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):
Contractor
(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
building:
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
residence?
building notification?
notification, identify
☐ Whistle
means in the next
☐ Verbal
block
☐ 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
-
Corridors/Hallways
-
Stairwells
-
Food preparation areas
☐ Opening doors and looking in:
-
Mechanical rooms
-
Electrical rooms
-
Laboratories
☐ 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
notification
☐ Contact the impairment coordinator or PM (see section 1) if they have questions or concerns
while performing the Fire Watch.
Person(s) performing Fire
Watch
Print Name
Signature
Print Name
Signature
Rev. July 2017