VA 01 00 00 General Requirements - Attachment 1a and 1b.pdf
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Attachments 1a & 1b
Fire Sprinkler Work
Notifications
SECTION 01 00 00
GENERAL REQUIREMENTS
ATTACHMENT #1 - A
NOTIFICATION OF IMPAIRED FIRE SPRINKLER BY CONTRACTOR PERSONNEL
PROJECT No. & TITLE:
NAME OF FACILITY:
NOTIFIED BY:
TITLE:
COMPANY:
NATURE OF IMPAIRMENT:
PRECAUTIONS TO BE TAKEN:
CLOSED VALVE #: BLDG. #: ROOM #:
CONTROLLING:
START DATE: Su M T W Th F Sa @ TIME:
END DATE: Su M T W Th F Sa @ TIME:
JUSTIFICATION:
COR CONTACTED: DATE/TIME
EXT: or CELL:
SAFETY OFFICER CONTACTED (EXT. 7292)
EGCC OPERATOR/CEP CONTACTED (EXT. 7080)
FIRE DEPARTMENT CONTACTED (813- 971-3636)
VISN SAFETY MANAGER( )
Section 01 00 00, Revised May 2015 General Requirements – Attachment #1 - A Page 1
SECTION 01 00 00
GENERAL REQUIREMENTS
ATTACHMENT #1 - B
NOTIFICATION OF RESTORED FIRE SPRINKLER BY CONTRACTOR PERSONNEL
PROJECT No. & TITLE:
NAME OF FACILITY:
NOTIFIED BY:
TITLE:
COMPANY:
NATURE OF IMPAIRMENT:
FULL PROTECTION RESTORED, EXCEPT:
OPENED VALVE #: BLDG. #: ROOM #:
CONTROLLING:
DATE: Su M T W Th F Sa @ TIME:
REASON FOR PARTIAL RESTORATION:
COR CONTACTED: DATE/TIME
EXT: or CELL:
SAFETY OFFICER CONTACTED (EXT. 7292)
EGCC OPERATOR/CEP CONTACTED (EXT. 7080)
FIRE DEPARTMENT CONTACTED (813- 971-3636)
VISN SAFETY MANAGER( )
Section 01 00 00, Revised May 2015 General Requirements – Attachment #1 - B Page 1
| DATETIMESAFETY OFFICER CONTACTED EXT 7598: |
| DATETIMEEGCC OPERATORCEP CONTACTED EXT 7080: |
| DATETIMEFIRE DEPARTMENT CONTACTED 8139713636: |
| DATETIMERSFPE CONTACTED: |
| DATETIMESAFETY OFFICER CONTACTED EXT 7598_2: |
| DATETIMEEGCC OPERATORCEP CONTACTED EXT 7080_2: |
| DATETIMEFIRE DEPARTMENT CONTACTED 8139713636_2: |
| DATETIMERSFPE CONTACTED_2: |
| Contract Information: |
| DATETIMECOTR CONTACTED: |
| DATETIMECOTR CONTACTED_2: |
| End Time - #1A: |
| Group18: Off |
| Group19: Off |
| Project # and Title - #1A: |
| Name of Facility - #1A: |
| Notified By - #1A: |
| Title - #1A: |
| Company - #1A: |
| Nature of Impairment - #1A: |
| Closed Valve - #1A: |
| BLDG # - #1A: |
| Room # - #1A: |
| Controlling - #1A: |
| Justification - #1A: |
| COTR Name - #1A: |
| COTR Phone Ext - #1A: |
| COTR Cell # - #1A: |
| RSFPE # - #1A: |
| Precautions Taken - #1A: |
| Precautions Taken - #1B: |
| Justification - #1B: |
| Start Time - #1A: |
| Start Time - #1B: |
| Group20: Off |
| Reset: |
| Print: |
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