Impairment Notification Form
Report life safety system impairments to the St. George Fire Prevention Bureau. Complete all sections as required by IFC 901.7.
Life Safety System Impairment Notification Form
IFC: 901.7 - Systems out of service. Where a required fire protection system is out of service, the fire department and the fire code official shall be notified immediately
Name of Occupancy With Impairment:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact/Occupancy Representative Name:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Life Safety System Type:
Fire Extinguisher
Special Locking
Fire Alarm
Fire Hydrant
Fire Sprinkler
Fire Suppression System
Conveyance Device
Impairment(s):
System Previously Tagged?
YES
NO
If YES, color of tag:
RED
YELLOW
Tag Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NOTE:
When a red tag is affixed to a system, the Office of State Fire Marshal must be notified within two (2) business days.
NOTE:
While it is not required that a red tag be placed on the system when the expiration period of a 60-day yellow impairment tag has passed, the system is considered to be in a ‘red tag condition” & the Office of State Fire Marshal must be notified within two (2) business days of the 60-day expiration of a yellow impairment tag. ( https://www.lasfm.org/licensing/impairments/ )
Life Safety System Impairments should be immediately reported to the St. George Fire Prevention Bureau via submitting this form, emailing Fire Prevention, and/or calling (225) 251-4800.
Submit
Should be Empty: