Concordia University

http://www.concordia.ca/content/concordia/en/campus-life/emergency/fire-prevention/hot-work-form.html

SGW Fire Prevention Form

Before completing the form below, please contact Facilities Management Call Center at extension 2400 or call2400@concordia.ca to request a work order for a Fire Alarm Bypass. You will need to enter the work order number in the form below. Please note that fire alarm system bypass work orders are billable requests.

Requests must be submitted 2 working days prior to conducting the hot work or any other activitiy as described in the Hot work section

Forms submitted with less than 48 hours notice, may not be approved and therefore the activity or scheduled work not permitted.

For any questions concerning this form or planned activities that may inplicate hot work, please contact us at Emergency.Management@concordia.ca

Campus Location / Emplacement sur le campus

*
(Ex; LB, EV, SP, H...)
*
(i.e. H001, H0023, H281...)

The Request / La demande

*
 Fire Alarm By-pass / Contournement des alarmes au panneau incendie
 Fire Alarm By-pass (emergencies only) / Contournement des alarmes au panneau incendie (urgences seulement)
 Fire alarm system maintenance / Maintenance du système d'alarme incendie
 Sprinkler system maintenance / Maintenance du système de gicleurs
 Other / Autre

Hot Work Fire Risks / Risques d'incendie reliés aux travaux à chaud

 
 Yes / Oui
 No / Non
 
(Welding, grinding, fire pump test, cooking or heating food, sanding...) / (Soudure, broyage, découpage, chauffage, cuisson, réchaud, ...)

On-site Precautions / Précautions sur le site

 
 Fire extinguisher / Extincteur portatif
 Smoke evacuator / Extracteur de fumée
 Spark or radiation screen / Pare-étincelles ou écran de protection radiologique
 Charged fire hose / Boyau Incendie
 Security agent / Agent de sécurité
 Other / Autre

Time Frame / Date et heure prévue

*
*
*

On-site Contact / Personne présente sur les lieux

*
*
*
Contact facilities management at extension 2400 to request a by-pass of the fire alarm system / Entrer en communication avec la gestion immobilière au poste 2400 pour faire ouvrir un bon de travail
 
Please add any other comments you have for consideration / SVP Laissez tout commentaire relatif

Agreement / Entente

*
*
*
*
 I have read, agreed to and will advise the on-site supervisor / worker of the terms of the mandatory hot work safety precautions / J'ai lu, j'accepte et j'ai fait part des conditions établies dans la section des précautions obligatoires de travail à chaud au personnel qui supervisera le travail sur place
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