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In emergencies, detailed planning is paramount, and the Fire Department Pre Plan form serves as a crucial tool in the formulation of such plans. This comprehensive document collects vital information spanning various categories, including facility identification, contact information for key personnel, occupancy details, and specifics about the physical structure of the premises. It meticulously outlines the building's construction class, roof type, access points, and critical infrastructure, enabling first responders to strategize effectively before arriving on the scene. The form also delves into occupancy specifics, detailing the presence of individuals—adults, children, the elderly, and those with special needs—thus prioritizing human safety. Moreover, response strategies are further enhanced through details on water supply, fire access routes, and emergency assembly points. For facilities housing hazardous materials, the form meticulously records chemical names, locations, quantities, and associated risks. The inclusion of diagrams and maps augments this wealth of information, providing a visual overview that is indispensable for emergency preparedness. By capturing a broad spectrum of information, from structural details to human elements and hazard materials, the Fire Department Pre Plan form equips fire departments with a robust framework to tackle emergencies with informed precision.

Preview - Fire Department Pre Plan Form

______________________________ Fire Department

_____________________________________________

__________________, IN ______________

Facility Name:______________________________________ Facility Number: _________

Diagrams, Maps: _______________________________________________________________

******************************* Contact Information *******************************

Address: ______________________________ City: _____________ State: ___ Zip: ________

Manager:

_______________________

Business Phone:

(___) ____-_______

Emergency Phone (1): (___) ____-_______

Emergency Phone (2): (___) ____-_______

2nd Contact:

_______________________

Business Phone:

(___) ____-_______

Emergency Phone (1): (___) ____-_______

Emergency Phone (2): (___) ____-_______

3rd Contact:

_______________________

Business Phone:

(___) ____-_______

Emergency Phone (1): (___) ____-_______

Emergency Phone (2): (___) ____-_______

Alarm Company: ___________________________ Phone: (____) ____-______

Notes: _______________________________________________________________________

_____________________________________________________________________________

******************************* Occupancy ***************************************

Business: ___

Industry: ___

Notes: __________________________________________

Single Family: ___

Multi Family: ___

# Apartments: ___

Number of Persons:

 

 

 

 

 

Adults:_____

 

Children: _____

Elderly: _____

Special Needs Persons: _____

Notes: __________________________________________

Special Needs Locations:

______________________________________________________

Employee/Resident Assembly Location:

__________________________________________

Evacuation Location (1):

______________________________________________________

Evacuation Location (2):

______________________________________________________

Transportation Needs:

 

______________________________________________________

________________________________________________________________________

Notes: ________________________________________________________________________

________________________________________________________________________

******************************* Structure Information *****************************

Construction Class:

____________

Roof Type:

__________________

Number of Stories:

____________

Roof Covering:

__________________

Length, Width, Height:

____________

Building Classification: _________________

Structure Notes: ________________________________________________________________

______________________________________________________________________________

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******************************* Fire Access Information ***************************

Main Access:

____________________________________________________________

Secondary Access:

____________________________________________________________

Roof Access:

____________________________________________________________

Attic Access:

____________________________________________________________

Basement:

____________________________________________________________

Lowest Access:

____________________________________________________________

Lock Box:

____________________________________________________________

Alarm Panel:

____________________________________________________________

Annunciator Panel:

____________________________________________________________

Notes: _______________________________________________________________________

_____________________________________________________________________________

******************************* Response Information ******************************

Primary Staging:

____________________________________________________________

Secondary Staging:

____________________________________________________________

******************************* Water Supply Information**************************

Hydrant-1 ______________________________________________________________

Volume (GPM)

________

Main Size:

_____

Status: ______________

Notes: _______________________________________________________________________

_____________________________________________________________________________

Hydrant-2 ______________________________________________________________

Volume (GPM)

________

Main Size:

_____

Status: ______________

Notes: _______________________________________________________________________

_____________________________________________________________________________

Hydrant-3 ______________________________________________________________

Volume (GPM) ________ Main Size: _____ Status: ______________

Notes: _______________________________________________________________________

_____________________________________________________________________________

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Alt Supply-1: ______________________________________________________________

Volume (GPM) ________ Main Size: _____ Status: ______________

Notes: _______________________________________________________________________

_____________________________________________________________________________

Alt Supply-2 ______________________________________________________________

Volume (GPM) ________ Main Size: _____ Status: ______________

Notes: _______________________________________________________________________

_____________________________________________________________________________

******************************* Protection Information *****************************

 

Yes/No

Special Notes

Sprinklers:

_____

_______________________________________________

Spare Heads:

_____

_______________________________________________

FD Connection:

_____

_______________________________________________

Stand Pipe:

_____

_______________________________________________

Gas Shutoff:

_____

_______________________________________________

Electrical Shutoff:

_____

_______________________________________________

Water Shutoff:

_____

_______________________________________________

Notes: _______________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

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Page 3 of 6

******************************* HAZMAT ****************************************

Chemical Name:

___________________________________________________________

Location:

 

___________________________________________________________

Quantity:

_____________ Gallons/Pounds

 

Flammable:

____

Toxic: ____

Corrosive: ____

Oxidizer: ____

UN #: _____

Guide # _____

 

 

NFPA 704:

Fire __ Health __ Reactivity __ Special _________

Chemical Name:

___________________________________________________________

Location:

 

___________________________________________________________

Quantity:

_____________ Gallons/Pounds

 

Flammable:

____

Toxic: ____

Corrosive: ____

Oxidizer: ____

UN #: _____

Guide # _____

 

 

NFPA 704:

Fire __ Health __ Reactivity __ Special _________

Chemical Name:

___________________________________________________________

Location:

 

___________________________________________________________

Quantity:

_____________ Gallons/Pounds

 

Flammable:

____

Toxic: ____

Corrosive: ____

Oxidizer: ____

UN #: _____

Guide # _____

 

 

NFPA 704:

Fire __ Health __ Reactivity __ Special _________

Chemical Name:

___________________________________________________________

Location:

 

___________________________________________________________

Quantity:

_____________ Gallons/Pounds

 

Flammable:

____

Toxic: ____

Corrosive: ____

Oxidizer: ____

UN #: _____

Guide # _____

 

 

NFPA 704:

Fire __ Health __ Reactivity __ Special _________

Copy this sheet and attach as many as necessary

http://www.henrycoema.org/forms/FDPreplanTemplate.pdf

Page 4 of 6

Basic Site Plan

http://www.henrycoema.org/forms/FDPreplanTemplate.pdf

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Basic Floor Plan,

____ Floor

 

 

 

 

Make as many copies as necessary

http://www.henrycoema.org/forms/FDPreplanTemplate.pdf

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Form Data

Fact Detail
Form Usage This form is designed for use by the fire department for pre-planning in case of an emergency.
State-Specific The form example is specific to Indiana (IN).
Facility Information Includes name, number, and location of the facility, alongside diagrams and maps.
Contact Information Lists up to three contacts with business and emergency phone numbers, and contact information for the alarm company.
Occupancy Details Details about the type of occupancy, number of persons (adults, children, elderly, special needs), and notes on special needs locations and evacuation plans.
Structure Information Includes construction class, roof type and covering, building classification, and detailed structure notes.
Protection Information Indicates whether the facility has sprinklers, spare heads, FD connection, standpipe, and shutoffs for gas, electrical, and water, with space for special notes.

Instructions on Utilizing Fire Department Pre Plan

Filling out the Fire Department Pre Plan form is a crucial step in ensuring the safety and preparedness of a location in case of emergency. This form helps organize vital information that fire departments need to respond effectively. To make this process smoother, follow these step-by-step instructions.

  1. Start with the Fire Department section at the top of the form. Enter the name of the fire department that will handle emergencies at the facility.
  2. Fill in the Facility Name and Facility Number fields to identify the facility or building.
  3. In the Diagrams, Maps section, list any documents that provide visual layouts of the facility, including where these documents can be found.
  4. Move on to the Contact Information section. Provide the address, city, state, and zip code of the facility.
  5. Enter the Manager's name and both their business and emergency phone numbers. Repeat this step for the 2nd and 3rd contacts.
  6. Document the Alarm Company's name and phone number, along with any relevant notes regarding alarm or security systems.
  7. Under Occupancy, mark the applicable category (Business, Industry, Single Family, Multi Family) and fill in details such as the number of apartments and occupants. Also, note any special needs persons and their locations.
  8. Indicate the assembly and evacuation locations for employees or residents, including any special transportation needs.
  9. For the Structure Information section, specify the construction class, roof type, number of stories, and building classification. Include dimensions and any pertinent structure notes.
  10. Detail the Fire Access Information, including main, secondary, roof, attic, and basement access points. Mention any lock box or alarm panel details.
  11. The Response Information section is for noting primary and secondary staging areas for emergency responders.
  12. Under Water Supply Information, list the locations and details of available hydrants and alternative water supplies.
  13. In the Protection Information area, indicate whether the facility has sprinklers, spare heads, fire department connections, standpipes, and shutoffs for gas, electrical, and water. Include any special notes.
  14. For facilities with hazardous materials, fill out the HAZMAT section. List chemical names, locations, quantities, properties, UN numbers, guide numbers, and NFPA 704 ratings. Attach additional sheets if necessary.
  15. Finally, include a basic site plan that outlines all the relevant information mentioned above. This can often be done on the last page or attached as a separate document.

Once the form is fully completed, review all the information to ensure accuracy and completeness. This document is a vital tool for emergency response teams, making it essential to fill out with care and precision. Once reviewed, submit the form to the appropriate fire department or emergency services office.

Obtain Answers on Fire Department Pre Plan

  1. What is a Fire Department Pre Plan form?

    A Fire Department Pre Plan form is a document used by fire departments to gather crucial information about a facility. This information includes contact details, building layout, occupancy characteristics, access points for firefighters, water supply, fire protection systems, hazardous materials on site, and other critical details that can help in planning and responding to an emergency.

  2. Why is it important to complete a Fire Department Pre Plan form?

    Completing a Fire Department Pre Plan form is vital as it equips fire departments with necessary knowledge about a facility before an emergency occurs. This proactive approach can significantly enhance the effectiveness of firefighting efforts, potentially save lives, reduce damage, and ensure a quicker, more coordinated response during emergencies.

  3. Who should complete the Fire Department Pre Plan form?

    The responsibility generally falls on the property manager or the owner of the facility. However, in collaboration with the local fire department officials, team members knowledgeable about the facility's specifics, such as safety officers or maintenance supervisors, can also contribute to ensuring that the form is accurately filled out.

  4. What information is needed to fill out the form?

    The form requires a range of information, including but not limited to:

    • Facility name and contact information
    • Diagrams or maps of the facility layout
    • Details about the building's structure and occupancy
    • Information about fire access points and water supply
    • Fire protection systems in place
    • Details regarding any hazardous materials located at the facility

  5. How often should the Fire Department Pre Plan form be updated?

    It's recommended to review and update the form at least annually or anytime significant changes occur within the facility that could affect emergency response, such as structural renovations, occupancy changes, or updates in fire protection systems or hazardous materials storage.

  6. How can one acquire a Fire Department Pre Plan form?

    The form can usually be obtained from the local fire department. Some fire departments may also offer the forms on their websites. It's advisable to contact your local fire department directly for the most relevant form and guidance on how to complete it.

  7. Is there a standard format for the Fire Department Pre Plan form, or does it vary?

    While the core elements of the Fire Department Pre Plan form tend to be consistent, focusing on gathering comprehensive safety and planning information, the format can vary from one fire department to another. Always use the form and follow the guidelines provided by your local fire department.

  8. Who has access to the information provided in the Fire Department Pre Plan form?

    The information on the form is generally accessible to the fire department personnel and other emergency response teams. It’s used to plan and respond to incidents effectively. The distribution and access to this sensitive information are managed carefully to ensure privacy and security, respecting the facility's operational confidentiality.

Common mistakes

Filling out the Fire Department Pre Plan form is a critical task that involves detailed accuracy to ensure the safety and efficient response in emergency situations. While the process is straightforward, certain common mistakes can limit its effectiveness. Understanding and avoiding these mistakes can significantly improve emergency response efforts.

  1. Not updating contact information: It’s crucial to regularly update the contact information. Changes in staff or emergency contacts can happen frequently, and outdated information can delay response times in emergencies.

  2. Incomplete diagrams or maps: Failing to provide comprehensive diagrams or maps of the facility can hinder the fire department's ability to navigate the premises quickly. This includes not indicating key locations like fire hydrants, main access points, and hazardous material storage.

  3. Overlooking special needs individuals: Not clearly stating the number and location of special needs persons within the facility is a critical oversight. This information is essential for executing a more focused and efficient evacuation strategy.

  4. Incorrectly marked locations for utilities shutoff: Gas, electrical, and water shutoffs are pivotal during a fire. Mislabeling or failing to mark these can prevent or delay crucial mitigation steps by the responding team.

  5. Omitting details about hazardous materials (HAZMAT): The presence of hazardous materials demands precise detailing about their locations, quantities, and specific handling instructions. Neglecting this section or providing incomplete information can dramatically increase the risk to both the fire personnel and the property.

  6. Not specifying water supply information: Adequate information about the water supply, including hydrants' locations and their flow rates, is indispensable for firefighting efforts. Inaccurate or missing information may lead to delays in establishing a water supply during firefighting operations.

Understanding and addressing these common mistakes can significantly contribute to the safety and well-being of everyone involved. Properly completed Fire Department Pre Plan forms ensure that during an emergency, responders have the most accurate and up-to-date information to help them respond effectively and efficiently.

Documents used along the form

When preparing a Fire Department Pre-Plan form, it's essential to gather and prepare other documentation that helps in understanding the facility, its hazards, and its procedures. These additional documents ensure a comprehensive approach to emergency planning, providing first responders with crucial details that could save time and lives in the event of an incident.

  • Emergency Action Plan (EAP): This document outlines the actions that employees and occupants should take in an emergency situation. It includes evacuation procedures, roles and responsibilities, and how to report emergencies. Having an EAP ensures that everyone knows what to do, making the site safer for both occupants and responders.
  • Building Layouts and Site Plans: Detailed plans of the building layout and site provide first responders with a visual guide to the facility's structure, entry and exit points, stairwells, and key areas like electrical rooms or hazardous material storage. This aids in strategic planning and helps responders navigate the site more effectively during an emergency.
  • Hazardous Material Inventory: Although the Fire Department Pre-Plan includes a section for hazardous materials, a comprehensive inventory provides more detailed information on all hazardous substances in the facility, including their locations, quantities, and specific handling instructions. This is crucial for preparing for potential HAZMAT incidents.
  • Contact List: A detailed list of all critical contacts, including facility managers, security personnel, and local emergency services, is important for effective communication during an emergency. This list goes beyond the basic contact information in the Pre-Plan form, ensuring that responders can quickly get in touch with key personnel who have in-depth knowledge of the facility.

Combining the Fire Department Pre-Plan form with these documents creates a robust emergency response plan. It equips fire departments and emergency responders with a thorough understanding of the facility, streamlining their response efforts and ultimately helping to protect lives and property.

Similar forms

  • Emergency Action Plans (EAPs): Like the Fire Department Pre Plan form, Emergency Action Plans are used to prepare for different types of emergencies within workplaces or public buildings. EAPs also include evacuation procedures, contact information, and special instructions for individuals with disabilities, mirroring the structure and intent of a Pre Plan form to ensure safety and preparedness.

  • Building Floor Plans: These documents resemble the diagrams and basic site plan sections of the Fire Department Pre Plan form by providing detailed layouts of a building. They mark critical locations such as exits, stairwells, and potentially hazardous areas, crucial for both emergency responders and occupants during an evacuation or other emergency situation.

  • Business Continuity Plans (BCPs): BCPs are designed to ensure that critical business functions continue during and after a disaster, similar to how Pre Plan forms ensure a building's safety aspects are addressed and planned for in advance. Although BCPs focus more on the operational aspects post-event, both documents share the goal of minimizing disruption and harm.

  • Hazardous Material Inventories: This documentation, often required by regulations, lists all hazardous materials on-site, their quantities, and locations, directly paralleling the HAZMAT section of the Pre Plan form. Such inventories are critical for emergency responders to know what they might encounter, impacting their strategy for addressing a fire or spill.

  • Incident Command System (ICS) Forms: ICS forms are utilized during emergency response operations to manage resources, strategies, and safety, similar to the response information and water supply information sections in the Pre Plan. Although used actively during incidents, ICS forms share the objective of pre-planning and responding effectively to emergencies with Fire Department Pre Plan forms.

Dos and Don'ts

When filling out the Fire Department Pre Plan form, there are several important dos and don'ts to remember. These guidelines are crucial for ensuring accurate and useful information is provided, aiding in the event of an emergency. Below are lists of things you should and shouldn't do:

What You Should Do:

  • Provide complete and accurate contact information: It's crucial to ensure that all contact details, including emergency phone numbers, are current and correct. This allows the fire department to quickly get in touch with key personnel in case of an incident.
  • Include detailed diagrams and maps: A comprehensive site plan, including locations of hydrants, gas, and electrical shutoffs, can significantly aid firefighting efforts. Make sure these are up to date and as detailed as possible.
  • Clearly identify hazardous material locations: For facilities storing hazardous materials, it is essential to clearly mark the storage locations and provide proper identification, including chemical names and quantities. This information assists in planning the appropriate emergency response.
  • Update the form regularly: Periodically review and update the form to reflect any changes in contact information, building layout, or hazardous materials on site. Regular updates help maintain the usefulness of the pre-plan in dynamic operational environments.

What You Shouldn't Do:

  • Omit sections of the form: Even if certain sections seem irrelevant, it's important to review and fill out the entire form. If a section truly does not apply, note it as such. Incomplete forms can lead to misunderstandings or delays during an emergency.
  • Use technical jargon without explanation: Avoid using industry-specific terms or acronyms that may not be widely understood by all emergency responders. If you must use them, provide clear definitions to ensure clarity.
  • Forget to specify locations for special needs occupants: Failing to identify areas where individuals with special needs are located can hamper rescue operations. It's important to include this information to ensure everyone's safety.
  • Assume one-time completion is enough: A common mistake is treating the Fire Department Pre Plan form as a "fill it and forget it" document. Changes in facility operations, personnel, or structure necessitate updates to ensure the information remains relevant and actionable in an emergency.

Misconceptions

There exist several common misunderstandings about the Fire Department Pre Plan form that can impede its effectiveness in emergency situations. By examining these misconceptions, facilities and first responders can enhance their preparedness and response strategies.

  • All facilities are required to submit a Fire Department Pre Plan form. While recommended, not every jurisdiction mandates the submission of these forms. Their requirement often depends on local fire codes and the nature of the business or establishment.
  • The form is only for large or high-risk facilities. This belief underestimates the utility of the Pre Plan form for a range of facilities, including small businesses, schools, apartment buildings, and single-family homes. Any location can benefit from having a comprehensive emergency plan in place.
  • Submitting the form once is sufficient. Fire Department Pre Plan forms need regular updates to reflect any changes in occupancy, structure, hazard materials, or contact information. Regular reviews ensure that the information remains current and accurate.
  • It's the sole responsibility of the fire department to fill out these forms. While the fire department often takes an active role in assisting with or reviewing these plans, it is typically the responsibility of the facility owner or manager to provide the initial details and ensure their accuracy.
  • The form is too complicated to complete. Although the form covers various information categories, its design aims to be comprehensive yet straightforward. Most sections are self-explanatory, and assistance from the fire department is usually available.
  • Information on the form is only used in case of a fire. The reality is that the details provided can be crucial in a variety of emergency situations, including natural disasters, hazardous material spills, and other crises requiring evacuation or special response strategies.
  • Digital submission of the Pre Plan form is universally accepted. While some fire departments have moved towards digital submissions, others still rely on physical documents. Always confirm with the local fire department regarding the preferred method of submission.

Dispelling these misconceptions about the Fire Department Pre Plan form is vital for improving the safety and preparedness of communities. Stakeholders should engage with local fire prevention and preparedness officials to ensure their plans are comprehensive, current, and effectively communicated.

Key takeaways

When it comes to preparing for emergencies, the Fire Department Pre Plan form plays a crucial role in ensuring the safety and readiness of both first responders and the community. It's more than just a form; it's a comprehensive tool that outlines vital information about a facility's layout, occupants, and hazards. Here are key takeaways about filling out and using this form effectively:

  • Accurate and Detailed Information: It's imperative to provide precise and detailed information about the facility, including address, contacts, and structural details. This ensures first responders have a clear understanding of the site before arriving.
  • Inclusion of Diagrams and Maps: Diagrams and maps are essential for visualizing the structure's layout, especially during emergencies. These should clearly mark exits, hydrants, and hazardous material locations, facilitating quicker response times and decision-making.
  • Contact Information: The form requires multiple contact persons for a reason. Emergencies can happen at any time, and having more than one contact ensures that the fire department can reach someone familiar with the facility around the clock.
  • Understanding the Occupancy: Detailing the type of occupancy (e.g., business, industry, residential) and the number of people (including adults, children, elderly, and special needs persons) in the building is crucial for preparing appropriate evacuation and rescue plans.
  • Structural Details Matter: Knowing the construction class, roof type, and other structural details helps fire departments anticipate and mitigate possible challenges they might face during operations.
  • Access Points and Water Supply Information: Clearly identifying access points for firefighters and providing details about water supply, including alternative sources, ensures that response efforts are not hampered by logistical issues.
  • HAZMAT Information: If the facility houses hazardous materials, accurately listing their names, locations, quantities, and associated risks (flammable, toxic, corrosive, etc.) is crucial. This information helps in planning the safest approach to handling these materials during emergencies.

In conclusion, completing the Fire Department Pre Plan form with attention to detail and accuracy not only ensures the safety of the facility but also supports the efficiency and effectiveness of first responders in emergency situations. It's a pivotal step in emergency preparedness that should be updated regularly to reflect any changes in occupancy, structure, or hazards.

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