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## FIRE PROTECTION SHUTDOWN NOTIFICATION

Requester Name
Hospital Name
Hospital Name is required
Site Name
Site Name is required
Level
Level is required
Fire System
Fire System is required
Affected Area:
Affected Area is required

#### Shutdown:

######
PLACE SYSTEM IN ISOLATE TO PREVENT FIRE ACTIVATIONS
WHEN SYSTEM IS BEING WORKED ON AND POSSIBLE FALSE ALARM CHARGES

Shutdown Date and time:
Shutdown Date is required
Emergency Request
Reason:
Emergency request reason is required
Reinstated is required
Reinstated:
Reinstated Date and Time:
Reinstated Date is required
Continuous Shutdown is required
Continuous Shutdown:
Select a Reason
Reason is required
Comment:
Hot Work Permit is required
Hot Work Permit:
Please upload area map:

## Hot Work Permit

#### Isolation of services

Mains Water | Chilled Water | Domestic Water | High Temp Hot Water / Steam
Domestic Hot Water | LV Power | HV Power 11kv | Sewer
Fuel Lines | Medical Gases Vacuum | FireProtection | BMS Alarms
Air Condition | Compressed Gases | Telecoms ICT | Others
Other Reasons: Explanations is required
Additional Info: Explanations is required
Safety Implications | Lock-Off Required | Safety Signs Posted | Air Monitoring Required
Safety Precautions:
Associated Hazards | Hot Work Permit Required | Fumes Dust Noise | HV Permit Required
Location: Explanations is required