Fire Watch Request Form - Smith & Associates

Currently, Fire Watch Services are only available in the San Francisco Bay Area. If services are required outside of this area, please contact us directly at (800) 503-3812 to discuss availability and special arrangements.

We appreciate your interest and look forward to assisting you with your fire safety needs.

Date of Request *

Is this an emergency? *

Scheduling with less than 72 hours’ notice is considered an emergency.

Requestor Information

Company Name *

Contact Person *

First

Last

Contact Phone Number *

Contact Email Address *

Fire Watch Location

Site Name *

Site Address *

Address Line 1

Address Line 2

City

State

Zip Code

Briefly describe the building/floor/area.

Service Details

Start Date / Time *

Date

Time

Is there an end date/time for this request? *

How will we be notified when the activity is complete? *

End Date / Time *

Date

Time

Notifying the Fire Marshal or other parties at the end of fire watch services, including after restoration of fire protection systems, is the responsibility of the owner or their representative. This is not part of the fire watch service. Inspection records are available upon request. *

Number of Fire Watch Personnel Requested *

When fire watch is required outside or regular business hours, designated personnel will rotate duties as needed to ensure continuous coverage. The requester is responsible for determining the number of fire watch personnel required based on potential risk.

emergency? Name If

Special Instructions

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

On-Site Management Name

First

Last

On-Site Management Phone Number

Please explain the circumstances requiring Fire Watch. *

Please provide any other informational comments if needed.

Fire watch requires access to a landline or sufficient cell signal at all times. How are you requesting that fire watch communicate with emergency services? *

If Applicable Directions for Using Landline

Fire Watch personnel will perform the following duties:

Sole responsibility: Fire Watch personnel’s only duty is to monitor for fires; they will not be assigned any other duties.

Continuous patrols: Fire Watch will continually patrol the area, structure, or facility and document their patrols at least once every hour.

Immediate reporting: Fire Watch will immediately report any fire to 9 1 1 before taking any other action.

Communication: Fire Watch will notify 9-1-1 and alert building occupants of any fire by knocking on doors and loudly shouting “Fire! Evacuate the building!” while moving through the premises as safely as possible.

Are there any other Request or Fire Marshall requirements?

Emergency Response Procedures

Fire Watch personnel will immediately notify area workers of fire hazard and contact on-site management in the event of a fire or fire-related emergency.

What are the established evacuation procedures? *

Please Upload Evacuation Procedure Document(s)

Click or drag files to this area to upload. You can upload up to 3 files.

Please describe the communication method to ensure all occupants are alerted of fire related emergencies. *

Please describe the location of the on-site restroom facility. *

Restroom access code (if applicable)

Restroom key location (if applicable)

Restroom key lockbox code (if applicable)

DISCLAIMER

The undersigned acknowledges that Fire Watch Services provided by Smith & Associates Environmental Health & Safety LLC are for monitoring purposes only and do not replace the functions of fire suppression systems, emergency response, or insurance coverage. Our personnel are trained to identify hazards, report incidents, and follow emergency protocols provided by the requester, but they are not responsible for firefighting or law enforcement actions. By submitting this request, the requester agrees to assume full responsibility for compliance with all applicable fire codes and regulations. Smith & Associates Environmental Health & Safety LLC shall not be held liable for any loss, damage, injury, or claims arising from fire incidents during the watch period.

Once your service request is confirmed, our Cancellation Policy takes effect. Locally scheduled visits cancelled with less than 24-hours’ notice will be charged a minimum of 4 hours at the client’s current hourly rate. To cancel a previously scheduled service, please contact us at 510-670-0809 or admin2@smith4safety.com.

Requestor Signature *

Clear Signature

Signature of Approval Date *