Submit a completed Fire Sprinkler Saves Form and you’ll receive a NIFSAB Challenge Coin for your submission.

Tell Us About Your Fire Sprinkler Save

Please use the following form to submit a fire sprinkler save to the Northern Illinois Fire Sprinkler Advisory Board. Your input is requested, desired and appreciated. If your browser does not support forms, Click here to download the PDF Version of this form.

Date of Fire

Time of Fire

Name of Occupancy/Building Where Fire Occurred

Address of Fire:

City

State

Zip

Brief description of incident:

How many fire sprinklers activated:

Estimated amount of money saved:

Any injuries:

Quote:

(example: "The sprinkler system did a great job. Two fire sprinklers activated, extinguished and controlled the fire prior to our arrival. No injuries. The Michael's Flower Shop was open for business the same day!" - Lt. Smith, ABC Fire Department)

Sprinkler Save Completed by:

Name *

Title

Fire Department/Organization *

Fire Department/Organization Address *

City *

State *

Zip

Email *

Fax

All “Saves” will be posted in the next edition of Fire Sprinkler Times and added to our “Saves” document available on the website and to all municipal and interested officials. If you’ve downloaded the PDF form, please submit to [email protected]

Upload Photos

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