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»Environmental Health and Safety
»Fire safety
»Equipment Impairment Notice

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Environmental Health and Safety
108 Edwards Hall
1810 Kerr Dr.
Kansas State University
Manhattan, KS 66506

785-532-5856
785-532-1981 fax
safety@k-state.edu

Fire Protection Equipment Impairment Notice

If you see this don't fill out this input box.

Date

Fire Alarm or Fire Sprinkler System

Select one

Fire Alarm

Fire Sprinkler

Reporting person's name

Phone

Are you the contact person? (If yes, skip the next two questions)

Yes

No

Contact person's name

Person conducting fire watch

Phone

Local Information (where will the impairment occur?)

Building Name

City

Phone

Location of Impairment (Entire building or area affected)

Nature of Impairment

Cause of impairment

Anticipated completion date/time

Printable Form

Equipment Impairment Notice (pdf)

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Kansas State University
Manhattan, KS 66506
785-532-6011
© Kansas State University
Updated: 12/12/19