Property Impairment Notification MARSH 29042011 Issue 6

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• MARSH DOCUMENT 29/04/2011 ISSUE 6

• MARSH pty ltd, Attention CFSGAM Team, Facsimile (02) 8864 8051 or email "fireimpairment.australia@marsh.com"

• Please ensure a copy is also forwarded to the Risk team via email to CFSGAM-AM_Risk@cfsgam.com.au or via fax to (03) 9936 1579

Details

• Location of property:

• Impairment notified by:

• Date and time of shutdown

  Date

• Expected restoration date

  Date

• Reason for shutdown

• TYPE OF DISCONNECTION/IMPAIRMENT

• WATER SUPPLY

  Yes

  No

• Fire Pump

• Fire Water Tank

• Direct Mains

• AUTOMATIC SPRINKLER PROTECTION

  Yes

  No

• Sprinkler Valve Number

• Area Affected

• FIRE/SMOKE ALARM DETECTION

  Yes

  No

• Area Affected

• IPAIRMENT/SHUTDOWN AFFECTS MORE THAN 25% OF THE BUILDING (limit area of impairment wherever possible)

  Yes

  No

• PRECAUTIONS TAKEN:

• 1. Fire Brigade notified

  Yes

  No

• Comments

• 2. Chief Fire Warden notified?

  Yes

  No

• Comments

• 3. Tenant(s) notified?

  Yes

  No

• Comments

• 4. Charged hose reels ready?

  Yes

  No

• Comments

• 5. Extra extinguishers provided?

  Yes

  No

• Comments

• 6. Cutting and welding prohibited?

  Yes

  No

• Comments

• 7. Fire watch provided?*

  Yes

  No

• *Only required if the impaired area is left without automatic protection or fire alarms, or in special circumstances (e.g. No on site management or security, major renovations, overnight or weekend)

• Comments

• 8. Emergency reinstatement procedure?

  Yes

  No

• Comments

Rectification

• SPRINKLERS RESTORED

• Drain tests made?

  Yes

  No

• Valve locked open?

  Yes

  No

• Performed by:

• PROTECTION RESTORED NOTIFICATION

• Date and time

  Date

• Signature:

  Sign

• System restored notification faxed to Marsh by: