

Have detailed floor plans and site maps on hand for the inspector even though they are not attached to the STD 850 itself. The inspector will want to confirm the layout matches what the licensing agency described and that evacuation routes are posted and unobstructed.

Passing, Failing, and Reinspection

If your facility passes, the fire authority enters clearance code 1 in Section 19 and returns the form. That is what allows the licensing agency to issue or modify your license. The clearance is tied to the specific capacity and occupancy type listed on the form. Adding beds later, or serving a different resident population, requires a new STD 850 and a new inspection.

If the facility fails, the fire authority enters denial code 2 with a letter code indicating the category of deficiency. Code 2A, for example, means the denial is based on exiting problems.¹ You will receive a correction notice listing the specific violations. Common denial triggers include unauthorized locks on exit doors, missing or expired fire extinguishers, and smoke alarms that are not hardwired where required. Once the deficiencies are fixed, the fire authority conducts a follow-up inspection. Contact your local fire department directly to schedule the reinspection; the licensing agency does not need to submit a new STD 850 for a correction visit.

ADA Visual Alarms

If your facility has an emergency alarm system, federal accessibility rules add another layer to what the inspector may look at. Under the ADA Accessibility Guidelines, any emergency warning system in new construction must include both audible and visual alarms. Visual alarms are required in all common-use spaces, including restrooms, hallways, lobbies, meeting rooms, cafeterias, break rooms, and examination or treatment rooms. The lamps must be xenon strobe type or equivalent, producing clear or nominal white light. If you replace or upgrade an existing alarm system, the new system must meet these visual alarm standards. Medical care facilities can follow standard health care alarm practices in their design, but the visual component is still required wherever an audible system exists.⁶

If You Participate in Medicare or Medicaid

Facilities certified for Medicare or Medicaid face an additional federal fire safety review on top of the state clearance. The Centers for Medicare and Medicaid Services requires compliance with the NFPA 101 Life Safety Code, and CMS partners with state agencies to conduct the surveys. Under those agreements, the designated fire authority surveys skilled nursing facilities, ambulatory surgical centers, and other certified facilities on schedules the state agency sets.⁷

CMS inspectors complete the Fire Safety Survey Report (Form CMS-2786) and prepare Statements of Deficiencies if problems are found. Only inspectors who have completed CMS-required training can conduct these surveys. CMS can grant waivers for specific Life Safety Code provisions when strict compliance would cause unreasonable hardship, but no waivers are available for board and care occupancy provisions, which is the classification that covers most residential care facilities.⁷

1
California Department of General Services. STD 850 – Fire Safety Inspection Request
2
California Legislative Information. California Code Health and Safety Code 13146
3
California Department of Social Services. LIC 9054 – Fire Safety Inspection Information
4
California Legislative Information. California Code Health and Safety Code HSC 1531.18
5
City of Benicia Fire Department. Residential Care Facilities Fire Safety Requirements
6
United States Access Board. ADAAG Bulletin 2 – Visual Alarms
7
Centers for Medicare & Medicaid Services. Life Safety Code and Health Care Facilities Code Requirements