Fillable PEChanga Fire Department (Pechanga Tribal Government)

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PEChanga Fire Department (Pechanga Tribal Government)

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PEChanga Fire Department
Impairment Plan for Fire Protection
PFD P-039 IMPAIRMENT PLAN FOR FIRE PROTECTION (Rev 8/19/20)
Page 1 of 2
2019 CFC 901.7 Systems Out of Service. When fire protection systems are affected by a planned or emergency impairment,
the property owner or designee shall establish an impairment plan to provide for the safety of occupants, protect the facility,
ensure the duration of the impairment is minimal, and ensure the system(s) are restored. The property owner or designee shall
designate an Impairment Coordinator (IC), provide approved fire watch for buildings/area(s) affected by impairment, and notify
Pechanga Fire Department. A copy of the impairment plan shall be provided to PFD, IC, fire watch, public safety, and facilities
personnel. A fire department permit is required to install new and modify existing fire protection systems.
Email this completed form to: PFD_Notification@pechanga-nsn.gov, PRC_SafetyOfficers@pechanga.com, jmariella@pechanga.com
TYPE OF IMPAIRMENT
PLANNED IMPAIRMENT EMERGENCY IMPAIRMENT
DATE OF IMPAIRMENT
START TIME
END TIME
FACILITY NAME
FACILITY ADDRESS
AREA(S) AFFECTED
SYSTEM(S) IMPAIRED
FIRE ALARM FIRE SPRINKLER SMOKE CONTROL SPECIAL HAZARD OTHER
SYSTEM(S) IDENTIFIER
REASON FOR IMPAIRMENT
INSPECTION/TEST/MAINTENANCE (ITM) REPAIR *INSTALL/MODIFY (*FD Permit Required)
EXTENT OF IMPAIRMENT
TOTAL PARTIAL
*FIRE PERMIT #
FIRE WATCH SCHEDULED
YES
NO
APPROVED BY
DATE
CROWD MANAGER SCHEDULED
YES
NO
APPROVED BY
DATE
FIRE ALARM MONITORING SCHEDULED
YES
NO
APPROVED BY
DATE
IMPAIRMENT COORDINATOR SCHEDULED
YES
NO
APPROVED BY
DATE
IC CELL #
IC OFFICE #
OFFICE PHONE #
SITE CONTACT CELL #
SITE CONTACT CELL #
SCOPE OF IMPAIRMENT (ATTACH DIAGRAMS & ADDITIONAL INFORMATION)
PFD P-039 IMPAIRMENT PLAN FOR FIRE PROTECTION (Rev. 8/19/20)
Page 2 of 2
IMPAIRMENT PLAN (INCLUDE ALL PERTINENT INFORMATION SUCH AS TIMELINE, CONTINGENCY PLANS, EMERGENCY PROCEDURES)
REQUIRED NOTIFICATIONS: PRC Risk Management, Facilities, DPS Fire Alarm Tech, and Pechanga Fire Department
shall be notified of all impairments. Pechanga Water Department shall also be notified of impairments to hydrants, fire
mains and when discharging significant amounts of water. Notification is made by submitting FIRE ALARM
MONITORING REQUEST FORM (7-21-16) to DPS Dispatch and all required entities listed on form.
TO REPORT EMERGENCIES, CALL PRC DISPATCH AT 951-770-2610
SUBMITTED BY
TITLE
EMAIL
DATE
OFFICE USE ONLY
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PEChanga Fire Department (Pechanga Tribal Government)

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Completed 27 January 2021

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