Pre Fire Plan Template Details

The Blank Fire Department Pre Plan Form is a free, downloadable form that helps you prepare your end-of-life wishes in the event of an emergency. It's important to think about these things now before they happen so that your family doesn't have to make tough decisions on their own when it becomes too late. This document will help you decide what life support measures you want or don't want and who should be contacted in case of an emergency. The form also includes space for any special requests or notes the individual may wish to include. The blank form can be filled out at home by anyone 18 years old or older, including children with parental guidance.

Below is some data that might be useful if you are trying to find out the time it will take you to complete blank fire department pre plan form and the number of PDF pages it includes.

QuestionAnswer
Form NameBlank Fire Department Pre Plan Form
Form Length6 pages
Fillable?Yes
Fillable fields185
Avg. time to fill out38 min 30 sec
Other namesblank pre fire plan template, fire pre plan template pdf, fire department pre plan, fire pre plan checklist

Form Preview Example

______________________________ 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

Page 1 of 6

******************************* 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

Page 2 of 6

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

How to Edit Blank Fire Department Pre Plan Form

We found the top programmers to develop the PDF editor. The app will enable you to complete the fire department pre plan worksheet form simply and won't take up a great deal of your time and effort. This easy-to-follow procedure will allow you to get started.

Step 1: Find the button "Get Form Here" and press it.

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It is important to provide the following data so you can create the file:

writing  pre incident plan template stage 1

Step 3: Press the Done button to save the file. Now it is offered for export to your device.

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