Fire Alarm System: Permit to Work

SECTION 1 - TO BE COMPLETED BY THE PERSON AUTHORISING THE PERMIT

Campus / Building
Reason for work requirement / 1.  Fire Alarm Maintenance
2.  Building maintenance
3.  Occupant Processes/Activities
Degree of Isolation required (tick) / Partial/Complete
Extent of areas affected
1. Level A – Engineering workshop
(Zone 1)
2. Level A - Engineering workshop
(zone 1) / 2 detectors to be isolated for maintenance
Complete zone isolated for maintenance
Extent of personnel affected
1. maintenance Staff
2.Academic Staff/Students / Approximately 6 Staff
Approximately 20 Occupants
Equipment / zones to be isolated.
1.  Detectors – Zone 1
2.  Detectors/Sounders – Zone 1 / 1.  Detectors only/Sounders not affected
2.  On detection of fire engineer will activate the alarm system to evacuate the premises/instigate secondary procedures
Contingency measures to be put in place
1.  None – Sounders not affected
2.  Air horns provided within area / 1. Other detectors in affected area/Engineeer in attendance throughout.
2. Occupants informed of change to fire alarm procedures/Security to call F&R Services on evacuation
Date(s) isolation required / From 10/03/08 / To 11/03/08
Time(s) isolation required / From 10.00 hrs / To 16.00 hrs
Authorising Person:………………………………………………… Job Title:………………………………………………

a)  Security notified (permit not valid unless signed) c Yes c No

b)  Call Centre notified (if applicable) c Yes c No

c)  Campus Principal notified (if applicable) c Yes c No

d)  Risk assessment has been carried out & is attached c Yes c No

e)  Method statement has been produced & is attached c Yes c No

f)  Additional emergency evacuation procedures are in place if required c Yes c No

SECTION 2 - TO BE COMPLETED BY THE PERSON CARRYING OUT THE WORK

I understand and will ensure compliance with Risk Assessment and Method Statement.
Signature: ……………..……………………...... ………...… Date: ………………………………………………

AUTHORISATION BY APPROPRIATE MANAGER * see guidance note

I believe the isolation of part of the Fire Alarm System is necessary and that the operation can be completed safely in accordance with the details above.
Authorised Person Name: ……………………………………………………………………………………………..
Signature: ……………..……………………...... ………...… Date: ………………………………………………

TO BE SIGNED ON COMPLETION OF WORK OR AT END OF PERMIT PERIOD BY PERSON CARRYING OUT WORK

The permitted work on the Fire Alarm System has been completed and the system is returned to full operational condition.
Signature: ……………..……………………...... ………...… Date: …………………………………………………
Additional Comments: …………………………………………………………………………………………………………….

Copy to Head of School/Service

Copy to Control Room/Security December 2006