Report Impairment

Report Life Safety System Impairment

This is a 2 part form. Complete Step 1 (Initial Reporting Form). You will then have the option to complete Step 2 immediately. You will also receive an email with a link to return and complete Step 2 (Impairment Completion Form).

Current Step 1 - Initial Impairment Report
Step 2 - Impairment Completion

Indicates required field

Title / Position

First

Last

Contact Phone Number

Agency / University

Department / Division Number

Complex / Asset Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Start Date

Estimated Days to Complete Work

Description of Impairment

Type of Impairment

Emergency Impairment

Planned Impairment

Other Type of Impairment...

Has the local fire department been notified of this impairment?

Yes

I verify the information above is correct.