Fillable Notice Fire Protection Impairment (University of New Haven)

Fill Online, Printable, Fillable, Blank Notice Fire Protection Impairment (University of New Haven) Form

Use Fill to complete blank online UNIVERSITY OF NEW HAVEN pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Notice Fire Protection Impairment (University of New Haven)

On average this form takes 19 minutes to complete

The Notice Fire Protection Impairment (University of New Haven) form is 1 page long and contains:

  • 2 signatures
  • 0 check-boxes
  • 69 other fields

Country of origin: US
File type: PDF

U.S.A. forms for University of New Haven

BROWSE UNIVERSITY OF NEW HAVEN FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
University of New Haven
NOTICE OF FIRE PROTECTION IMPAIRMENT
Notice of Fire Protection Impairment (4).xls
Page 1
Revised:7/17/2012
SECTION A: IMPAIRMENT REQUESTER IMPAIRMENT#
Requester: Phone #
Building: Floor: Room:
Work being performed:
Work performed by: _____________
_________________ __________________
Date of this Request:
Start
Time
End
Time
SECTION B: DETAILS FOR IMPAIRMENT REQUEST (Completed by Facilities Manager)
Fire Alarm System Shutdown:
Fire Sprinkler System Shutdown:
FORM OF EQUIVALENT FIRE PROTECTION TO BE PROVIDED DURING IMPAIRMENT IF NEEDED:
Facilities Manager
Associate VP Public Safety__________________________________________
UNH Police - IMPAIRMENT Received by:
Date:
SECTION C: IMPAIRMENT INITIATION LOG SECTION D: IMPAIRMENT RESTORATION LOG
Initiation
Date
Time
Police personell W.H. Fire Notified
Time
Police personell
W.H. Fire Notified
(or designee)
Signature:
________________________________________________
Date work Begins
Date work Ends
Signature:
Signature:
ALL FIRE IMPAIRMENTS NEED TO BE SUBMITTED 24 HOURS PRIOR TO SCHEDULED WORK
FIRE PROTECTION IMPAIRMENT PROCEDURE
(or designee)
click to sign
signature
click to edit
click to sign
signature
click to edit
University of New Haven
NOTICE OF FIRE PROTECTION IMPAIRMENT
Notice of Fire Protection Impairment (4).xls
Page 2
Revised:7/17/2012
1. Requester completes Section A of form and signs request 24 hours prior to work
Requester then submits form to the Facilities Office.
(Impairments may be approved for up to 5 consecutive work days)
2. Facilities Manager (or designee) fills out Section B, signs, and delivers to Safety Officer.
〈 Copy of signed Impairment is posted in Facilities office
3. Campus Safety Officer (or designee) signs and deilvers to Campus Police station.
3. Campus Police department then acknowledges receipt by signing and dating form.
(Police will not accept an incomplete form).
〈 Form to be placed in the "OPEN SECTION" of the Fire System Log, located at Police desk
〈 Campus Police assigns an Impairment # and performs request at specified date
and time on form.
〈 Campus Police notify West Haven Fire Dept. of impairment and complete section C
4. Upon notification by Facilities Manager or his designee that the activity necessitating the request is
complete, Or at "End Time" of Impairment, Campus Police return Fire Alarm System to normal status,
notifies West Haven Fire Dept. that system is restored and signs Section D of the form.
5. Campus Police then place completed form in the "CLOSED SECTION" of the Fire System Log, located at the
Police Dept. desk.
〈 If Impairment is approved for more then one day the impairment is placed back into the
"OPEN SECTION" of the Fire system Log
6. Campus Police then Notifies Facilities Manager and Safety Officer that Fire system has been restored.
This form is to be used for all scheduled shutdown requests. Emergency Shutdowns are to be done immediately
at the request of the Facilities Manager or Safety Officer. This form will be filled out
within a 48-hour period after each Emergency Shutdown.
Scheduled Hot Work is not an Emergency Shutdown and should be scheduled like any other shutdown.
Fire Protection Impairment Procedures
PLEASE SEE PROCEDURE ON REVERSE
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Notice Fire Protection Impairment (University of New Haven)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document