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The Fire Department Pre Plan form serves as a crucial tool for emergency preparedness and response. It captures essential information about a facility, including its name, address, and contact details for key personnel. The form also requires diagrams and maps to illustrate the layout of the building, aiding firefighters in navigating the premises during emergencies. Occupancy details are outlined, specifying the type of business or residence and the number of individuals present, including those with special needs. Furthermore, the form addresses structural information, such as construction type, roof characteristics, and access points, ensuring that firefighters have a comprehensive understanding of the building's design. Water supply information is meticulously documented, detailing the location and status of hydrants and alternative water sources. Protection systems like sprinklers and standpipes are also noted, along with any hazardous materials present on-site, including their quantities and classifications. Overall, the Fire Department Pre Plan form is designed to enhance safety and efficiency during emergency situations, providing first responders with the critical data they need to act swiftly and effectively.

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: ________________________________________________________________

______________________________________________________________________________

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

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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: _______________________________________________________________________

_____________________________________________________________________________

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

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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: _______________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

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

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

Page 5 of 6

Basic Floor Plan,

____ Floor

 

 

 

 

Make as many copies as necessary

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

Page 6 of 6

Document Specifics

Fact Name Description
Purpose The Fire Department Pre Plan form is designed to provide essential information about a facility to aid in emergency response planning.
Facility Identification Each form includes fields for the facility name and number, ensuring accurate identification during emergencies.
Contact Information It collects detailed contact information for key personnel, including managers and emergency contacts, to facilitate communication.
Occupancy Details The form requires information about the type of occupancy, number of residents, and special needs, which helps in planning evacuations.
Structure Information Details about the building's construction class, roof type, and dimensions are included to assist firefighters in understanding the structure.
Water Supply Information on hydrants and alternative water supplies is documented, ensuring that responders know where to access water during a fire.
Protection Systems The form outlines existing fire protection systems, such as sprinklers and standpipes, which are critical for effective firefighting.
HAZMAT Information It includes sections for hazardous materials, detailing their types, quantities, and locations to inform responders of potential risks.

Fire Department Pre Plan: Usage Instruction

Completing the Fire Department Pre Plan form is essential for ensuring safety and preparedness in case of emergencies. This document gathers critical information about your facility, including contact details, occupancy specifics, structure information, and emergency access points. Following these steps will help you fill out the form accurately.

  1. Begin by entering the Fire Department name and the location (city and state) at the top of the form.
  2. Fill in the Facility Name and Facility Number in the designated spaces.
  3. Provide Diagrams and Maps if available, as this information can be crucial for emergency responders.
  4. Complete the Contact Information section, including the address, city, state, and zip code. Add the manager's name and both business and emergency phone numbers for up to three contacts.
  5. In the Occupancy section, indicate the type of business or industry and provide additional details about the facility's occupants, including the number of adults, children, elderly, and individuals with special needs.
  6. Identify the Employee/Resident Assembly Location and list two Evacuation Locations.
  7. Detail any Transportation Needs and add relevant notes.
  8. In the Structure Information section, specify the construction class, roof type, number of stories, roof covering, and dimensions of the building.
  9. Provide details about Fire Access, including main and secondary access points, attic and basement access, and any lock boxes or alarm panels.
  10. Complete the Response Information by indicating primary and secondary staging areas.
  11. Fill in the Water Supply Information for up to three hydrants and alternative water supplies, including their volume, main size, and status.
  12. In the Protection Information section, indicate whether certain systems are in place, such as sprinklers and shutoff valves, and provide any special notes.
  13. For HAZMAT information, list any chemicals present, their locations, quantities, and relevant safety classifications.
  14. Finally, review the form for completeness and accuracy before submitting it.

Learn More on Fire Department Pre Plan

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 assist emergency responders during a fire or other emergency situations. It includes details about the building's layout, occupancy, access points, and any hazardous materials present. This information helps ensure a coordinated and effective response, enhancing safety for both occupants and responders.

Who should complete the Fire Department Pre Plan form?

The form should be completed by facility managers or designated personnel responsible for safety and emergency preparedness. It is important that the information provided is accurate and up-to-date to facilitate effective communication with emergency services.

How often should the Pre Plan form be updated?

The Pre Plan form should be reviewed and updated regularly, ideally every year or whenever significant changes occur within the facility. Changes may include renovations, modifications to occupancy, or the introduction of new hazardous materials. Regular updates ensure that emergency responders have the most current information available.

What information is required on the form?

The form requires various details, including:

  • Facility name and contact information
  • Occupancy details, including the number of occupants and any special needs
  • Structure information, such as construction type and dimensions
  • Fire access information, including main and secondary access points
  • Water supply information, detailing hydrants and their status
  • Protection information, such as sprinkler systems and shutoff locations
  • Hazardous materials present on-site

Providing complete and accurate information in these areas is crucial for effective emergency response.

How is the information on the Pre Plan form used by emergency responders?

Emergency responders use the information from the Pre Plan form to assess risks and develop strategies for addressing potential emergencies. Knowing the layout of the building, locations of hazardous materials, and evacuation routes allows responders to act quickly and efficiently, ultimately protecting lives and property.

Where should the completed Pre Plan form be submitted?

The completed Pre Plan form should be submitted to the local fire department. It is advisable to keep a copy on-site and provide copies to all relevant personnel within the facility to ensure everyone is informed and prepared.

What should I do if I have questions while filling out the form?

If you have questions while completing the Pre Plan form, it is recommended to reach out to your local fire department for guidance. They can provide assistance and clarification on specific sections of the form, ensuring that all necessary information is accurately captured.

Common mistakes

Completing the Fire Department Pre Plan form accurately is crucial for ensuring safety and effective emergency response. However, many individuals make common mistakes that can hinder this process. One frequent error is the omission of critical contact information. Failing to provide complete details for the facility manager and emergency contacts can delay response times during emergencies. Accurate phone numbers and addresses are essential for first responders to reach the right individuals without unnecessary complications.

Another common mistake involves inadequate descriptions of the facility's structure and occupancy. Many people neglect to specify the number of stories, construction class, and roof type. This information is vital for firefighters to assess risks and strategize their approach. Additionally, misrepresenting the occupancy details, such as the number of residents or special needs individuals, can lead to confusion during an emergency. Each detail contributes to a clearer understanding of the environment that responders will face.

Inaccuracies in water supply information are also prevalent. Individuals often provide incomplete or incorrect details about hydrants and alternative water sources. For instance, failing to note the volume of water available or the status of hydrants can significantly impact firefighting efforts. Firefighters rely on this information to determine how quickly they can access water and how much is available to combat a fire effectively.

Lastly, neglecting to update the form regularly can lead to serious issues. Facilities may undergo changes, such as renovations or alterations in occupancy, that require updates to the Pre Plan form. Keeping this document current ensures that first responders have the most relevant information available. Regular reviews and updates can prevent miscommunication and enhance overall safety.

Documents used along the form

When preparing for emergencies, having the right documentation is crucial. The Fire Department Pre Plan form serves as a vital resource, but it is often complemented by several other forms and documents. These additional materials help ensure a comprehensive understanding of the facility, its hazards, and the necessary response protocols.

  • Emergency Action Plan: This document outlines the procedures for responding to various emergencies, including evacuation routes and communication strategies.
  • Site Map: A detailed map of the facility that highlights key areas such as exits, fire extinguishers, and hazardous materials storage.
  • Hazardous Materials Inventory: A list of all hazardous substances present on the premises, including their locations and safety data sheets.
  • Fire Safety Inspection Report: A record of the most recent fire safety inspection, detailing compliance with fire codes and any identified deficiencies.
  • Employee Training Records: Documentation of fire safety training sessions attended by employees, including dates and topics covered.
  • Building Plans: Architectural drawings that provide structural details of the facility, essential for understanding potential fire spread and access points.
  • Fire Alarm System Inspection Report: A report confirming that the fire alarm system has been tested and is functioning properly, including any maintenance performed.
  • Emergency Contact List: A current list of key personnel, including their roles and contact information for quick communication during emergencies.
  • Fire Department Response Plan: A document that outlines the specific procedures the fire department will follow when responding to incidents at the facility.
  • Maintenance Logs: Records of all maintenance performed on fire safety equipment, ensuring that everything is up to code and operational.

Each of these documents plays a significant role in enhancing safety and preparedness. By maintaining and regularly updating these forms, businesses can ensure a swift and effective response to any fire-related incidents.

Similar forms

The Emergency Action Plan (EAP) serves as a crucial document for organizations to outline procedures in the event of an emergency. Similar to the Fire Department Pre Plan form, the EAP identifies emergency contacts and outlines evacuation routes, ensuring that employees are aware of their roles during a crisis. Both documents emphasize the importance of clear communication and preparedness, enabling organizations to respond effectively to emergencies and minimize risks to personnel and property.

The Hazardous Materials Inventory is another document that shares similarities with the Fire Department Pre Plan form. This inventory provides a detailed account of hazardous materials present on-site, including their locations and quantities. Like the pre-plan, it highlights the need for first responders to be informed about potential dangers, thereby facilitating a safer and more efficient response during incidents involving hazardous substances.

The Site Safety Plan (SSP) focuses on maintaining safety standards during construction or renovation projects. This document outlines safety protocols, emergency contacts, and evacuation routes, paralleling the Fire Department Pre Plan form in its commitment to protecting individuals on-site. Both documents serve as vital resources for ensuring that all personnel are aware of safety measures and emergency procedures, ultimately fostering a culture of safety within the organization.

The Building Evacuation Plan is designed to provide clear instructions on how to safely exit a building during an emergency. Similar to the Fire Department Pre Plan form, this plan includes designated evacuation routes and assembly points. It ensures that all occupants are informed about the safest methods for exiting the premises, thereby reducing confusion and enhancing safety during emergencies.

The Fire Safety Plan outlines the strategies and measures in place to prevent and respond to fire incidents. This document shares the same goal as the Fire Department Pre Plan form: to ensure the safety of individuals in the event of a fire. Both documents detail fire prevention measures, emergency contacts, and evacuation procedures, highlighting the importance of preparedness in mitigating fire-related risks.

The Business Continuity Plan (BCP) is essential for organizations to maintain operations during and after a crisis. This plan, like the Fire Department Pre Plan form, emphasizes the importance of clear communication and designated contacts. Both documents aim to ensure that organizations can quickly adapt to emergencies, minimizing disruptions and safeguarding employees and assets.

The Incident Command System (ICS) is a standardized approach used by emergency responders to manage incidents effectively. The ICS shares similarities with the Fire Department Pre Plan form in its emphasis on clear roles and responsibilities during emergencies. Both documents facilitate coordinated responses, ensuring that all personnel understand their duties and can work together efficiently to address incidents.

The Risk Management Plan identifies potential risks and outlines strategies to mitigate them. This document aligns with the Fire Department Pre Plan form by focusing on preparedness and safety. Both documents aim to protect individuals and property by identifying hazards and establishing protocols for addressing them, ultimately fostering a safer environment.

The Emergency Response Guidebook (ERG) provides essential information for first responders dealing with hazardous materials incidents. Similar to the Fire Department Pre Plan form, the ERG offers guidance on how to respond effectively to various emergencies. Both documents prioritize safety and preparedness, ensuring that responders have the necessary information to manage incidents safely and efficiently.

Dos and Don'ts

When filling out the Fire Department Pre Plan form, it's essential to follow specific guidelines to ensure accuracy and completeness. Here’s a list of things you should and shouldn't do:

  • Do: Provide clear and accurate contact information for all key personnel.
  • Do: Include detailed descriptions of the facility's layout and any special features.
  • Do: List all hazardous materials present, including quantities and classifications.
  • Do: Indicate all access points, including main and secondary routes.
  • Do: Update the form regularly to reflect any changes in the facility or operations.
  • Do: Ensure that all emergency contacts are reachable and informed about their roles.
  • Don't: Leave any sections blank; incomplete information can hinder emergency response.
  • Don't: Use vague terms; be specific about locations and materials.
  • Don't: Forget to include any special needs individuals or evacuation plans.
  • Don't: Assume that the fire department has prior knowledge of your facility.
  • Don't: Submit outdated information; always provide the most current data.
  • Don't: Overlook the importance of clear diagrams or maps for the site.

Misconceptions

Misconceptions about the Fire Department Pre Plan form can lead to misunderstandings about its purpose and importance. Here are eight common misconceptions:

  • The form is only for large facilities. Many believe that only large businesses need to complete the Pre Plan form. In reality, all facilities, regardless of size, should have a plan to ensure safety during emergencies.
  • It is a one-time requirement. Some think that once the form is filled out, it does not need to be updated. However, changes in occupancy, structure, or hazards necessitate regular updates to the Pre Plan.
  • Only the fire department uses the information. While the fire department relies on the form, it is also valuable for facility managers, employees, and emergency responders. Everyone benefits from understanding the layout and hazards of the facility.
  • Filling out the form is too complicated. Many people feel overwhelmed by the amount of information required. However, the form is designed to be straightforward, and assistance is available for those who need help.
  • The Pre Plan is only about fire hazards. Although fire safety is a primary focus, the form also addresses other emergencies, including hazardous materials and evacuation procedures, making it a comprehensive safety tool.
  • It is not necessary to include contact information. Some individuals overlook the importance of contact details. Accurate contact information is crucial for effective communication during emergencies.
  • The form is only relevant during a fire. This misconception ignores the broader scope of emergencies. The Pre Plan is essential for all types of incidents, including medical emergencies and natural disasters.
  • Only management should complete the form. While management plays a key role, input from employees and safety personnel is vital. Collaboration ensures that all perspectives are considered, leading to a more effective plan.

Key takeaways

Filling out the Fire Department Pre Plan form is essential for ensuring safety and preparedness. Here are key takeaways to keep in mind:

  • Complete All Sections: Fill out every section of the form thoroughly. Incomplete information can hinder emergency response.
  • Accurate Contact Information: Ensure that contact details are up-to-date. This includes emergency contacts and alarm company information.
  • Occupancy Details: Clearly specify the type of occupancy and the number of individuals present, including special needs persons.
  • Access Points: Identify all access points to the building. This includes main, secondary, roof, and attic access.
  • Water Supply Information: Document the locations and status of fire hydrants and alternative water supplies. This information is crucial for firefighting efforts.
  • Protection Systems: Note the presence of fire protection systems, such as sprinklers and standpipes. Include any special notes regarding their condition.
  • HAZMAT Information: If hazardous materials are present, provide detailed information about their location, quantity, and classification.

Using this form effectively can significantly improve emergency response times and enhance safety measures. Regular updates to the form are also recommended to reflect any changes in the facility or its operations.