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2. In the event a required fire protection system must be taken out of service for repairs, maintenance, or another reason, a representative of your company must submit an Impairment Request to the Fire and Life Safety Branch. A fire investigator will review the request and notify you if and when it is approved along with any requirements to be satisfied.
4. Site Address*
5. City*
6. Zip Code*
8. Type of system to be impaired*

   1. Fire Alarm
   2. Automatic Sprinkler
   3. Standpipe
   4. Clean Agent
   5. Other

   Check all that apply
9. Other type of system*
   Detail additional system to be impaired
10. Type of Interruption *
    -- Select One --Temporary ImpairmentCancellation
12. Date and time system will out of service *
    Date and time system will out of service

    Date and time system will out of service
13. Date and time system will be reactivated*
    Date and time system will be reactivated

    Date and time system will be reactivated
15. Notes
17. Attach any files relevant to impairment site or work to be done.
21. Contact Info
23. First Name*
24. Last Name*
26. Phone Number*
27. Email Address*
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field