Fire Safety Plan Template Details

Creating a fire safety plan is an important task for any business. Fortunately, there are many resources available to help businesses create a comprehensive plan that meets all regulatory requirements. The Fire Safety Plan Nyc Template is one such resource, providing businesses with everything they need to develop a comprehensive fire safety plan. The template is easy to use and can be customized to meet the specific needs of any business.

You may find information regarding the type of form you need to complete in the table. It can tell you the time it may need to finish fire safety plan nyc template, exactly what fields you need to fill in and several further specific facts.

QuestionAnswer
Form NameFire Safety Plan Nyc Template
Form Length22 pages
Fillable?No
Fillable fields0
Avg. time to fill out5 min 30 sec
Other namesinstructions fire plan, fire plan nyc sample, fill in fire safety plan forms, fire safety plan nyc

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Instructions for Fire Safety Plan, NYC Fire Department

Office Buildings 10/08

The following information should be used while preparing or revising Fire Safety Plan:

Prepare Fire Safety Plan exactly as set by the guidelines with all information as requested in the guideline.

Attach to the Fire Safety Plan:

1.Copy of the most recent Certificate of Occupancy or Temporary Certificate or Occupancy or Schedule A if building is under construction.

2.Copies of the representative floor plans including basement(s) meeting criteria as listed below.

3.Copy of riser diagram for standpipe and/or sprinkler system for the building.

4.Copies of any other supporting documents like request for variance(s).

The following are the requirements for the acceptable representative floor plans:

Submit architectural type of representative floor plans (B&W) including basement and sub-basement not larger than 11x17. Plans must be of good print quality and show the entire floor areas. Include a site plan showing frontage of the building. Locate on floor plans:

a.Partitions showing layouts of corridors.

b.Stairs with letter designations same as listed in Building Information Form.

c.Elevators/elevator banks with letter designations same as listed in Building Information Form.

d.Fire Command Station.

e.Pulls, fire warden phones.

f.Standpipe outlets.

g.Other Fire Safety Plan related items.

h.Show legend for all symbols used.

i.Indicate Northerly direction along with premise location and cross streets.

Submit complete, with all attachments Fire Safety Plan or revised Fire Safety Plan with all information for review by Fire Department. Do not submit individual sheets.

Rejected Fire Safety Plans must be resubmitted 30 days from the date of the letter of disapproval. If you require further clarification of the above instructions, please call number listed in the letter of the disapproval or 718- 999-1509. You may submit Fire Safety Plan electronically with all documents included by e-mailing to e-mail box listed in the letter of the disapproval. Currently acceptable file formats are *.doc and *.pdf.

Sheet 1 of 22 Rev.:0, 10/04/05

FIRE SAFETY PLAN AND GUIDELINES - OFFICE BUILDINGS

Purpose

To establish a method of systematic, safe and orderly evacuation of an area or building by and of its occupants in case of fire or other emergency, in the least possible time, to a safe area or by the nearest safe means of egress; also the use of such available fire appliances (including sounding of alarms) as may have been provided for the controlling or extinguishing of fire and the safeguarding of human life.

Objective

To provide proper education as part of continuing employee indoctrination and through a continuing written program for all occupants, to assure the prompt reporting of fire, the response to fire alarms as designated, and the immediate initiation of fire safety procedures to safeguard life and contain fire until the arrival of the Fire Department.

1.Building Address:_____________________________ Name of Building_____________________

Borough and Zip Code: ________________________ Telephone Number: __________________

2.Fire Safety Director

2.1Name/Job Title: _________________________________________

2.2Certificate of Fitness # and expiration date: _____________________________

2.3Regularly assigned location: _________________________________

2.4How is he/she notified when at regular location - include business or cell phone #s if applicable: ___________________________________

2.5How is he/she notified when not at regular location - include business

or cell phone #s if applicable: ____________________________________

2.6Normal working days and hours: _______________________________________

2.7Duties of Fire Safety Director – Verbatim as per Appendix A

3.Deputy Fire Safety Director

3.1Name/Job Title: _________________________________________

3.2Certificate of Fitness # and expiration date: _____________________________

3.3Regularly assigned location: _________________________________

3.4How is he/she notified when at regular location-include business or cell phone # if applicable: ___________________________________

3.5How is he/she notified when not at regular location-include business

or cell phone # if applicable: ____________________________________

3.6Normal working days and hours: _______________________________________

3.7Duties of Deputy Fire Safety Director – Verbatim as per Appendix B

4.Fire wardens and Deputy Fire Wardens. (Ref.#1)

4.1Are the names on Organizational Charts for each floor and/or tenancy (Yes/No):_______

4.2Submit typical completed Organizational Chart for Fire Drill and Evacuation assignment.

4.3Duties of Fire Wardens and Deputy Fire Wardens– Verbatim as per Appendix C

Sheet 2 of 22 Rev.:0, 10/04/05

5.Building Evacuation Supervisor

5.1Name/Job Title: _________________________________________

5.2Regularly assigned location: _________________________________________

5.4How is he/she notified when at regular location-include business or cell phone # if applicable: ___________________________________

5.5How is he/she notified when not at regular location -include business

or cell phone # if applicable: ____________________________________

5.6Normal working days and hours: _______________________________________

5.7Duties of Building Evacuation Supervisor – Verbatim as per Appendix D

6.Fire Brigade (Ref.#2)

6.1Submit a completed Organizational Chart for Fire Brigade for each shift, naming person in charge, and his/her title in the building.

6.2List standards of selection from building employees:______________________________

________________________________________________________________________

6.3How are they notified? Include business or cell phone # if applicable: ________________

6.4How are they notified when they are not at their regularly assigned locations? Include business or cell phone # if applicable: ______________________

6.5Means of responding – indicate location they go to: ______________________________

________________________________________________________________________

6.6Duties of Each member of Fire Brigade -Verbatim as per Appendix E

7.Occupant Instructions

7.1Distribution of instructions to all tenants, tenants employees and building employees- See Appendix F

8.Evacuation Drills

8.1Frequency of drills- indicate start date and frequency: ____________________________

8.2How announced: _________________________________________________________

8.3

Participation.

Who participated? __________________________________________

 

How?: __________________________________________________________________

8.4Controls and supervision: __________________________________________________

8.5Where is current record of drills kept: ________________________________________

9.Fire Command Station

9.1Location (also show location on Floor plan): ___________________________________

9.2Requirements:

9.2.1Adequate Illumination (Yes/No): ______________

9.2.2Adequate communication to mechanical equipment room, elevator control room, each floor (list devices for each location:

_______________________________________________________

_______________________________________________________

9.2.3Copy of Fire Safety Plan (Yes/No): __________________________

9.2.4Copy of Building Information Form (Yes/No): _________________

9.2.5Representative floor plans (Yes/No): _________________________

Plans must include all aspects as listed on instruction sheet (a-i).

Sheet 3 of 22 Rev.:0, 10/04/05

10.Signs

10.1Signs at elevator landing with Floor diagrams (Yes/No): ____________________

10.2Floor numbering in stair enclosure (Yes/No): ___________________

10.3Stairway identification on occupancy side of stair door (Yes/No): _________________

10.4Elevator identification– (where posted): _____________________________________

10.5Stair Re-entry– (where posted – list re-entry floors): ___________________________

_____________________________________________________________________

11.Fire Prevention and Fire Protection Program for the building – See Appendix G

12.Building Information Form – See Appendix H

13.Representative Floor Plans (architectural type,11x17 max. ,B&W ) – See Appendix I

14.Fire Safety Plan general preparation guideline– See Appendix K

15.Prepared/revised by (provide contact information): __________________________________

__________________________________________________________________________________

15.1Date prepared: _________________________

15.2Date revised: _________________________

Sheet 4 of 22 Rev.:0, 10/04/05

Appendix

A.Fire Safety Director Duties

B.Deputy Fire Safety Director Duties

C.Fire Wardens and Deputy Fire Wardens Duties and Organizational Chart for Fire Drill and Evacuation Assignment

D.Building Evacuation Supervisors Duties

E.Fire Brigade Duties, and Organizational Chart for Fire Brigade

F.Occupant Instructions

G.Fire Prevention and Fire Protection Program

H.Building Information Form

I.Representative Floor Plan

J.Evacuation Procedure

K.Fire Safety Plan

Sheet 5 of 22

Rev.:0, 10/04/05

APPENDIX

A.Fire Safety Directors Duties

1.Be familiar with the written Fire Safety Plan providing for fire drill and evacuation procedure in accordance with Fire Prevention Code.

2.Select qualified building service employees for a Fire Brigade and organize, train and supervise such Fire Brigade.

3.Be responsible for the availability and state of readiness of the Fire Brigade.

4.Conduct fire and evacuation drills.

5.Be responsible for the designation and training of a Fire Warden for each floor, and sufficient Deputy Fire Wardens for each tenancy in accordance with Fire Department rules.

6.Be responsible for a daily check for the availability of the Fire Warden and Deputy Fire Warden, and see that up-to-date organizational charts are posted.

NOTE- If the number of Fire Wardens and Deputy Fire Wardens in the building is such that it is impractical in individually contact each one daily, a suggested method to satisfy the requirement is to make provisions for the Fire Warden, or a Deputy Fire Warden, in the absence of the Fire Warden, to notify the Fire Safety Director when the Fire Warden, or required number of Deputy Fire Wardens are not available. In order to determine the compliance by the Fire Warden and Deputy Fire Warden when this method is used, the Fire Safety Director shall make a spot check of several floors each day.

7.Notify the owner or other persons having charge of the building when any designated individual is neglecting his responsibilities contained in the Fire Safety Plan. The owner or other person in charge of the building shall bring the matter to the attention of the firm employing the individual. If the firm fails to correct the condition, the owner or person in charge of the building shall notify the Fire Department.

8.In the event of a fire, shall report to the Fire Command Station to supervise, provide for and coordinate:

(a)Insure that the Fire Department has been notified of any fire or fire alarms.

(b)Manning of the fire Command Station.

(c)Direction of evacuating procedures in the Fire Safety Plan.

(d)Reports on conditions of fire floor for information for Fire Department on their arrival.

(e)Advise the Fire Department Chief in charge in the operation of the Fire Command Station.

9.Be responsible for the training and activities of the Building Evacuation Supervisor.

B.Deputy Fire Safety Directors Duties

1.Subordinate to the Fire Safety Director

2.Perform duties of Fire Safety Director in his absence

C.Fire Wardens and Deputy Fire Wardens

1.The tenant or tenants of each floor shall, upon request of the owner or person in charge of the building, make responsible and dependable employees available for designation by the Fire Safety Director as Fire Warden and Deputy Fire Warden.

2.Each floor of a building shall be under the direction of a designated Fire Warden for the evacuation of occupants in the event of fire. He shall be assisted in his duties by a Deputy Fire Warden. A Deputy Fire Warden shall be provided for each tenancy. When the floor area of a tenancy exceeds 7,500 square feet, a Deputy Fire Warden shall be assigned for each 7,500 square feet of part thereof.

3.Each Fire Warden and Deputy Fire Warden shall be familiar with the Fire Safety Plan, the location of the exits and the location and operation of any available fire alarm system.

Sheet 6 of 22

Rev.:0, 10/04/05

4.In the event of a fire, or fire alarm, the Fire Warden shall ascertain location of the fire, and direct the evacuation of the floor in accordance with directions received and the following guidelines:

(a)The most critical areas for immediate evacuation are the fire floor and floors immediately above. Evacuation from the other floors shall be instituted when instructions from the Fire Command Station or conditions indicates such action. Evacuation should be via uncontaminated stairs. He shall try to avoid stairs being used by the Fire Department. If this is not possible, he shall try to attract the attention of the Fire Department personnel before such personnel open the door to the fire floor.

(b)Evacuation to two or more levels below the fire floor is generally adequate. He shall keep the Fire Command Station informed regarding his location.

(c)Fire Wardens and their Deputies shall see that all occupants are notified of the fire, and that they proceed immediately to execute the Fire Safety Plan.

(d)The Fire Warden on the fire floor shall, as soon as practicable, notify the Fire Command Station of the particulars.

(e)Fire Wardens on the floor above the fire shall, after executing the Fire Safety Plan, notify the Fire Command Station of the means being used for evacuation and any other particulars.

(f)In the event that stairways serving fire floor and/or floors above are unusable due to contamination or cut-off by fire and/or smoke, or that several floors above fire involving large numbers of occupants must be evacuated, consideration may be given to using elevators in accordance with the following:

1.If the elevators servicing his/her floor also sevices the fire floors, they shall not be used. However, elevators may be used if there is more than one bank of elevators, and he is informed form the Fire Command Station that one bank is unaffected by the fire.

2.If elevators do not service the fire floor and their shafts have no opening on the fire floor; they may be used, unless otherwise directed.

3.Elevators manned by trained building personnel or firemen also may be used.

4.In the absence of a serviceable elevator the Fire Warden shall select the safest stairway to use for evacuation on the basis of the location of the fire and any information received from the Fire Command Station. The Fire Warden shall check the environment in the stair prior to entry for evacuation. If it is affected by smoke, an alternate stair shall be selected, and the Fire Command Station notified.

5.The Fire Warden shall keep the Fire Command Station informed of the means being employed for evacuation by the occupants of his floor.

(g)Determine that an alarm has been transmitted.

5.Organizational Chart for Fire Drill and Evacuation Assignment See Example Ref.#1

A chart designating employees and their assignments shall be prepared and posted in a conspicuous place in each tenancy and on each floor of a tenancy that occupies more than one floor and a copy shall be in the possession of the Fire Safety Director.

Sheet 7 of 22 Rev.:0, 10/04/05

6.Have available an updated listing of all personnel with physical disabilities who cannot use stairs unaided. Make arrangements to have these occupants assisted in moving down the stairs to 2 or more levels below fire floor. If necessary to move such occupants to still lower levels during the fire, move them down the stairs to the uppermost floor served by an uninvolved elevator bank and then remove to street by elevator. Where assistance is required for such evacuation, notify Fire Safety Director.

7.Provide for fire warden identification during the fire drills and fires, such as using armbands, etc.

8.Assure that all persons on the floor are notified of fire and all are evacuated to safe areas. A search must be conducted in the lavatories to assure all are out. Personnel assigned as searchers can promptly and efficiently perform this duty.

9.Check availability of applicable personnel on Organizational Chart and provide for substitute when position on chart is not covered.

10.After evacuation, perform a head count to assure that all regular occupants know to have occupied the floor have been evacuated.

11.When alarm is received, the Fire Warden shall remain at a selected position in the vicinity of the communication station on the floor, in order to maintain communications with the Fire Command Station and to receive and give instruction.

Sheet 8 of 22

Rev.:0, 10/04/05

ORGANIZATIONAL CHART FOR FIRE DRILL AND EVACUATION

 

 

(Typical)

 

FIRE SAFETY DIRECTOR

 

_____________________________

 

DEPUTY FIRE SAFETY DIRECTOR

 

_____________________________

 

 

FLOOR

 

 

 

FIRE WARDEN

 

______________________________

 

DEPUTY FIRE WARDENS

_____________________

______________________

_____________________

_______________________

 

 

SEARCHERS

MALE

 

 

FEMALE

_____________________

______________________

ALARM TRANSMISSION:

Any person discovering fire or smoke should without delay cause the transmission of an alarm of fire by any of the following methods available.

1.Telephone (Call 911 to report a fire)

2.Street Alarm Box (list location): _________________________________________________

3.Building Fire Alarm. If building fire alarm is not connected to central station, also notify Fire

Department. Indicate if alarm is connected to central station: ________________________________________

NOTE: Also notify Fire and/or Deputy Fire Wardens that Alarm has been transmitted.

Date prepared: _________________

Date revised: __________________

Ref.#1

Sheet 9 of 22

Rev.:0, 10/04/05

D.Building Evacuation Supervisors Duties

A Building Evacuation Supervisor is required at all times when there are occupants in the building and there is no Fire Safety Director required to be on duty in the building.

1.Capable of directing the evacuation of the occupants as provided by the Fire Safety Plan.

2.During fire emergencies, the primary responsibility of the Building Evacuation Supervisor shall be to man the Fire Command Station, and the direction and execution of the evacuation as provided in the Fire Safety Plan.

(a) The Building Evacuation Supervisor’s training and related activities shall be under the direction of the Fire Safety Director in accordance with these rules, and the Fire Safety Plan. Such activities shall be subject to Fire Department control.

E.Fire Brigade Duties

1.On receipt of an alarm for fire the Fire Brigade shall:

(a)Report to the floor below the fire to assist in evacuation and provide information to the Fire Command Station.

(b)After evacuation of fire floor, endeavor to control spread of fire by closing doors, etc.

(c)Attempt to control the fire until arrival of the Fire Department, if the fire is small and conditions do not pose a personal threat.

(d)leave one member on the floor below the fire to direct the Fire Department to the fire location and to inform them of conditions.

(e)On arrival of the Fire Department the Fire Brigade shall report to the Fire Command Station for additional instructions.

(f)Have a member designated as Alarm Box Runner, who shall know the location of the nearest street Fire Alarm Box, and be instructed in its use. Such member shall immediately, upon receipt of information that there is a fire or evidence of fire, go to the street alarm box, transmit an alarm and await the arrival of the fire department and direct such department to the fire.

Sheet 10 of 22

Rev.:0, 10/04/05

ORGANIZATIONAL CHART FOR FIRE BRIGADE

Shift hours: from: _______________ to: ________________

Minimum staffing requirement: (4) members each Fire Brigade.

 

Names of Members of Fire Brigade

 

* FSD/DFSD not to be used as fire brigade*

Person in Charge – Title

____________________________________

Member assigned to assist in evacuation

____________________________________

 

____________________________________

 

____________________________________

Members assigned to attempt to

____________________________________

control small fires. Minimum

 

of two persons.

____________________________________

 

____________________________________

Alarm box runner for transmitting alarm.

 

(if applicable)

____________________________________

Back up runner.

 

(if applicable)

____________________________________

Member assigned to

____________________________________

communicate conditions to Fire

 

Command Station.

 

Member assigned to the floor

____________________________________

below fire to direct Fire

 

Department.

 

Date Prepared: __________________________________

 

Date Revised: ___________________________________

 

Ref.#2

Sheet 11 of 22

Rev.:0, 10/04/05

F.Occupants Instructions

(a)The applicable parts of the approved Fire Safety Plan shall be distributed to all tenants of the building by the building management when the Fire Commissioner has approved the Fire Safety Plan

(b)The applicable parts of the approved Fire Safety Plan shall then be distributed by the tenants to all their employees and by the building management to all there building employees.

(c)All occupants of the building shall participate and cooperate in carrying out the provisions of the Fire Safety Plan.

G.Fire Prevention and Fire Protection Program (see note)

1.A plan for periodical formal inspections of each floor area, including exit facilities, fire extinguishers and housekeeping shall be developed.

A copy of such plan shall be submitted

Information that can be included is as follow:

(a)At the start of the day a check of each exit shall be required to determine that self-closing doors are in the closed position but are not illegally locked in any manner.

(b)No obstructions shall be permitted in corridors or aisle spaces

(c)Necessary exit signs and lights where required, shall be lighted and in good condition.

(d)All personnel shall know the location and operation of fire extinguishers. The Maintenance shall be controlled by the Fire Safety Director.

(e)Poor housekeeping is a fire breeder. All establishments shall avoid accumulation of combustible debris.

2.Provision shall be made for the monthly testing of communication and alarm systems.

Note: This is a guideline only. Plan must be specific to applicable building

Sheet 12 of 22 Rev.:0, 10/04/05

H.Building Information Form

Building Address: ___________________________________ Zip Code: __________________

1.Owner or person in charge of the building.

Company: ________________________ Name of representative:________________

Address including ZIP Code:______________________________________________

Business telephone No.: _______________________________

2. .

Fire Safety Director (FSD) and Deputy Fire Safety Director (DFSD).

 

 

Name

Business/Cell No.

 

FSD:

__________________________________

______________________________

 

DFSD:

__________________________________

______________________________

 

DFSD:

__________________________________

______________________________

 

DFSD:

__________________________________

______________________________

 

DFSD:

__________________________________

______________________________

 

 

Add sheets if necessary

 

3.Attach copy of: current C of O or temporary C of O or Letter of no Objections from Buildings Department or Affidavit of No C of O issued by Building Department.

If under construction attach copy of Schedule A.

Location where C of O is posted in the building: _______________________________

4.General description of the building:

Building Height in feet: ________ No. of stories: ______ No.of basements: _______

Area (Length X Width) at ground level: ___________________ (sf)

Class of construction as listed on current C of O: ______________________________

5a.

Number, type and location of fire stairs and/or fire towers, and/or fire escapes and/or

 

utility/access stairs. Include alphabetical letter identification, location, and floors

 

served.

 

 

 

 

Letter

 

 

 

 

designation Type

Location

Levels (floors) served

 

____

_________ ______________

_________________________________

 

____

_________ ______________

_________________________________

 

____

_________ ______________

_________________________________

 

____

_________ ______________

_________________________________

 

____

_________ ______________

_________________________________

 

 

 

Add sheets if necessary

Sheet 13 of 22 Rev.:0, 10/04/05

Building Information Form cont’d

5b. List re-entry floor numbers and indicate if fail-safe on re-entry floor is installed.

_____________________________________________________________________

_____________________________________________________________________

6.Number of, type and location of Horizontal exits or other Areas of Refuge.

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

7.Elevator and/or escalator information:

Number of elevator banks and/or elevators: __________________________________

Elev. Bank

No. of

Pass. or

Operation

 

Designation

Cars

Freight

(Man/Auto)

Levels (floors) served

_________

______

_________

__________

___________________________

_________

______

_________

__________

___________________________

_________

______

_________

__________

___________________________

_________

______

_________

__________

___________________________

Elev. Bank

Firemen Service

Elevator Machine

Designation

(Yes/No)

Room Location

__________

___________

____________________________________________

__________

___________

____________________________________________

__________

___________

____________________________________________

__________

___________

____________________________________________

 

Add sheets if necessary

Number of escalators: ___________________

Escalator

Levels (floors) served

__________

__________________________________________

__________

__________________________________________

 

Add sheets if necessary

8.Interior Fire Alarms, or alarms to central stations. Type of fire alarm/communications (Brand and Model No.) and name Alarm Company ONLY.

.___________________________________________________________________________

____________________________________________________________________________

9.Communications systems other than Class E alarm system communications like

walkie-talkies, telephones, etc

____________________________________________________________________________

____________________________________________________________________________

Sheet 14 of 22

Rev.:0, 10/04/05

Confirm if tied into fire alarm system.

Building Information Form cont’d

10.Standpipe system information:

Location of riser: ______________________________ Size of riser: __________________

Location of riser: ______________________________ Size of riser: __________________

No. of gravity tanks: ________ Location(s): _____________________________________

Capacity of gravity tank(s) (gals): __________________ Fire Reserve (gals): ___________

No. of pressure tanks: ________ Location(s): ____________________________________

Capacity of pressure tank(s) (gals): _______________________________

No. of fire pumps: ______ Location/output(s) (gpm): _____________________

_________________________________________________________________________

Type(s) of pump(s) (automatic or manual): ______________________________________

_________________________________________________________________________

Number and Location(s) of Siamese connection(s):

_________________________________________________________________________

Name of Certificate of Fitness holder: __________________________________________

Certificate No.: ____________________________ Expiration date: __________________

11.Sprinkler system information:

Primary water supply: __________________ Secondary water supply: ________________

Is this a combination of Standpipe/Sprinkles system? (Yes/No): _________

Areas protected: ____________________________________________________________

_________________________________________________________________________

No. of gravity tanks: ________ Location(s): _____________________________________

Capacity of gravity tank(s) (gals): _______________________________

No. of pressure tanks: ________ Location(s): ____________________________________

Capacity of pressure tank(s) (gals): _______________________________

No. of fire pumps: ______ Location/output(s) (gpm): ______________________________

Name of Certificate of Fitness holder: __________________________________________

Certificate No.: ____________________________ Expiration date: __________________

12.Special Extinguishing systems information. Example- Halon, Pre-Action Range hood

(Ansul), Deluge – Include Location(s).

____________________________________________________________________________

____________________________________________________________________________

13.Average number of persons normally employed in building.

DAYTIME: ____________

NIGHTTIME: ____________

Sheet 15 of 22

Rev.:0, 10/04/05

Building Information Form cont’d

14.Average number of handicapped people employed in building. Keep locations at Fire Command station readily available for FDNY.

DAYTIME: ___ LOCATION(S)/NUMBER OF: _____________________________

NIGHTIME: ___ LOCATION(S)/NUMBER OF: ____________________________

15.Number of Persons normally visiting building.

DAYTIME: ______________

NIGHTTIME: ____________

16.Service Equipment such as:

(a)Electric Power:

Primary – Street name where power enters the building: ________________

Auxiliary -Auxiliary Generator (Yes/No): __________

Location of generator: __________________________Type of fuel: _______

List capacity and location of the tank in Item 18

(b)Emergency Lighting:

TypeLocations.

_______________ __________________________________________

Add sheets if necessary

(c)Heating:

Type: ____________________________________

Fuel: _____________________________________

Location of heating unit: __________________________________________

Add sheets if necessary

(d)Ventilation:

Emergency means of exhausting heat and smoke (Yes/No): ______________

Smoke purge system (Yes/No): ________ Smoke shaft (Yes/No): _________

Do the windows open on any floors? (Yes/No): __________

If YES, list locations where windows open: ___________________________

______________________________________________________________

Are keys required? (Yes/No): _____ If YES, list where located: ___________

Type of key (1620 or 2642) if required: __________________

(e)Air Conditioning System – Be specific:

Central A/C (Yes/No): ______ Through floor duct work (Yes/No): _______

If YES, list floors: ______________________________________________

Sheet 16 of 22 Rev.:0, 10/04/05

Building Information Form cont’d

 

Location of

 

Area Served

Supply Fan

 

 

_________________

__________________________________________

_________________

__________________________________________

 

 

Add sheets if necessary

Package units on each floor (Yes/No): _______

Unit

Size

Location

Area Served

ID

 

 

 

_______

_________

______________

__________________________

_______

_________

______________

__________________________

_______

_________

______________

__________________________

 

 

Add sheets if necessary

 

(f)Refuse storage and disposal (Yes/No): ___________

If Yes, list type and location: _______________________________________

(g)Firefighting equipment and appliances, OTHER than standpipe and sprinkler

systems.

_____________________________________________________________________

(h)Other pertinent building information and the locations. Example – roof set-back, utility shafts, cross bridges, tunnels etc.

___________________________________________________________

___________________________________________________________

17.Alterations and repair operations if any and the protective and preventive measures necessary to safeguard such operations with attention to torch operations. (Torch operator must have valid Certificate of Fitness).

____________________________________________________________________________

____________________________________________________________________________

18.Storage and use of flammable solids, liquids and/or gases (including Fuel storage tanks). Be specific-Type/quantity and location.

____________________________________________________________________________

____________________________________________________________________________

19.Special Occupancies in the building:

Example: Place of Public Assembly-studios, cafeterias, retail stores, auditoriums,

theaters, etc.(include listing of locations)

____________________________________________________________________________

____________________________________________________________________________

Sheet 17 of 22

Rev.:0, 10/04/05

Building Information Form cont’d

20.Number and location of electrical transformers containing liquid poly-chlorinated biphenyles (PCB).

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

I.Representative Floor Plans.

Submit copy of floor plans for ALL floors, INCLUDING Basements and roof meeting requirements listed on the instruction sheet.

J.Evacuation Procedure (if deemed necessary)

(a)The most critical areas for immediate evacuation are the fire floor and the floors immediately above. Evacuation from the other floors shall be instituted when instructions from the Fire Command Station or conditions indicate such actions. Evacuation should be via uncontaminated stairs. Occupants shall try to avoid stairs being used by the Fire Department. If this is not possible, occupants shall try to attract the attention of the Fire Department personnel before such personnel open the door to the fire floor.

(b)Evacuation to two or more levels below the fire floor is generally adequate.

(c)The Fire Safety Director shall see that all occupants are notified of the fire and that they proceed immediately to execute the Fire Safety Plan.

(d)The Fire Brigade members on the fire floor shall, as soon as practicable, notify the Fire Command Station of the particulars.

(e)In the event that stairways serving fire floor and/or floor above are unusable due to contamination or cut-off by fire and/or smoke, or that several floors above the fire involving large numbers of occupants must be evacuated, consideration may be given to using the elevators in accordance with the following:

(ee)Elevators serving fire floors shall not be used. However, elevators may be used if there is more than one bank of elevators and the Fire Command Station is notified that one bank is unaffected by the fire.

(ff)If elevators do not service the fire floor and their shafts have no openings on the fire floor, they may be used, unless otherwise directed by authorized personnel.

(gg)Elevators manned by trained building personnel or firemen may also be used.

(hh)In the absence of a serviceable elevator occupants shall select the safest stairway to use for evacuation on the basis of the location of the fire and any information received from the Fire Command Station. Occupants shall check the environment in the stair prior to entry for evacuation. If it is effected by smoke, an alternate stair shall be selected.

(f)The Brigade shall keep the Fire Command Station informed of the means employed for evacuation of the occupants.

Sheet 18 of 22

Rev.:0, 10/04/05

K.Fire Safety Plan

In planning evaluate the individual floor layouts, the population of floors, the number and kinds of exits the zoning of the floor by area and occupants. Determine the movement of traffic by the most expeditious route to an appropriate exit and alternative route for each zone, under fire conditions one or more exits may not be useable.

** This format for Fire Safety Plan is to be used in the preparation of the Fire Safety Plan**

Nothing contained in the Fire Safety Plan format is to be construed as all-inclusive. All rules and other requirements are to be fully complied with.

Attach additional pages if necessary, have pages numbered.

Sheet 19 of 22 Rev.:0, 10/04/05

NOTICE OF NEW CUSTOMER SERVICE PROCEDURES

Do you need to:

Drop off a plan or variance for review?

Then, please visit our

Fire Prevention’s Customer Service Center,

conveniently locat ed in dow ntow n Brooklyn at 9 Metrotech Center on the 1st

Floor ( The entrance is on Flatbush Avenue) .

Business hours are Monday through Friday 9:00 AM to 3:00 PM.

At the center you can request or pick up FDNY documents, pay any outstanding permit fees, submit documentation for compliance with Fire Department Code requirements, apply for, take or renew a Certificate of Fitness license, or drop off documents, plans or variances for review.

Meetings w ith Fire Prevention technical staff is by appointment only.

Fire Prevention…I nspecting Today and Engineering a safer tomorrow …

www.fdny.gov

718 - 999 - 2541

Sheet 20 of 22

Rev.:0, 10/04/05

INSTRUCTIONS FOR

PROCESSING

FORM NAME: FIRE SAFETY PLAN AND GUIDELINES

FORM NUMBER: INTDOC – 12/07 Purpose of Form

To provide Class E Office Buildings or Class J Hotels Motels with the forms which must be submitted and approved

by the FDNY

TO SUBMIT COMPLETE APPLICATION BY MAIL

New York City Fire Department

Bureau of Fire Prevention

9 Metro Tech Center

Brooklyn NY 11201

Attn: Rm. 3W 11K for NEW Plans

Attn: Rm 3E 09K for APPROVED or

AMMENDED plans

OR BY WALK IN:

9 Metro Tech Center – 1st floor

Flatbush Ave Entrance

At rear of Fire Dept HQ building Get number from greeter desk for Customer Service window 8

SPECIAL INSTRUCTIONS

Plans must be updated before any renovations are made, personnel changes, and revisions, which affect the safety

conditions

Sheet 21 of 22

Rev.:0, 10/04/05

WHO SHOULD USE THIS DOCUMENT

Property Owners, Fire Safety Directors and other management staff required to file Fire Safety Plans

 

 

 

 

 

PAYMENT INFORMATION

 

Is payment required?

Yes $ 210

 

 

If so, when?

At time of submission

 

 

 

 

 

 

 

 

FOR FURTHER QUESTIONS, CONTACT

 

 

New York City Fire Department

 

 

Bureau of Fire Prevention

 

 

Fire Safety Plan Review

 

 

Contact Numbers:

 

 

New Plans or General Questions

 

 

718 999-1509, 1508, 2376

 

 

For General Questions e-mail

 

 

pastusw@fdny.nyc.gov

 

 

Approved or Amended Plans

 

 

718 999-2557, 2558, 2559, 2560

 

 

For General Questions e-mail

 

 

alyaly@fdny.nyc.gov

 

 

 

Sheet 22 of 22 Rev.:0, 10/04/05

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