Homepage Blank Fire Department Pre Plan PDF Form
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The Fire Department Pre Plan form serves as a crucial tool for ensuring safety and preparedness in emergency situations. This form collects essential information about a facility, including its name, address, and contact details for key personnel. It also provides critical data regarding the structure itself, such as construction class, number of stories, and roof type. Notably, the form includes diagrams and maps that illustrate fire access points and emergency exits, which are vital for quick and efficient response during a fire. Additionally, it outlines the occupancy details, highlighting the number of residents and any special needs individuals, ensuring that first responders can effectively plan for evacuation and assistance. Water supply information, including the location and status of hydrants, is also documented, along with any protective measures in place, such as sprinklers and shutoff systems. Furthermore, the form addresses hazardous materials present on-site, detailing their quantities and potential risks. By compiling all this information, the Fire Department Pre Plan form enhances communication and coordination between facility managers and emergency responders, ultimately contributing to a safer environment for everyone.

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______________________________ 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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******************************* 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

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Basic Site Plan

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Basic Floor Plan,

____ Floor

 

 

 

 

Make as many copies as necessary

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Form Specifications

Fact Name Description
Purpose The Fire Department Pre Plan form helps firefighters prepare for emergency responses at specific facilities.
Facility Information Includes details like facility name, number, and diagrams/maps for better navigation during emergencies.
Contact Details Captures essential contact information for the facility manager and additional contacts, ensuring quick communication.
Occupancy Details Records occupancy types, including single-family and multi-family units, along with the number of residents and special needs individuals.
Structure Information Gathers data on construction class, roof type, and building dimensions to assess potential hazards.
Fire Access Identifies main and secondary access points, roof and attic access, and lock box locations for efficient fire response.
Water Supply Details on hydrants and alternative water supplies, including their volume and status, are crucial for firefighting efforts.
Protection Features Indicates the presence of sprinklers, standpipes, and shutoff valves, enhancing safety measures during a fire response.
HAZMAT Information Records hazardous materials on-site, including quantities and properties, to inform firefighters of potential risks.
Governing Laws In Indiana, the use of this form is guided by local fire codes and regulations to ensure compliance with safety standards.

Fire Department Pre Plan: Usage Guidelines

Filling out the Fire Department Pre Plan form is an important step in ensuring safety and preparedness for your facility. Follow these steps carefully to provide all necessary information accurately.

  1. Start by entering the Fire Department name and location in the designated fields.
  2. Fill in the Facility Name and Facility Number.
  3. Attach any Diagrams or Maps that may be required.
  4. Provide your Contact Information:
    • Address
    • City
    • State
    • Zip Code
    • Manager's Name
    • Business Phone
    • Emergency Phone (1)
    • Emergency Phone (2)
  5. List a 2nd Contact with their details in the same manner as above.
  6. Repeat for a 3rd Contact.
  7. Enter the Alarm Company name and phone number.
  8. Note any additional information in the Notes section.
  9. For Occupancy, indicate the type of business or industry and any special notes.
  10. Fill in the number of Single Family or Multi Family units, including the number of apartments and persons (adults, children, elderly, special needs).
  11. Identify the Employee/Resident Assembly Location and any Evacuation Locations.
  12. Outline any Transportation Needs that may be necessary.
  13. Provide details for Structure Information, including construction class, roof type, number of stories, and dimensions.
  14. Fill in Fire Access Information for main and secondary access points, roof and attic access, and lock box details.
  15. Document Response Information for primary and secondary staging areas.
  16. For Water Supply Information, list hydrants and alternative supply sources with their respective details.
  17. Indicate the presence of Protection Information such as sprinklers, spare heads, and shutoffs.
  18. Complete the HAZMAT section with chemical names, locations, quantities, and hazard classifications.
  19. If needed, copy the HAZMAT sheet and attach additional pages.
  20. Review all entries for accuracy before submission.

Your Questions, Answered

What is the purpose of the Fire Department Pre Plan form?

The Fire Department Pre Plan form is designed to provide essential information about a facility to emergency responders. It helps firefighters and other emergency personnel understand the layout, hazards, and specific needs of a building before they arrive on the scene. This preparation can significantly enhance response times and effectiveness during emergencies, ensuring the safety of both occupants and responders.

What information is required on the form?

The form requires various details, including the facility name, contact information, occupancy type, and structural information. Additionally, it includes sections for fire access points, water supply details, protection systems, and any hazardous materials present. Each section is crucial for creating a comprehensive picture of the facility, which aids in emergency planning and response.

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

Who is responsible for completing the form?

Where should the completed form be submitted?

The completed Fire Department Pre Plan form should be submitted to the local fire department. Each jurisdiction may have its own procedures for submission, so it’s essential to check with local fire officials for specific instructions. Some departments may allow electronic submissions, while others may require a physical copy.

What should be done with the form once it is completed?

Once the Fire Department Pre Plan form is completed and submitted, it should be stored in an accessible location at the facility. It's also beneficial to keep a copy on hand for training purposes and to ensure that staff members are familiar with the emergency procedures outlined in the plan. Regular training sessions can help reinforce the information contained in the form and prepare everyone for a potential emergency.

Common mistakes

  1. Incomplete Contact Information: Failing to provide complete contact details for all relevant personnel can lead to communication issues during emergencies. Ensure that all fields for business and emergency contacts are filled out accurately.

  2. Neglecting Special Needs: Omitting information about special needs persons can hinder evacuation efforts. It is crucial to identify and document any individuals requiring assistance during emergencies.

  3. Insufficient Water Supply Details: Not detailing the water supply information, such as hydrant locations and their statuses, may delay firefighting efforts. Make sure to include all relevant hydrant data and alternative water sources.

  4. Overlooking Evacuation Routes: Failing to specify clear evacuation locations can create confusion. Clearly outline primary and secondary evacuation routes to ensure safe exits during an emergency.

  5. Ignoring Structure Information: Inaccurate or incomplete structure information, such as the number of stories or construction class, can affect fire response strategies. Provide detailed and accurate descriptions of the facility's structure.

  6. Not Updating the Form: Using outdated information can lead to ineffective emergency responses. Regularly review and update the Pre Plan form to reflect any changes in personnel, structure, or hazards.

Documents used along the form

The Fire Department Pre Plan form is an essential document used to prepare for emergencies at a facility. It provides critical information about the building, its occupants, and emergency response protocols. Alongside this form, several other documents are commonly utilized to ensure a comprehensive emergency response strategy. Below is a list of these related forms and documents.

  • Fire Incident Report: This document details the specifics of a fire incident, including the cause, response actions taken, and outcomes. It serves as a record for future reference and analysis.
  • Emergency Action Plan: This plan outlines the procedures to follow in the event of an emergency, including evacuation routes and responsibilities of staff members.
  • Hazardous Materials Inventory: This inventory lists all hazardous materials present at a facility, including their locations and quantities, to inform emergency responders of potential risks.
  • Building Evacuation Plan: This plan provides a visual representation of evacuation routes and assembly points, ensuring all occupants know how to exit safely during an emergency.
  • Fire Safety Inspection Report: Conducted by fire safety officials, this report assesses the compliance of a facility with fire safety regulations and identifies any hazards that need addressing.
  • Training Records: Documentation of fire safety training sessions attended by employees, which ensures that staff are prepared to act in emergencies.
  • Access Control Plan: This document outlines the protocols for controlling access to the facility, particularly during emergencies, to ensure safety and security.
  • Emergency Contact List: A comprehensive list of key personnel and emergency contacts, including phone numbers and roles, to facilitate communication during a crisis.
  • Site-Specific Response Plan: Tailored to the unique characteristics of a facility, this plan details specific response strategies for various emergency scenarios.

These documents collectively enhance the effectiveness of emergency preparedness and response efforts. They ensure that all stakeholders are informed and ready to act in the event of an emergency, ultimately promoting safety and minimizing risk.

Similar forms

  • Emergency Response Plan: Similar to the Fire Department Pre Plan, this document outlines procedures for responding to emergencies, including contact information and evacuation routes.
  • Building Evacuation Plan: This plan details the evacuation routes and assembly points for occupants, much like the evacuation locations noted in the Pre Plan form.
  • Hazardous Materials Inventory: This document lists hazardous materials on-site, similar to the HAZMAT section of the Pre Plan that details chemical names and quantities.
  • Site Safety Plan: This plan identifies potential hazards at a facility and outlines safety measures, paralleling the risk assessment features of the Pre Plan.
  • Fire Safety Inspection Report: This report documents findings from fire safety inspections, akin to the protection information section in the Pre Plan.
  • Access Control Plan: This plan specifies access points for emergency responders, similar to the access information included in the Fire Department Pre Plan.
  • Utility Shutoff Procedures: This document provides instructions for shutting off utilities during emergencies, reflecting the utility shutoff information in the Pre Plan.
  • Emergency Contact List: This list includes essential contacts for emergencies, much like the multiple contact fields in the Pre Plan.
  • Fire Drill Records: These records document fire drills conducted at a facility, similar to the occupancy and safety notes in the Pre Plan.
  • Facility Maintenance Log: This log tracks maintenance activities and inspections, paralleling the structural information and notes section of the Pre Plan.

Dos and Don'ts

When filling out the Fire Department Pre Plan form, there are several important things to keep in mind to ensure accuracy and effectiveness. Below is a list of what you should and shouldn't do:

  • Do: Provide clear and accurate contact information for all relevant personnel.
  • Do: Include detailed notes regarding any special needs or unique features of the facility.
  • Do: Clearly mark all access points and emergency exits on any diagrams or maps.
  • Do: Regularly update the form to reflect any changes in the facility or personnel.
  • Don't: Leave any sections blank unless they are truly not applicable.
  • Don't: Use abbreviations or shorthand that may confuse responders.
  • Don't: Forget to include information about hazardous materials present on the premises.
  • Don't: Submit the form without reviewing it for errors or omissions.

Misconceptions

  • Misconception 1: The Fire Department Pre Plan form is only necessary for large facilities.
  • This is not true. All facilities, regardless of size, benefit from having a Pre Plan. It ensures that first responders are familiar with the layout and specific hazards of the building.

  • Misconception 2: Completing the form is a one-time task.
  • In reality, the Pre Plan should be updated regularly. Changes in occupancy, structure, or hazards necessitate revisions to keep the information current and useful.

  • Misconception 3: Only the facility manager should fill out the form.
  • While the facility manager plays a key role, input from various staff members is valuable. Different perspectives can highlight unique aspects of the facility that may be critical in an emergency.

  • Misconception 4: The form is only for fire emergencies.
  • The Pre Plan is designed to address various emergencies, including medical incidents and hazardous material spills. It provides a comprehensive overview of safety measures and resources.

  • Misconception 5: The form is too complicated to complete.
  • While it may seem daunting, the form is structured to guide users through the necessary information step by step. Assistance is often available from local fire departments to help with completion.

  • Misconception 6: Once submitted, the form is not reviewed or used.
  • This is incorrect. Fire departments actively use the information provided in the Pre Plan during training and actual responses. It serves as a vital resource for ensuring safety.

  • Misconception 7: The Pre Plan is not legally required.
  • Although specific legal requirements may vary by jurisdiction, many areas encourage or mandate the completion of Pre Plans to enhance safety and preparedness. It is always best to check local regulations.

Key takeaways

Filling out the Fire Department Pre Plan form is essential for ensuring safety and preparedness in case of an emergency. Here are some key takeaways to consider:

  • Accurate Information: Provide precise details about the facility, including the name, address, and contact information for key personnel.
  • Emergency Contacts: List multiple emergency contacts, including their business and emergency phone numbers. This ensures that help can be reached quickly.
  • Occupancy Details: Clearly outline the type of occupancy, number of occupants, and any special needs individuals. This information is crucial for emergency responders.
  • Evacuation Plans: Identify and document evacuation locations. This allows for efficient and safe evacuation during an emergency.
  • Water Supply: Include information about nearby hydrants and their capabilities. Knowing the water supply can significantly impact firefighting efforts.
  • Access Points: Detail all access points to the building, including main, secondary, and roof access. This helps firefighters navigate the premises quickly.
  • Hazardous Materials: List any hazardous materials on-site, including their quantities and classifications. This information is vital for the safety of responders.
  • Regular Updates: Keep the form updated regularly. Changes in occupancy, contact information, or hazardous materials should be reflected promptly.

By following these guidelines, you can help ensure that the Fire Department Pre Plan form serves its purpose effectively, enhancing safety and preparedness for everyone involved.