FIRE PROTECTION IMPAIRMENT FORM

Protection impairments occur when a fire prevention, protection, alarm or supervisory system is shut off, impaired or otherwise taken out of
service completely or in part. Such circumstances are sometimes unavoidable due to a number of reasons such as a fault, failure or accidental
damage of equipment, renovation or expansion of the areas being protected. As a result of these system(s) being impaired, the premises or
equipment previously protected are now exposed to a greater loss should an incident occur. Proper impairment handling procedures can assist
Management in reducing the impact of such impairments to property and life safety.

INSTRUCTIONS: When fire protection systems (e.g. sprinkler systems, fire detection systems, special-extinguishing systems) are impaired
as follows:
 Impairment/isolation exceeds 8 hours duration or extends overnight, and/or
 Impairment/isolation of any primary fire water supply (city water mains and fire pumps), and/or
 Impairment/isolation affecting more than 25% of the complex/building
1. Complete this form
2. Send this form to Building Manager at afiq.sirat@lendlease.com

WORKING AREA: LEVEL 1 ZONE: LEVEL 1 TOILET CORRIDOR

PERSON REPORTING IMPAIRMENT: ZAKUAN CONTACT NO: 0133838667

DATE OF IMPAIRMENT: 15/11/2021 TIME OF IMPAIRMENT: 11PM

HOW LONG WILL IMPAIRMENT LAST: 5.00AM

DESCRIPTION OF IMPAIRMENT: TO CUT THE CEILING AND REPLACE NEW DUCT

REASON FOR IMPAIRMENT: FOR M&E WORK – TO REPLACE DUCT

NAME OF CONTRACTOR COMPLETING WORK: CLIMATE SYSTEMS SDN BHD

CONTRACTOR CONTACT NAME & NUMBER: ZAKUAN 0133838667 & NETHIYAA 014361933

ACTION TAKEN BY LOCAL MANAGEMENT STATUS

1 BOMBA notified ?
2 Are additional fire extinguishers available in impaired area?
3 Are security guards patrolling impaired area ?
4 Is impaired area monitored by a fire detection system?
Heat Smoke Other (specify)
5 Detection system monitored by:
6 Is hydrant/hose reel system available for impaired area ?
7 Have hazardous operations been discontinued (eg. welding) ?
8 Other:

ADDITIONAL ACTIONS (IF ANY) RECOMMENDED BY THE BUILDING MANAGER WILL BE ADVISED BY RETURN
EMAIL

Requested by: Approved by:

Name: NETHIYAA RAJENDRAN Name:

Date 11/11/2021 Date

NOTE: MINIMUM NOTICE PRIOR TO REQUEST IS 48 HOURS

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