Fire Protection System Impairment - Harleysville Insurance

12123456789101112Z-1589 06/ 1Z-1587 07/ 1Z-1590 06 / 1Z-15 8 06/ 1HARLEYSVILLE RISK SERVICESYour Partner in Preventing Losses SMFire Protection System ImpairmentRisk Services DepartmentHarleysville Insurance355 Maple AvenueHarleysville, PA 19438-2297Tel: 1.800.523.6344, ext. 8100Fax: 215.513.5345riskservices@harleysvillegroup.comwww.harleysvillegroup.comAs part of our Harleysville Impairment Program, we can provideyou with a Fire Protection System Impairment kit that includestools to help you manage these outages and save your businessfrom catastrophe when a fire protection system goes down. Itprovides your impairment coordinators (see below) with achecklist, impairment forms, posters, notification stickers,reporting forms and hang cards. All of these tools help you planand manage impairments until fire protection is fully-restored.(To obtain a Fire Protection System Impairment Kit, callHarleysville Risk Control Services at 1.800.523.6344, ext. 8100, orcontact your independent Harleysville agent.)The Harleysville Impairment Program will help you: Plan and report the impairment outage and communicatethese conditions Notify employees of any necessary operational changes Manage the outage until your fire protection systems arefully-restoredAll employees and contractors should follow the HarleysvilleImpairment Program whenever it is necessary to disable a fireprotection system. This procedure applies to sprinkler and firealarm systems and their components.Before youshut down afire protectionsystem …HARLEYSVILLE RISK SERVICES Your partner in preventing losses(or when one goes out of service on its own)… contact one ofthese coordinators!Help prevent fires from starting!Your insurance agreement requires notification to Harleysville if fire protection systems areimpaired. The notification period varies by state and by agreement, but is often within 48 hours.The Harleysville Impairment Program will help you meet this requirement and reduce the risk ofcatastrophic fire loss at your business.Assignment of an impairment coordinatorThe Harleysville Impairment Program requires the property owner to designate an impairmentcoordinator for each work shift. To improve communication, you should post the names of thesecoordinators, along with their contact information.Impairment coordinators are responsible for: Authorizing the shutdown of the fire protection system Ensuring that impairment procedures are being followed and completed Verifying that the steps necessary to restore systems to proper working condition have beenfollowed and those systems are restored to service as soon as possibleThe Harleysville Risk Services team is available to answer any questions youmay have about these procedures. Call us at 1.800.523.6344, ext. 8100.WeekdaysFirst shiftWeekdaysSecond shiftWeekdaysThird shiftWeekendsHolidaysRisk Services DepartmentHarleysville Insurance355 Maple AvenueHarleysvi le, PA 19438-2297NamePhone #NamePhone #NamePhone #NamePhone #NamePhone #Most fire catastrophes occur when sprinkler and other systems are down!Tel: 1.800.523.6344, ext. 8100Fax: 215.513.5345Email: riskcontrol@harleysvillegroup.comwww.harleysvi legroup.comFire Protection SystemPRIMARY SECONDARYHARLEYSVILLE RISK SERVICES Your partner in preventing lossesFIRE PROTECTION SYSTEM IMPAIRMENT FORMSystem Coordinators: Use one of these forms for every impairment!Part A—Before a system impairment (or upon learning a system is down)Instructions: After completing Part A …Send this entire form to Harleysvi le via Fax: 215.513.5345 or Email: riskcontrol@harleysvillegroup.comPlace this entire form in a clear plastic envelope, and hang the envelope System(s) shut o f:Type of operationsthe valve or impaired device along with an “Out of Service” hang card.____ Alarm/detection system in a fected area(s):Company’s Name: _______________________________________________________________ ____ Fire hydrant____ Construction____ Fire pump____ Hotel/motelYour Name: ______________________________________________________________________ ____ Public water main____ Manufacturing____ Reservoir/tank____ Office spacePhone #: _________________________________ Fax #: ___________________________________ Special extinguishing system ____ RetailEmail Address: __________________________________________________________________ ____ Sprinkler____ Warehouse/storage____ Yard main____ Other _______________ Other ___________________ _____________________Location of impairment: _______________________________________________________Expected duration of impairment: ____________________________________________ Type of impairment:____ Freeze-up ____ Renovation/constructionTime shut o f: ______________ ____ a.m. p.m. Date: ____ / ____ /________ ____ Maintenance ____ RepairActions Taken by Building ManagementWas the alarm company notified? . . . . . . . . . . . . . . ____ Yes ____ NoWas the fire department notified? Note: Alarm company does not call FD. . . . . . ____ Yes ____ NoWas the risk manager/security/fire brigade/emergency organization(s) notified? . . . . . . . ____ Yes ____ NoHave “Out of Service” hang cards been placed on the impaired system(s)? . . . . . . . ____ Yes ____ NoIs the impaired area monitored by a heat/smoke detection system? . . . . ____ Yes ____ NoIs the protection system monitored loca ly or by central station? . .____ Local ____ Central StationIs a standpipe system available for the impaired area? . . . . ____ Yes ____ NoAre additional fire extinguishers available in the impaired area? . . . ____ Yes ____ NoHave hazardous operations been discontinued? . . . . . . . . . . . . . ____ Yes ____ NoWi l the impaired area be patro led by watchmen/security personnel every 15-30 minutes during the impairment? . ____ Yes ____ NoHas smoking in the area been prohibited? . . . ____ Yes ____ NoDid you do the fo lowing?Instructions: After completing this part …Conduct 2" main drain test? ____ Yes NoSend this entire form to Harleysvi le via Fax: 215.513.5345 or• Test results: Static __________________________________Email: riskcontrol@harleysvi legroup.comResidual ________________________________Keep a copy on file for future reference.• Compare results to past test results? ____ Yes ____ NoToday’s Date: ____ / ____ /________ Date System Restored: / /________ Test sprinkler alarms? ____ Yes ____ NoYour Name: ______________________________________________________________________ Notify central station? ____ Yes ____ NoPhone #: _________________________________________________________________________ Remove “Out of Service” hang cards? ____ Yes ____ NoRisk Services Department Tel: 1.800.523.6344, ext. 8100Harleysville Insurance Fax: 215.513.5345355 Maple AvenueEmail: riskcontrol@harleysvi legroup.comHarleysvi le, PA 19438-2297 www.harleysvi legroup.comOUT OFSERVICEHarleysvi le Insurance Risk Services1.800.523.6344, ext. 8100riskcontrol@harleysvi legroup.comPart B—Upon system restorationATTENTION!Do not shut down any portion of thisfire protection system without the knowledgeof your company’s fire protection systemcoordinator. That individual must notify thefire department, central station alarm companyand Harleysville Insurance of any shutdown.Don’t know your fire protection system coordinator’s name?Ca l Harleysville Insurance Risk Services at 1.800.523.6344, ext. 8100.© 2012 Harleysville Group Inc. All rights reserved.This information is designed to help users address their own risk management and insurance needs. Although we go to greatlengths to make sure our information is accurate and useful, we do not warrant its accuracy or completeness, and we recommendyou consult your insurance agent or other insurance professional to ensure that this information, and your interpretation of it, isappropriate to your particular situation. This information does not address all conditions, and may not be in compliance withfederal, state or local laws.Z-1605 02/12