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Pre-Plan Form
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Preplan
Life Hazards
Fire Protection Systems
Fire Walls
Fire Doors
Fire Alarm System
Access
Utility Shutoffs
Describe the Building
Diagram
1st Due
2nd Due
3rd Due
4th Due
Occupancy Name
Occupancy Address
Occupancy Type
Assembly
Commercial
Educational
Hazardous
Industrial
Institutional
Mercantile
Residential
Storage
Combustibility of Contents
C-1 Non-Combustible
C-2 Limited Combustibility
C-3 Combustible
C-4 Free Burning
C-5 Rapid Burning or Flash Burning
Construction Type
I - Fire Resistive
II - Non-combustible
III - Ordinary
IV - Heavy Timber
V - Wood Frame
Light weight wood truss
Life Hazards
Hazards To Firefighters:
Civilian Life Hazards:
Fire Flow Requirements:
100% Involvement:
GPM
50% Involvement:
GPM
Hydrants
Number
Distance From Building
Feet
Feet
Feet
Feet
Feet
Flow
GPM
GPM
GPM
GPM
GPM
Fire Protection Systems
Sprinklers
Yes
Yes but only part of bldg.
No
Where is the Fire Department connection?
Where are the sprinkler valves
Is there a fire pump?
Yes
No
If yes who controls it?
From where is it controlled?
Fire Walls
Yes
No
Where are they?
What are they made of?
How thick are they?
What are the fire walls rated?
Are they violated
Yes
No
If violated where and how?
Fire Doors
Where are they?
How do they operate
How are they rated?
Are they likely to be blocked open?
Yes
No
Are any fire doors automatic with a potential for closing and trapping firefighters?
Yes
No
Fire Alarm System
Yes
No
If yes, where is the control panel?
Types of alarm activation system?
Pull Alarms
Smoke Detectors
Heat Detectors
Water Flow switch
Tamper Switch
Flame Detectors
Access
Are there problems with access by either personnel or apparatus? If so, describe and suggest solutions.
What is the best way to access the roof?
What is the best way to access the attic?
Is there a basement?
Yes
No
If yes, what is the best way to access?
Utility Shutoffs
Electric
GPU
Other
Where is the meter?
Where is the breaker box?
water
Gas
Natural
Propane
Where is the shutoff?
Describe the building
Primary Contact
Name
Address
Business Phone
Home Phone
Cell Phone
Pager
Secondary Contact
Name
Address
Business Phone
Home Phone
Cell Phone
Pager
Diagram
prepared by:
Date:
Officer
Firefighter
Firefighter
Firefighter
working...
Name:
Address:
City:
State:
Zip:
Notes:
Icon:
Attachments: (limited to 6 jpg images per location)
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