Fire Watch
Building Fire System Impairment
(Supplement to Fire System Impairment Notice)
Section 1 – General Information (Completed by requesting organization or impairment coordinator)
Building Name:
Building Address:
Impairment Coordinator
Bob Slavik 303-273-3312 / 303-885-8557 (Primary); Ray Castillo (Back up) 303-273-3263 / 720-
(Name and phone number):
496-7782; Craig Crow 303-273-3356 / 303-421-0832 (Back up)
CSM Project Manager
(Name and phone number):
(Company name, name of onsite
representative and phone number):
Section 2 – Impairment Information (Completed by requesting organization or impairment coordinator)
System Impaired:
Affected area within the
Reason for Fire Watch
☐ Impairment will extend beyond 10 hours
☐ Impairment extends after hours
☐ Fire panel cannot annunciate alarm in building
☐ Emergency Outage
☐ Fire panel cannot notify Golden Fire Department
Does the impairment affect Fire
☐ Yes
If yes then fire watch personnel will need to have a cell phone or phone access in the
Panel ability to notify GFD?
☐ No
immediate area to call 911
Does the impairment affect Fire
☐ Yes
If yes, then will the fire
☐ Yes
If no, then use
☐ Building PA
Panel ability to notify building
☐ No
pull station initiate
☐ No
alternate means of
☐ Bull horn
building notification?
notification, identify
☐ Whistle
means in the next
☐ Verbal
☐ Other _________
Start Time and Date:
End Time and Date:
Section 3 – Fire Watch Details
Fire Watch Personnel have
☐ Assigned duty requirements, check the one that applies
been briefed to the following:
☐ They have no other duties other than to perform a fire watch.
☐ Limited duties may be assigned; must remain attentive in the building.
☐ Their primary role, check the one that applies
☐ Look for observable signs of smoke and/or fire.
☐ Listen for a fire alarm and call 911 if a fire alarm is activated.
☐ They are to wear the Fire Watch vest provided during their patrols
☐ Continually patrol/monitor the affected area (refer to section 2) by:
☐ Walking through:
Common areas
Food preparation areas
☐ Opening doors and looking in:
Mechanical rooms
Electrical rooms
☐ Other ____________________________________________________
☐ If signs of smoke and/or fire is observed then they will take the following actions:

Call 911

Notify building occupants by pulling the nearest fire alarm pull station or using an
alternate means as identified in section 2
☐ Do not put themselves in jeopardy when notifying building residence using alternate means of
☐ Contact the impairment coordinator or PM (see section 1) if they have questions or concerns
while performing the Fire Watch.
Person(s) performing Fire
Print Name
Print Name
Rev. July 2017