Fire Protection Impairment Notification Form

This form is to be used to notify DIA of works being conducted on the fire protection system, to log & monitor precautions put in place and to ensure all isolations have been reinstated. 

This information should be reported to DIA at least 48 hours in advance or as soon as practical prior to work starting and be signed off when protection is restored. 

This form and other associated paperwork must be duly signed and returned to Electrical Maintenance Coordinator for filing and review.

Part 1 – Application Details

This email will be used to send the approval notification and the link to fill up the system restoration form.
Impairments should be limited where possible to specific areas or alarm zones

Part 2 - Location/ Description

ARFFS MUST be notified prior to isolations and at de-isolation. (8920 4810)

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Part 3 - DIA Assessment

Including this impairment what will the total terminal isolation percentage be. If over 10%, a Risk Assessment will be triggered.
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Part 4 - System Restoration

All equipment has been reinstated and systems have been checked. Please complete this form to confirm de-isolation.

Restored by

DIA Notified by

Part 5 - Drawings/ Block Plans

Part 6 - DIA Sign Off