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Sprinkler Impairment Notification
School Board
Location Name
Location Address
Name of Person Responsible
Email Address
Copy To
Phone Number
Fire Protection Information
Type of Protection
Sprinkler System
Fire Pump
Special Protection
Other
Valve Number/Equipment Identifier
Area Protected
Reason for Impairment
Number of Turns to Close
Authorized By
Fire Protection Equipment Operator
Precautions Taken
Emergency organization notified
Continuous work authorized
Public fire department notified
Ongoing patrol of area
Hazardous operations stopped
Hydrant connected to sprinkler riser
Hot work prohibited
Pipe plugs on hand
Smoking restricted
Fire hose laid out
Other
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