1. (1) The provider must train all program staff in safety procedures prior to beginning their first regular shift.
2. (2) Every resident must be trained in resident safety procedures as soon as possible within the first 72 hours of residency.

3. (3) The program must develop and implement a written emergency procedure and disaster plan. The plan must cover such emergencies and disasters as fires, explosions, missing persons, accidents, earthquakes, lockdowns, infectious disease outbreaks, loss of utilities, hazardous air quality, floods, and extreme weather events. The plan must be immediately available at all times to the program administrator and program staff. The plan must include diagrams of the program’s evacuation egress routes, and these must also be posted along evacuation egress routes. The plan must specify short-range and long-range shelters where residents will reside and receive services from program staff if the setting becomes uninhabitable. This plan must be easily accessible to all program staff. The program must update the plan annually to include:

   1. (a) Emergency instructions for employees;
   2. (b) The telephone numbers of the local fire department, police department, the poison control center, the administrator, the administrator's designee, and other persons to be contacted in emergencies; and
   3. (c) Instructions for the evacuation of residents and employees.

4. (4) Noncombustible and nonhazardous materials must be used whenever possible. When necessary to the operation of the program, flammable and combustible liquids and other hazardous materials must be safely and properly stored in clearly labeled, original containers in areas secure to prevent tampering by residents or vandals and in accordance with the Oregon Fire Code. Any quantities of combustible and hazardous materials maintained must be the minimum necessary:

   1. (a) Oxygen and other gas cylinders in service or in storage must be adequately secured to prevent the cylinders from falling or being knocked over.
   2. (b) No smoking signs must be visibly posted where oxygen is stored or used;
   3. (c) Liquid propane gas must not be stored in an attached garage or enclosed storage space. Enclosed structures used for the storage of liquid propane gas may not share a wall or direct openings to the program.
5. (5) Non-toxic cleaning supplies must be used whenever possible. Poisonous and other toxic materials must be properly labeled and stored apart from all personal care supplies, personal hygiene supplies, food and medications.

6. (6) Evacuation capability categories are based upon the ability of the residents and program staff as a group to evacuate the building or relocate from a point of occupancy to a point of safety. Buildings must be constructed and equipped according to a designated evacuation capability for occupants:

   1. (a) Only residents assessed to be capable of evacuating in accordance with the designated facility evacuation capability may be admitted to the program; and
   2. (b) Residents experiencing difficulty with evacuating in a timely manner must be provided assistance from staff and offered environmental and other accommodations, as practical. Under such circumstances, the program must consider increasing staff levels, changing staff assignments, offering to change the resident’s room assignment, arranging for special equipment, and taking other actions to assist the resident. The program must assist residents who still cannot evacuate the building safely in the allowable period of time and must assist with transferring to another facility with an evacuation capability designation consistent with the resident's documented evacuation capability.

7. (7) The program must ensure that every resident participates in an unannounced evacuation drill at least once every three months:

   1. (a) At least once every twelve months, the program must conduct a drill during resident sleeping hours between 10 p.m. and 6 a.m.;
   2. (b) Drills must be scheduled at different times of the day, on different days of the week and with different locations designated as the origin of the fire for drill purposes;
   3. (c) Any resident failing to evacuate within the established time limits must be provided with assistance as identified in OAR 309-035-0145(6)(b) above and a notation made in the resident service record; and
   4. (d) Complete written evacuation records must be maintained for at least three years. Records must include documentation made at the time of the drill specifying the date and time of the drill, the location designated as the origin of the fire for drill purposes, weather conditions at the time of the drill, the names of all residents and staff present, the amount of time required for each individual and staff to evacuate to the point of safety, notes of any difficulties experienced, and the signature of the staff person conducting the drill.
8. (8) All stairways, halls, doorways, passageways, and exits from rooms and from the building must always remain unobstructed.

9. (9) The program must provide and maintain one or more 2-A:10-B:C rated fire extinguishers on each floor, including basements, in accordance with the Oregon Fire Code. Fire extinguisher must:

   1. (a) Be inspected and maintained at least annually and in accordance with the requirements of the Oregon State Fire Marshal or local authority having jurisdiction;
   2. (b) Be located in conspicuous locations along normal paths of travel where they will have ready access and be immediately available for use;
   3. (c) Not be obscured from view. In rooms or areas in which visual obstruction cannot be completely avoided, signage must be provided to indicate the locations of extinguishers;
   4. (d) Be installed on the hangers or brackets supplied.  Hangers or brackets must be securely anchored to the mounting surface in accordance with the manufacturer’s installation instructions;
   5. (e) Be installed so that the tops are not more than five (5) feet above the floor;
   6. (f) Be installed so that the bottoms are not less than four (4) inches above the floor; and
   7. (g) Not be locked.
10. (10) The program must provide and maintain at least one plug-in rechargeable flashlight available for emergency lighting in a readily accessible area on each floor.
11. (11) The program must provide and maintain evacuation route diagrams in each common room and hallway and immediately adjacent to every egress door. Evacuation diagrams must include fire exits, location of fire extinguishers, stairs, and escape routes.
12. (12) Approved fire detection and alarm systems, carbon monoxide alarms, and smoke alarms must be UL approved and installed according to Building Code and Oregon Fire Code requirements and the manufacturer’s instructions.
13. (13) Fire detection and alarm systems, carbon monoxide alarms and smoke alarms must be tested monthly.
14. (14) Programs initially licensed on or after February 1, 2025, must have fire detection and alarm systems, carbon monoxide alarms, and smoke alarms that are interconnected and permanently wired with battery back-up.

15. (15) Carbon monoxide alarms must be installed:

    1. (a) In each bedroom or within 15 feet outside of each bedroom door; and
    2. (b) On each level of the setting when bedrooms are on separate floor levels.
16. (16) The program must provide appropriate signal devices for persons with disabilities who do not respond to the standard auditory alarms. All assistive devices must be inspected and maintained in accordance with the requirements of the Oregon State Fire Marshal or local authority having jurisdiction.

17. (17) The program must install and maintain an automatic sprinkler system in compliance with Building Codes and Oregon Fire Code. The program must install an automated sprinkler system as follows:

    1. (a) Programs initially licensed prior to July 1, 2016, are not required to install or maintain a sprinkler system if one was not present at the time of initial licensure;
    2. (b) The Division recommends that all programs licensed prior to July 1, 2016, install and maintain sprinkler systems;
    3. (c) Program initially licensed on or after July 1, 2016, must have and maintain an automated sprinkler system.
    4. (d) The Building Code Authority or designee may determine that a program is not required to install and maintain a sprinkler system. Any determination made by the Building Code Authority or designee must be submitted to the Division in writing.
18. (18) The Division will not issue any variances related to automatic sprinkler systems in programs licensed on or after July 1, 2016.
19. (19) First aid supplies must be readily accessible to staff. All supplies must be properly labeled.
20. (20) Portable heaters are a recognized safety hazard and may not be used except as approved by the Oregon State Fire Marshal, or authorized representative.

21. (21) The provider must develop and implement a comprehensive safety plan to identify, prevent, and respond to hazards within the program. Hazards may include, but are not limited to, extreme heat, communicable diseases, dangerous substances, sharp objects, unprotected electrical outlets, use of extension cords or other electrical adapters, slippery floors or stairs, exposed heating devices, broken glass, inadequate water temperatures, unsafe ashtrays and ash disposal, and other potential fire hazards. The provider must update the plan as needed and it must include:

    1. (a) Procedures for maintaining the safety of the built environment including, but not limited to how program staff can report structural security hazards and timelines for the program’s response to these identified hazards, methods for maintaining the safety of the built environment, and protocols to ensure the physical safety of lone workers; and
    2. (b) Procedures for notifying the local public health agency when significant health risks are present, including but not limited to, communicable and noncommunicable diseases and conditions, pest infestations, and other environmental hazards.
22. (22) Safety equipment must be checked monthly, including but not limited to, fire extinguishers, flashlights, windows, dryer vents, and furnace filters.

Statutory/Other Authority

ORS 413.042 & 443.450

Statutes/Other Implemented

ORS 413.032, 443.400 - 443.465 & 443.991

History

BHS 13-2026, temporary amend filed 06/01/2026, effective 06/01/2026 through 11/25/2026
BHS 6-2026, amend filed 04/30/2026, effective 05/01/2026
BHS 5-2026, amend filed 04/30/2026, effective 06/01/2026
BHS 32-2025, temporary amend filed 12/30/2025, effective 01/01/2026 through 06/27/2026
BHS 9-2025, minor correction filed 04/08/2025, effective 04/08/2025
BHS 4-2025, amend filed 02/28/2025, effective 03/01/2025
MHS 5-2017, f. & cert. ef. 6-8-17
MHS 2-2017(Temp), f. 3-3-17, cert. ef. 3-4-17 thru 8-30-17
MHS 13-2016(Temp), f. 9-6-16, cert. ef. 9-7-16 thru 3-3-17
MHS 4-2008, f. & cert. ef. 6-12-08
MHD 4-2005, f. & cert. ef. 4-1-05
MHD 4-1998, f. 5-21-98, cert. ef. 6-1-98
MHD 9-1985, f. & ef. 6-7-85
MHD 9-1984(Temp), f. & ef. 12-10-84