Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Step One – Contractor to complete

  • Property Address:
  • Colliers Personnel Requesting Work:

  • Name of Contractor’s company:

  • Contractor’s name and mobile phone number:

  • Date and time work to commence:

  • Date and time work to cease:

  • Describe nature of fire protection impairment: sprinklers/hydrants/fire detection system) and area affected:

Reason for impairment: Tick the box describing the purpose of the work that requires the fire services impairment:

  • Shop Fit out

  • Repairs

  • Maintenance

  • Emergency

PRECAUTIONS TO BE TAKEN Tick the box(es) describing the precautions to be taken:

  • Helpdesk / Site Security Notified

  • Fire Extinguisher on hand

  • Tenant Notified

  • Ongoing Patrol of Impairment Area

  • Fire Hoses Laid Out

  • Hydrant Connected to Sprinkler Riser

  • Pipe Plugs on hand

  • Hazardous Operations Stopped e.g. cutting/welding

  • Smoking Restricted

  • Impairment area minimised (i.e. not entire floor)

If sprinkler system impaired, the following equipment must be put back on line:

  • Diesel/Electric pump

  • Fire Indicator Panel

  • Valves restored to normal operating condition

Restoration of Fire Sprinkler Services

  • A 50mm running test of fire sprinkler services will be undertaken after restoring protection completed to ensure that valves are fully open.

Step Two – Colliers International REM to email this form to the following: *The Colliers International REM person who is the controller of this impairment process *Colliers International REM insurers *The relevant Fire Services Monitoring Company

  • I authorise that the fire services may be isolated based on the implementation of the control measures detailed in section one of this fire services impairment form.

  • Signed:

  • Date and time:

Step Three – The Colliers International REM Controller is responsible for contacting the contractor at cease date and time documented in Step One to ensure the work has been completed:

  • I DECLARE THAT I HAVE BEEN ADVISED THAT THE FIRE SYSTEMS HAVE BEEN FULLY RESTORED.

  • Signature:

  • Title:

  • Date:

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