HomeMy WebLinkAboutcert of local fire inspection 2024,"@,DEPARTMEMT OF PUBLIC HEAITH
OIVISION OF HEAI"TH CARE FAOT]TY
LICENSURE & CERNFICATION
99 cheuncy sueet, 11* Floo,
Boston, MA 021U
lnstructions: Facilities and programs are to provide a copy of this form to their local Fire Department when
requesting a fire inspection for licensure purposes. Facilities and programs must return this form completed, or
the inspection certificate issued by the head of their local Fire Department, when applying for or renewing a
license, Nursing homes and rest homes must maintain on file with the facility proof of quarterly fire inspections
as required under 105 CMR 150.015(D).
Facility/Program Name Shields MRI & lmaging Center of Cape Cod, LLC
FACILITY/PROGRAM INFORMATTON
Facility/Program Address 2 lyannough Rd, West Yarmouth MA 02673
d
Reason for lnspection:
lnitial Lacensure/ Licensure Renewal Fac ility/Progra m Renovations
NursinB Home or Rest Home Quarterly lnspection (105 CMR 150.015(D))
This is to document that the above facility/program was inspected on:
and determined to be:(D te)
compliance with local ordinances regarding fire prevention and safety.
_ Not to be in compliance with local ordinances regarding fire prevention and safety, The following
violations were observed (list violations, or indicate if a list of violations is attached):
10
I Fire entsiSnat al
al.-l
[.Wrt /w14 totl
Rev.0625/15
Firc.3
Typed or Printed Name of Local Fire Department Offlcial
CERTIFICATION OF
TOCAL FIRE INSPECTION
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INSPECTION INFORMATION