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Fire Protection Impairment Report Form

Fire protection impairments expose your property to potentially catastrophic damage in the event of a fire. Any time a fire protection system is not functioning properly, specific steps should be taken to help ensure prompt action is taken to resolve the issue.

Fire protection impairment form

Complete the form below to help track both planned and unplanned impairments to your fire protection systems. For an overview of common impairments, their causes, and ways to help control them, download the impairment guide below. Sample valve tags can also be found at the end of the document.

View impairment guide (Opens in a new window)
Account identifier

Helps us find your information. SAI or Job Number (from your most recent Travelers Risk Assessment).

Contact information

(who we can follow-up with)
Is the contact also the Authorized Impairment Manager?*

The designated individual responsible for overseeing, documenting, and managing interruptions to fire protection systems.

These individuals will also receive email reminders and confirmations. Separate multiple email addresses by a semicolon.

Facility information

Specific location identifiers so that we can discuss the facility in question if we need to contact you.

Please enter the full address.

Impairment information

Start date of impairment* (MM/dd/yyyy)

Impairment description, area impacted, reason for impairment, etc.

Estimated restoration date* (MM/dd/yyyy)

If a planned impairment is expected to last less than 8 hours, reporting the impairment is not required. Estimated Restoration Date for Routine Inspection/Testing/Maintenance will be the same day as the Start Date.

Do you require a phone consultation with a Travelers Risk Control Representative?*
Precautions*

Here is a list of all measures which need to be taken. Please check off the measures completed to date.

All safety precautions should be completed immediately to ensure proper protection. If you require assistance with your impairment, please indicate above that you require a phone consultation with a Travelers Risk Control Representative. For additional guidance, our Fire Protection Impairments brochure outlines recommended steps to follow.

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