Fire System Impairment Notification

FIRE SYSTEM IMPAIRMENT NOTIFICATION
INSTRUCTIONS

A Fire System Impairment Notice is requested by DFES for fire systems undergoing repair or maintenance work that will extend for a period greater than 24 hours before the system is returned to its required operational performance. You should also check with the applicable local government as to their requirement to be notified of fire system impairments.

Planning:
- Remediation/Maintenance works are to be kept to a minimum duration. Preparatory actions should be exhausted with the aim of minimising isolation times.
Time Limits:
- Minimum notice required for a planned impairment is 72 hours or as soon as possible for an unplanned event.
Scheduled Restoration:
- Part B of this form is to indicate the completion date of work details.
PREMISES DETAILS
Site Address:*
Suburb:*
Postal Code:*
Project / Site Name:*
APPLICANT DETAILS
Requester:*
Company Name:*
Telephone / Mobile:
Please enter a valid phone number.
Email Address*
example@dfes.wa.gov.au
PART A: NOTIFICATION OF IMPAIRMENT
Date of Notification*

DayMonthYear
Date
Submitted By:*
FIRE SYSTEM IMPAIRMENT (select from below)

Ensure Fire System Impairment/s have been selected
Fire HydrantsFire PumpsTank StorageFire MainPublic Water SupplyFire DetectionFire Suppression SystemEmergency Vehicle AccessOther
AFFECTED AREA - DESCRIBE LOCATION AND OCCUPANCY INVOLVED
0/250
REASON FOR AND DESCRIPTION OF IMPAIRMENT
0/250
Date & Time of Isolation: *

DayMonthYear
Date
Hour Minutes
SAFETY PRECAUTIONS TAKEN (Select From Below)

Ensure Safety Precautions have been selected
Management, staff, and contractors notifiedFire watch implementedEmergency water supplyHazardous operations prohibitedSystem reinstated on COBHot work suspended24 hour occupancyAdditional equipment providedTrading ceasedOther
PART B: NOTIFICATION OF SCHEDULED RESTORATION
Your Restoration Date must be the same or greater than the Isolation Date
Date & Time of Scheduled Restoration:*

DayMonthYear
Date
Hour Minutes
Calculation
ADDITIONAL INFORMATION
0/250
Please verify that you are human*
Should be Empty:

FIRE SYSTEM IMPAIRMENT NOTIFICATION

INSTRUCTIONS

PREMISES DETAILS

APPLICANT DETAILS

PART A: NOTIFICATION OF IMPAIRMENT

FIRE SYSTEM IMPAIRMENT (select from below)

AFFECTED AREA - DESCRIBE LOCATION AND OCCUPANCY INVOLVED

REASON FOR AND DESCRIPTION OF IMPAIRMENT

SAFETY PRECAUTIONS TAKEN (Select From Below)

PART B: NOTIFICATION OF SCHEDULED RESTORATION

ADDITIONAL INFORMATION