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

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Environmental Health and Safety
135 Dykstra Hall
1628 Claflin Rd
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*

Reporting person's email*

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: 9/15/23