RED TAG PERMIT

PART 1 INSTRUCTIONS

RED TAG PERMIT(Rev. 8/11) Printed in USA

Firesafety Supervisor: Fill out using ball-point pen, sign and issue permit as follows:

Phone Part 1 information or fax this part to the FM Global number listed on theRed Tag Permit Wall Kit.

Place Part 2 in center pocket of Wall Kit as visual reminder of impairment. IssuePart 3 (Red Tag) to Fire Protection Equipment Operator to attach to impaired equipment.

Part 1 of 3

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

INSURED NAME

INSURED LOCATION (City, State/Province)

INSURED FAX NO.INSURED PHONE NO.

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (PRINT NAME)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

FIRE PROTECTION EQUIPMENT OPERATOR (PRINT NAME)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

RED TAG PERMIT

PART 1 INSTRUCTIONS

RED TAG PERMIT(Rev. 8/11) Printed in USA

Firesafety Supervisor: Fill out using ball-point pen, sign and issue permit as follows:

Phone Part 1 information or fax this part to the FM Global number listed on theRed Tag Permit Wall Kit.

Place Part 2 in center pocket of Wall Kit as visual reminder of impairment. IssuePart 3 (Red Tag) to Fire Protection Equipment Operator to attach to impaired equipment.

Part 1 of 3

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

INSURED NAME

INSURED LOCATION (City, State/Province)

INSURED FAX NO.INSURED PHONE NO.

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (PRINT NAME)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

FIRE PROTECTION EQUIPMENT OPERATOR (PRINT NAME)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

RED TAG PERMIT

PART 1 INSTRUCTIONS

RED TAG PERMIT(Rev. 8/11) Printed in USA

Firesafety Supervisor: Fill out using ball-point pen, sign and issue permit as follows:

Phone Part 1 information or fax this part to the FM Global number listed on theRed Tag Permit Wall Kit.

Place Part 2 in center pocket of Wall Kit as visual reminder of impairment. IssuePart 3 (Red Tag) to Fire Protection Equipment Operator to attach to impaired equipment.

Part 1 of 3

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

INSURED NAME

INSURED LOCATION (City, State/Province)

INSURED FAX NO.INSURED PHONE NO.

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (PRINT NAME)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

FIRE PROTECTION EQUIPMENT OPERATOR (PRINT NAME)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

OUT OF SERVICE

PART 2 INSTRUCTIONS

RED TAG PERMIT

Firesafety Supervisor: Place in center pocket of Red Tag Permit Wall Kit as avisual reminder of present impairment.When fire protection is restored and Red Tag is returned by Fire ProtectionEquipment Operator, transfer information needed to this part and phone theinformation or fax this part to the FM Global number listed on Wall Kit.

Please send more permits. Quantity if needed:Mail to (Name):

(Address):

Part 2 of 3

ACTUAL DATE/TIME CLOSED

ACTUAL DATE/TIME OPEN

2 in. DRAIN TESTPERFORMED

YES NO

NO. OF TURNS TO CLOSE NO. TURNS TO OPEN

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

INSURED NAME

INSURED LOCATION (City, State/Province)

INSURED FAX NO.INSURED PHONE NO.

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (PRINT NAME)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

OUT OF SERVICE

PART 2 INSTRUCTIONS

RED TAG PERMIT

Firesafety Supervisor: Place in center pocket of Red Tag Permit Wall Kit as avisual reminder of present impairment.When fire protection is restored and Red Tag is returned by Fire ProtectionEquipment Operator, transfer information needed to this part and phone theinformation or fax this part to the FM Global number listed on Wall Kit.

Please send more permits. Quantity if needed:Mail to (Name):

(Address):

Part 2 of 3

ACTUAL DATE/TIME CLOSED

ACTUAL DATE/TIME OPEN

2 in. DRAIN TESTPERFORMED

YES NO

NO. OF TURNS TO CLOSE NO. TURNS TO OPEN

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

INSURED NAME

INSURED LOCATION (City, State/Province)

INSURED FAX NO.INSURED PHONE NO.

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (PRINT NAME)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

OUT OF SERVICE

PART 2 INSTRUCTIONS

RED TAG PERMIT

Firesafety Supervisor: Place in center pocket of Red Tag Permit Wall Kit as avisual reminder of present impairment.When fire protection is restored and Red Tag is returned by Fire ProtectionEquipment Operator, transfer information needed to this part and phone theinformation or fax this part to the FM Global number listed on Wall Kit.

Please send more permits. Quantity if needed:Mail to (Name):

(Address):

Part 2 of 3

ACTUAL DATE/TIME CLOSED

ACTUAL DATE/TIME OPEN

2 in. DRAIN TESTPERFORMED

YES NO

NO. OF TURNS TO CLOSE NO. TURNS TO OPEN

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

INSURED NAME

INSURED LOCATION (City, State/Province)

INSURED FAX NO.INSURED PHONE NO.

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (PRINT NAME)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

FIRE PROTECTION OUT OF SERVICE

PART 3 INSTRUCTIONS

RED TAG PERMIT

Fire Protection Equipment Operator: Write the date, time and number of turnsneeded to close the sprinkler control valve and fasten the Red Tag to the shutvalve.When the impairment is over reopen the valve.Perform a 2 in. drain test. Write the reopening information on this Red Tag andreturn it to the Firesafety Supervisor.If equipment is other than sprinklers, return equipment to automatic service whenthe impairment is over.Firesafety Supervisor: Retain this copy in your Wall Kit or other permanent filewhen impairment is over.

Part 3 of 3

ACTUAL DATE/TIME CLOSED

ACTUAL DATE/TIME OPEN

2 in. DRAIN TESTPERFORMED

YES NO

NO. OF TURNS TO CLOSE NO. TURNS TO OPEN

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (Signature)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

FIRE PROTECTION EQUIPMENT OPERATOR (Signature)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

FIRE PROTECTION OUT OF SERVICE

PART 3 INSTRUCTIONS

RED TAG PERMIT

Fire Protection Equipment Operator: Write the date, time and number of turnsneeded to close the sprinkler control valve and fasten the Red Tag to the shutvalve.When the impairment is over reopen the valve.Perform a 2 in. drain test. Write the reopening information on this Red Tag andreturn it to the Firesafety Supervisor.If equipment is other than sprinklers, return equipment to automatic service whenthe impairment is over.Firesafety Supervisor: Retain this copy in your Wall Kit or other permanent filewhen impairment is over.

Part 3 of 3

ACTUAL DATE/TIME CLOSED

ACTUAL DATE/TIME OPEN

2 in. DRAIN TESTPERFORMED

YES NO

NO. OF TURNS TO CLOSE NO. TURNS TO OPEN

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (Signature)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

FIRE PROTECTION EQUIPMENT OPERATOR (Signature)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

FIRE PROTECTION OUT OF SERVICE

PART 3 INSTRUCTIONS

RED TAG PERMIT

Fire Protection Equipment Operator: Write the date, time and number of turnsneeded to close the sprinkler control valve and fasten the Red Tag to the shutvalve.When the impairment is over reopen the valve.Perform a 2 in. drain test. Write the reopening information on this Red Tag andreturn it to the Firesafety Supervisor.If equipment is other than sprinklers, return equipment to automatic service whenthe impairment is over.Firesafety Supervisor: Retain this copy in your Wall Kit or other permanent filewhen impairment is over.

Part 3 of 3

ACTUAL DATE/TIME CLOSED

ACTUAL DATE/TIME OPEN

2 in. DRAIN TESTPERFORMED

YES NO

NO. OF TURNS TO CLOSE NO. TURNS TO OPEN

PRECAUTIONS TAKEN (CHECK AS APPROPRIATE)

INDEX NUMBERCONTROL NUMBER

SPRINKLER VALVE LOCATION/NUMBER

AREA PROTECTED

REASON FOR IMPAIRMENT

PLANNED DATE/TIME TO BE CLOSED

AUTHORIZED BY (Signature)

PLANNED DATE/TIME TO BE OPEN

CHECK IFSPRINKLERFIRE PUMPCO2HALONOTHER

NAME/TITLE OF RESPONSIBLE PERSON (PRINT)

FIRE PROTECTION EQUIPMENT OPERATOR (Signature)

Emergency Organization NotifiedPublic Fire Department NotifiedHazardous Operations StoppedHot Work ProhibitedSmoking RestrictedOther

Continuous Work AuthorizedOngoing Patrol of AreaHydrant Connected to Sprinkler RiserPipe Plugs on HandFire Hose Laid Out

FIREPROTECTION

OUT OFSERVICE

FIREPROTECTION

OUT OFSERVICE

FIREPROTECTION

OUT OFSERVICE