Fire Impairment Notification System
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Submit a new Fire Impairment Notification
Look up your existing Fire Impairment Notification
Find an Existing Fire Impairment Notification
ID Number:
Email Address:
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Submit a New Fire Impairment Notification
Contact Information
Full Name:
Contact Phone Number:
Email:
Employer:
Please Select
NSHE Employee
Contractor
Organization:
Request Info
Submission Date:
Reason for impairment:
Date and Time of Impairment:
Estimated Date and Time of Restoration:
Location Info
Institution:
Please Select
UNLV
NSU
LegacyDegree
Building:
Room/Location:
Effected Fire Protection Information
Select all that apply:
Fire Alarm System
Standpipe and Hose System
Water Supply
Detection system
Underground Piping & Control Valves
Special Suppression Systems
Automatic Sprinkler Systems
Fire Pumps
Other
Valve Number/Equipment Identification Number:
During the scheduled impairment time, will any of the following be occuring?
Will Hotwork be needed?
No
Yes
Will continuous work be needed?
No
Yes
Will the hydrant be connected to the sprinkler risers?
No
Yes
Will a fire hose need to be laid out?
No
Yes
Will pipe plugs be on hand?
No
Yes
File Attachments
Are there any files you would like to attach to your Fire Impairment Notification? (PDFs only, ctrl + click for multiple file selection)
Approval Checklist
Are there lockout/tagout requirements?
Please Select
No
Yes
Is a Fire Watch needed?
Please Select
No
Yes
Is a Hotwork Permit needed?
Please Select
No
Yes
Is there an Impairment Permit Posted?
Please Select
No
Yes
Comments:
Who else needs to be contacted? (ie. Building Coordinator)
Contact Email:
Closure Checklist
Fire Alarm or Devices back in service?
Please Select
No
Yes
Are all mechanical devices in service (i.e. Locked back into the proper position)?
Please Select
No
Yes
Are the fire sprinklers in normal servce?
Please Select
No
Yes
Has the impairment permit been removed?
Please Select
No
Yes
Comments:
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