MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C6BAF1.3C06A170" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C6BAF1.3C06A170 Content-Location: file:///C:/6E0CBA36/Impairment_8-06.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" HOT WORKS/OPEN FLAME SAFETY PROGRAM

University of Minnesota-Duluth

Faci= lities Management

Impa= irment Notice (Revised 11/2005)

 

IMPAIRMENT NOTICE DISTRIBUTION INSTRUCTIONS<= /p>

Im= pairment Coordinator:

Fi= ll out       (a)using a black ball-point pen for readability    or    (b)online and print, = then sign and issue permit as follows:

 

(1= )   Fax or E-mail Impairment N= otice to parties indicated below (Fire dept/Simplex/FM desk require a phone cal= l)

 

       &nbs= p;  Office   =        &nbs= p;            &= nbsp;           &nbs= p;           Telephone       &nbs= p;            &= nbsp;  Fax           &nbs= p;            &= nbsp;       Email Address

      Faciliti= es Management-UMD       &nbs= p;  (218)726-8262       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;        facmgt@d.umn.edu

      Simplex =        &nbs= p;            &= nbsp;           &nbs= p;        (888)746-7539

      City of Duluth-Fire Dept Stn #4      (218)723-3214

      TVA Fire= and Life Safety Inc       &nbs= p;  (877)916-2774       &nbs= p;        (619)839-3892       &nbs= p;       impairment@tvafiresafety.com

      BSAC-UMD=        &nbs= p;            &= nbsp;           &nbs= p;   (218)726-7900       &nbs= p;        (218)726-8008   &n= bsp;          dmckerch@d.umn.edu<= /o:p>

      Risk Management-UM       &nbs= p;         &nbs= p; (612)626-0552       &nbs= p;        (612)626-0234       &nbs= p;       risk@facm.umn.edu

      Building= Code Office-UM       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;         (612)625-6667   &n= bsp;          

 

 

PRECAUTIONS TAKEN (CHECKED AS APPROPRIATE FOR IMPAIRMENT LEVEL)

  Emergency Organization Notified (II – III)       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;    Hot Works Proh= ibited (II – III)

 

  Continuous Work Authorized       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;           Ongoing Fire W= atch – Patrol (II – III)

 

  Hazardous Oper= ations Stopped (I – III)       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       User’s Informed (II –= III)

 

  Other – Specify:    &= nbsp;  

 

Duluth-Main       &nbs= p;    NRRI       &nbs= p;   Glensheen       &nbs= p;   RLBW-Old Campus       &nbs= p;   Other-Specify:    &= nbsp;  

 

Bu= ilding:   = ;          &nbs= p;            &= nbsp;           &nbs= p;  City:   = ;          &nbs= p;            &= nbsp;   State:   = ;          &nbs= p;       

In= sured Phone Number:  (218)726-8262=

In= sured Fax Number:  (218)726-8127<= /o:p>

Ch= eck Systems Affected:

 

  Sprinkler       &nbs= p;            &= nbsp;              Standpipe=

 

  Fire Pump       &nbs= p;            &= nbsp;            Emergency Gene= rator

 

  Fire Alarm       &nbs= p;            &= nbsp;            Extinguishing = System

 

  Smoke Control<= span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;     Electrical Sup= ply

 

  Water Supply       &nbs= p;            &= nbsp;       Other-<= !--[if supportFields]> FORMTEXT   = ;          &nbs= p;     

 

Sp= rinkler Valve Location:    =    

Ar= ea Protected:    =    

Ma= in Drain Static Pressure:   FORMTEXT   =    

Ma= in Drain Residual Pressure:  <= !--[if supportFields]> FORMTEXT   =    

Re= ason for Impairment:    = ;          &nbs= p;            &= nbsp;           &nbs= p;         

Pl= anned Date to be Disabled (m/d/yyyy) :   = ;   

Pl= anned Time to be Disabled:   = ;          &nbs= p;     <= !--[if supportFields]> FORMCHECKBOX a.m.     p.m.

Pl= anned Date to be Enabled (m/d/yyyy) : &nb= sp;   = ;   

Pl= anned Time to be Enabled :    = ;        &nb= sp;      a.m.     p.m.

Na= me/Title of Responsible Person (print):   = ;          &nbs= p;            &= nbsp;           &nbs= p;                  &nbs= p;            &= nbsp;       Impairment Level:   = ;   

Impairment Coordinator= – Steve Chepelnik (218)726-6060       &nbs= p;             Alt. Coordinator – D= ave Clark (218)726-8286

Sy= stem Returned to Service:       &nbs= p;        Date (m/d/yyyy) :                     &nbs= p;            &= nbsp;            Time:   = ;          &nbs= p;     a.m.      p.m.

Complete and send to Risk Management via email at risk@facm.umn.edu or fax to (612)626-= 0234

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 <= /o:p>

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           

 

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