TX HHS Form 1127. Fire Marshal/State Fire Marshal Notification

The TX HHS Form 1127, Fire Marshal/State Fire Marshal Notification, is a crucial document that helps resolve issues related to the inappropriate placement of residents in assisted living facilities. This form is typically used when an assisted living facility or the Texas Health and Human Services Commission (HHSC) determines that a resident does not meet all requirements for evacuation outlined in the Licensing Standards for Assisted Living Facilities.

This notification form requires the Fire Marshal or State Fire Marshal (authority having jurisdiction) to acknowledge receipt of the information, indicating that the waiver request is being submitted to HHSC. The facility is responsible for notifying the local Fire Marshal or State Fire Marshal about the change in evacuation capability of this resident. This process ensures compliance with fire and life safety codes and standards.

The form includes key sections such as the name of the facility, facility ID, resident's name, date facility determined resident is inappropriately placed, and date facility received Form 3724 (Statement of Licensing Violations and Plan of Correction). The Fire Marshal or State Fire Marshal must sign and date the notification, acknowledging receipt of the information. Key points to note:

• The form is used when a resident does not meet all requirements for evacuation.
• The facility is required to notify the local Fire Marshal or State Fire Marshal about the change in evacuation capability.
• The notification does not indicate approval of the resident remaining in the facility.