Vicinity - HS-FR-28-01 System Isolation Notification

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Fire System Isolation Notification

• This notification is to be completed for isolations that exceed eight hours and emailed to australia_impairment@aig.com or fax 02 9240 1722
  

• Please ensure a copy is also forwarded to the Risk team via email to risk.management@vicinity.com.au

Fire System Isolation Details

• Location of Property

• Isolation Notified by:

• Date and Time of System Shutdown

  Date

• Expected Restoration Date

  Date

• Reason for Isolation/Shutdown

Type of Disconnection/Isolation

• Water Supply

  Yes

  No

  N/A

• Fire Water Tank

• Direct Mains Supply

• Automatic Sprinkler Protection

  Yes

  No

  N/A

• Area Affected

• Fire/Smoke Alarm Protection

  Yes

  No

  N/A

• Area Affected

• Other Disconnection/Isolation:

• Tick if Applicable Isolation/Shutdown affects more than 25% of building Yes or N/A (Limit area of isolation wherever possible)

Precautions

• 1. Fire Brigade notified?

  Yes

  No

  N/A

• 2.Chief Warden Notified?

  Yes

  No

  N/A

• 3. Tenant(s) notified?

  Yes

  No

  N/A

• 4. Charged hose reels ready?

  Yes

  No

  N/A

• 5. Extra extinguishers provided?

  Yes

  No

  N/A

• 6. Cutting and Welding prohibited?

  Yes

  No

  N/A

• 7. Fire watch provided?*

  Yes

  No

  N/A

• 8. Emergency reinstatement procedure?

  Yes

  No

  N/A

• Comments

• * 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)

Protection Restoration Notification

• Sprinklers restored?

  Yes

  No

  N/A

• Drain tests made?

  Yes

  No

  N/A

• Valve locked open?

  Yes

  No

  N/A

• System safe/active/operational?

  Yes

  No

  N/A

• Performed by:

  Sign

• Date/Time

  Date

• Company

• System restoration notification emailed or faxed to AIG by: