Name: Position: Keys? ( Yes / No ) Address: Business Phone: Mobile Phone: Home Phone:

Transcription

1 PRE-PLAN WORKSHEET Facility Name: City/State/Zip: Occupancy: Facility Usage: Time Range Number f Peple Average Age Mbility CONTACTS Name: Psitin: Keys? ( Yes / N ) Business Phne: Mbile Phne: Hme Phne: Fax#: Name: Psitin: Keys? ( Yes / N ) Business Phne: Mbile Phne: Hme Phne: Fax#: Name: Psitin: Keys? ( Yes / N ) Business Phne: Mbile Phne: Hme Phne: Fax#:

2 CONSTRUCTION Date f Cnstructin r last renvatin: Number f Renvatins: Type f Cnstructin: Building Size: Building Value: Cntents Value: Dumpster: ROOFING (Trusses: Yes / N ) Cnstructin: Cvering: Decking: Rf Access: Flr Cnstructin: Wall Cnstructins: Vid Spaces: Openings: ELEVATOR Service Cmpany/Phne: Type f Elevatr: Dr Key Lcatin: Fire Dept Key: Methd f Operatin: Ntes: Mechanical Rm Ntes:

3 HAZMAT Material Amunt Lcatin/Ntes ALARM Alarm ID: Alarm Cmpany/Phne: Alarm Type: Annuciatr Panel Lcatin: Alarm Cverage Ntes: Knx Bx ( Yes / N ) Lcatin/Ntes: SPRINKLER ( Yes / N ) Type: FDC Cnnectin Lcatin: Cverage & Ntes: Main Valve Lcatin:

4 STANDPIPE ( Yes / N ) Type: Cverage: Lcatin: Discharges: SUPPRESSION Type Cverage Cntrl Lcatin UTILITIES Check mark if it applies Type Natural Gas Prpane Fuel Oil Electric Emergency Pwer/Generatr Water Steam Shut Off

5 Ht Water Slar Panels Phtvltaic Panels STRATEGY - Fire Cmpany Use Ntes: Primary Hydrant: Secndary Hydrant: Fire Predictin: Nearest Draft Site & Ntes: Water Flw: Expsures: Side Descriptin

6 Hampden Twnship Vlunteer Fire Cmpany Instructins fr Cmpleting the Pre-Plan Wrksheet (PPWS) Please use the fllwing instructins and infrmatin t cmplete submit the Pre-Planning Data Frm prvided as a part f this packet. Please cntact the Hampden Twnship Fire Administratr Officer (FAO) at (717) with any questins r cncerns. Facility/Business Name: Specify the actual business name. If yur business is cmprised f multiple buildings n ne site, a PPDF must be cmpleted fr each building and a site plan must be included that depicts all f the buildings relative t each ther alng with their individual identifiers. If yur business has multiple buildings within Hampden Twnship that are lcated n separate sites, a PPDF must be cmpleted fr each building. Business Specify the actual street address f the building. If the business nly utilizes a Pst Office Bx, accurately describe the lcatin f the building. Facility Usage/Occupancy Classificatin: Describe the business and/r the type f wrk that takes place within the building, be as specific as pssible. Examples f respnses wuld be: Warehuse with high rack strage, cnveyrs, and packaging areas; General Merchandise Retail Sales, Aut Repair Garage with strage f mtr il, hazardus fluids, vehicle batteries, and tires; Factry that includes wdwrking, assembly f furniture, and the strage f uphlstery, fabrics, and varius glues. Occupancy: Time Range Specify the times that the building is nrmally ccupied frm pening t clsing, if pen 24 hurs per day, state s. Specify mre than ne time range t accmmdate perids when there will be a large number f peple in the building (e.g. ver the lunch hur fr a restaurant). Number f Peple Specify the average number f peple expected in the building at a given time. Prvide peple cunts fr each f the Time Ranges specified abve (e.g. if yu are a service prvider and mre peple are in the building during the lunch hur, then specify tw Time Ranges and indicate the maximum number f peple expected ver the lunch hur and shw the average number f peple during nrmal business hurs). Average Age Imprtant fr Nursing Hmes, Hspitals, r any type f businesses that cater t yunger r lder grups f peple. If nly an ffice r restaurant, fr example, prvide yur best guess. Mbility Specify ambulatry, nn-ambulatry, r mixed. Imprtant respnse fr Nursing Hmes, Hspitals, r any types f businesses that cater t lder grups f peple, r fr example where physical therapy r utpatient surgery is perfrmed. Page 1 f 8

7 Cntacts: Specify full cntact infrmatin (name. address, psitin/title, whether r nt they have keys fr the business, business phne, mbile phne, hme phne, fax number, and address) fr three (3) respnsible individuals that wuld be available during bth nrmal business hurs plus during ff hurs in the event f an emergency. Name: Psitin/Title: Keys (Yes/N): Business Phne #: Mbile Phne #: Hme Phne #: Fax #: Name: Psitin/Title: Keys (Yes/N): Business Phne #: Mbile Phne #: Hme Phne #: Fax #: Name: Psitin/Title: Keys (Yes/N): Business Phne #: Mbile Phne #: Hme Phne #: Fax #: Cnstructin: Date f Cnstructin r Last Renvatin Specify the year f riginal cnstructin plus include the year(s) that any building renvatin ccurred. The term renvatin nly applies t actual changes t the building walls, rfs, windw penings, drs added r deleted, flrs added r deleted (e.g. mezzanine). The changing f carpets, painting, etc. des nt apply as a renvatin. Number f Renvatins Specify the number f renvatins that yu perfrmed r that yu knw have been perfrmed t the building by previus Owners. Prvide as much infrmatin as yu have persnal knwledge abut. If yu d nt knw because yu are a new(er) Owner, indicate unknwn. Building Value Indicate the value f the building itself t the nearest $10,000, if pssible. This value des nt include the building cntents value but des include the land value. (Suggestin: Check with yur Insurance Agent). Cntents Value Indicate the value f the cntents nly, excluding the building r land value. Type f Cnstructin The type f building cnstructin is defined by the Internatinal Building Cde, 2009 editin. Select the building type that mst clsely defines yur building. Type I - Fire Resistive Type I cnstructin is cmpsed f nly nncmbustible r limited cmbustible materials and prvides the highest level f safety. Type I cnstructin can be expected t remain structurally stable during a fire fr the duratin f the fire resistance rating f its members. All structural members are cmpsed f nly nncmbustible materials and pssess a high fire-resistance rating. Reinfrced cncrete and precast cncrete alng with prtected steel frame cnstructin meet the criteria. Page 2 f 8

8 Type II - Nncmbustible Type II cnstructin is cmpsed f building materials that will nt cntribute t fire develpment r spread. Structures with metal framing members, metal cladding, r cncrete-blck cnstructin f the walls with metal deck rfs supprted by unprtected pen-web steel jists are the mst cmmn frm f this cnstructin type. Type III - Ordinary Type III cnstructin is cmmnly used fr but nt limited t churches, schl, apartment dwellings, and mercantile structures. This cnstructin type requires that exterir walls be cnstructed f nncmbustible materials and cncrete elements be cnstructed f any material permitted by the Building Cde. Brick, cncrete, and reinfrced cncrete are typical materials used in exterir walls and interir nnbearing walls. Flrs, rfs, and interir nnbearing framing and partitins are cnstructed f small-dimensin wd r metal stud systems. Type IV - Heavy Timber Type IV cnstructin is characterized by the use f large-dimensined lumber (greater than 4 inches) fr all structural elements. Exterir walls are cnstructed f nncmbustible materials. Interir building elements are slid r laminated wd with n cncealed spaces. Examples f Type Iv cnstructin include lder mill buildings, churches, and strage facilities. Type V - Wd Frame Type V cnstructin cnsists f exterir bearing walls that are cmpsed entirely f wd and ther cmbustible materials. Occasinally, a veneer f brick r stne may be cnstructed ver the wd framing. The veneer ffers the appearance f a masnry-type cnstructin while prviding little additinal fire prtectin t the structure. A cmmn example f this type f cnstructin is a single-family residence. Building Size Specify the enclsed area f yur building n a square ftage (ft²) basis. If yur building has mre than ne flr and/r has a basement, specify the square ftage n a flr-by-flr basis and then include the verall ttal square ftage as well. Dumpster Indicate whether r nt yur building has a dumpster, if s, indicate hw many dumpster(s) are n yur prperty and their lcatin. Rfing Trusses (Yes/N) If trusses, specify what they are cnstructed f (e.g. wd, laminated wd, etc.) Flr Cnstructin Specify hw the flrs are cnstructed (e.g. 4 inch thick pured cncrete, 2 X 12 wd jist, engineered wd jists, etc.) Cnstructin Specify hw the rf is cnstructed if nt a truss (e.g. metal bar jists, heavy steel frame, etc.) Wall Cnstructin Separately specify hw the exterir and the interir walls are cnstructed. Examples include but are nt limited t: pured-in-place cncrete, precast cncrete, cast-in-place cncrete, cncrete masnry units (CMU), brick facing, metal r wd studs (4 r 6 thick), exterir insulatin and finishing system (EFIS r Dryvit), blwn-in, batt, r rigid insulatin, stucc, vinyl, metal, r aluminum siding, wd sheathing, gypsum drywall, wd paneling, etc. Cvering Indicate what type f rf deck cvering is installed. Examples include but are nt limited t: rubber rfing (EPDM) either ballasted (stnes) r unballasted (adhered with glue and metal pins with washers), rigid, blwn-in, r batt insulatin, shingles r wd shakes. Page 3 f 8

9 Vid Spaces Applies mainly t multistry buildings where shafts/penings run between the flrs and culd permit unnticed fire spread. Examples include but are nt limited t: pipe chases, HVAC return air chases, laundry chutes, dumbwaiters, etc. Decking Refers t the type f surface that is installed abve the rf cnstructin and belw the rf cvering. Examples include but are nt limited t: metal fluted decking, pured-in-place cncrete, precast cncrete, cast-in-place cncrete, etc. Openings Refers t penetratins thrugh the rf frm the interir f the building. Examples include but are nt limited t: HVAC fresh air intake hds, ventilatin exhaust air hds, skylights, etc. Rf Access Indicate whether r nt rf access is available frm inside the building thrugh a hatch r rf scuttle. If access is available, specify the number f hatches/scuttles and whether stairs r ladders are included as part f the means f egress t the rf. Elevatr Service Cmpany/Phne Number Identify the name f yur Elevatr Service Cmpany plus bth the nrmal hurs and emergency cntact phne numbers. Type f Elevatr Specify the type f elevatr(s) that is/are present within yur building (e.g. hydraulic, geared tractin, r gearless tractin) Dr Key Lcatin Specify where yur elevatr dr/histway key is lcated fr Fire Department r rescue purpses. Fire Department Key Specify where the fire department elevatr key is lcated fr use by the Fire Department in the event f a fire within the building. Methd f Operatin Prvide detailed instructins fr the prper use f yur elevatr key in yur elevatr in the event f a fire. (Suggestin: Cntact yur elevatr service cmpany fr their specific instructins n hw t use the elevatr key). Ntes Prvide infrmatin regarding yur elevatr(s) that might be useful t the Fire Department in the event f a fire r during an elevatr rescue. Include all infrmatin regarding any histrical events that have ccurred with yur elevatr(s). Mechanical Rm Ntes Prvide pertinent infrmatin regarding yur elevatr mechanical rm including but nt limited t: the rm lcatin, emergency shutff lcatin, histway access lcatin, whether the histway and/r the mechanical rm are prtected by a sprinkler, whether a pit is lcated belw the elevatr and if s, prvide the access lcatin, etc. HazMat (Hazardus Materials) Material Specify the material by its name and indicate whether it is a chemical, radilgical, r bilgical substance Amunt Specify the amunts f any hazardus material that is stred r sld by yur facility. Utilize the frm f measurement specified n the material packaging. Examples include but are nt limited t: unces, punds, tns, liters, gallns, 55 galln drums, etc.). Page 4 f 8

10 Lcatin/Ntes Prvide infrmatin addressing the specific lcatins f all hazardus materials bth interir and exterir t yur facility. Material Safety Data Sheets (MSDS) shuld be available fr each and every hazardus material that is present at yur lcatin. Specify the lcatin where the MSDS dcuments are stred fr use in the event f an emergency. If large quantities f hazardus materials are present at yur lcatin, prvide all pertinent cntact infrmatin fr yur identified HazMat cleanup team. Alarm Alarm ID Hw the building r Owner is identified at the alarm cmpany. Alarm Cmpany/Phne Identify yur alarm cmpany s name plus all emergency cntact infrmatin. Alarm Type Select the type f alarm signaling system that is utilized at yur building as described belw: Prtected Premises (Lcal) System A prtected premises (lcal) alarm system is designed t transmit bth a visible and an audible alarm nly within the immediate premises. There are n prvisins fr ff-site reprting. The alarm s purpse is t nly alert the building s ccupants and t ensure their life safety. Auxiliary Fire Alarm System An auxiliary fire alarm system is cnnected t a municipal fire alarm system. Alarms are transmitted ver this system t a public fire telecmmunicatins center where the apprpriate respnse agencies are selected and dispatched t the alarm. Prprietary System A prprietary system is used t prtect large cmmercial and industrial buildings, high-rise structures, and grups f cmmnly wned facilities such as a cllege campus r an industrial cmplex in a single lcatin. Each building r area has its wn system that is wired int a cmmn recurving pint in the facility. The receiving pint must be in a separate structure r a part f the structure that is remte frm any hazardus peratins. Central Statin System A central statin is a cmpany that sells its services t many custmers. When an alarm is activated at a particular client s lcatin, central statin emplyees receive that infrmatin and cntact the fire department and representatives f the ccupancy. The alarm systems at the prtected prperty and the central statin are mst cmmnly cnnected by dedicated telephne lines. The primary difference between a central statin system and a prprietary system is that the receiving pint fr alarms in a central statin system is lcated utside the prtected premises and is mnitred by a cntracted service. The external receiving pint is called the central statin. Remte Receiving System A remte receiving system is cmmn in lcalities that are nt served by central statin systems. Instead f being cnnected t the fire department telecmmunicatins center thrugh a municipal fire alarm bx system, the remte system is cnnected by anther means, usually a leased telephne line. Annunciatr Panel Lcatin(s) Specify the lcatin where the annunciatr panel(s) is/are lcated within the building, being as detailed as pssible. If any panel is lcated behind clsed and/r a lcked dr, r requires a key t unlck and reset the panel, please make nte f it. Prvide written instructins n hw t reset the panel since manufacturers utilize many different methds and include the passwrd if ne is required. Page 5 f 8

11 Alarm Cverage Ntes Prvide any additinal infrmatin that might be pertinent fr use by the Fire Department r in the event f an emergency. Knx Bx (Yes/N) and Lcatin/Ntes Stipulate whether r nt yu have a Knx Bx at yur facility. If yu d, give specific infrmatin regarding its lcatin and indicate what keys, card keys, FOB s, cntact infrmatin, building flr plans, r ther pertinent infrmatin will be fund in yur Knx Bx. Sprinkler (Yes/N) Stipulate whether r nt yur building has a sprinkler system. Type Select the type f sprinkler system that is utilized at yur building as described belw: Wet Pipe Sprinkler System Pipes cntinually charged with water under pressure that discharges immediately when ne r mre sprinkler heads are activated by heat frm a fire. This is the mst cmmn type f sprinkler system. Dry Pipe Sprinkler System Pipes cntinually charged with air r nitrgen under pressure. When a sprinkler head activates, the air within the pipe is released allwing the dry pipe water-flw cntrl valve t perate and charge the system with water. These types f systems are utilized in areas where freezing water temperatures ptentially can ccur. Deluge Sprinkler System Cnsists f pen sprinklers attached t unpressurized dry pipes. The system is activated when a detectin device in the prtected area senses a fire and pens the water-flw cntrl valve t the system. All sprinkler heads discharge water simultaneusly. Preactin Sprinkler System Pipes cntinually charged with air that may r may nt be under pressure. The system nly perates when bth a sprinkler head pens and a detectin device in the same area activates the water-flw cntrl valve. Antifreeze Sprinkler System A wet pipe system that is cntinually charged with an antifreeze slutin. When the system is activated, the antifreeze slutin is discharged, activating the water-flw valve and allwing water t flw t the pen sprinkler head(s). This type f system requires additinal maintenance; the antifreeze slutin must be charged nce a year. FDC Cnnectin/Lcatin If yur building has a sprinkler system and/r a standpipe system, there will be a Fire Department Cnnectin (FDC) at the exterir f yur building. Prvide specific infrmatin as t the lcatin f the FDC relative t the exterir f yur building. Main Valve Lcatin Every autmatic sprinkler system is equipped with a main valve r valves, als referred t as water-flw cntrl valves, which are lcated n either side f a check valve/backflw preventer that prevents sprinkler system water frm flwing back int the public water supply system that serves the building. Water-flw cntrl valves are utilized t islate the public water supply t the sprinkler system when maintenance is required t the sprinkler system itself. Prvide specific infrmatin as t the lcatin f the main valve lcatin. The valve may be interir r exterir t the building. Cverage and Ntes Indicate if the building is ttally r partially sprinklered. Ttally sprinklered means every area and space f the building has cverage. Page 6 f 8

12 If yur building has a clean agent fire extinguishing system utilizing agents such as haln, carbn dixide, Haltrn, FM-200, Inergen, ECARO-2 r FE- 336, prvide specific infrmatin regarding the lcatin f the prtected space, the type f agent, and the lcatin f any verrides and/r cntrls. If a cmmercial kitchen is present within yur building, specify whether the autmatic fire extinguishing system lcated within the exhaust hd is a dry r wet system and identify the lcatin f any verrides and/r cntrls. Standpipe (Yes/N) Type Stipulate whether r nt yur building has a standpipe system. Cverage Identify what specific areas f yur building are accmmdated by a standpipe. Lcatin Specify the exact lcatin(s) f the standpipe(s) themselves, be as detailed as pssible. Discharges Select the type f standpipe discharge that is utilized at yur building frm the descriptin shwn belw: Class I: Firefighters Class I standpipe systems are primarily fr use by firefighters trained in handling large headlines (2-1/2 hse). Class I systems must be capable f suppling effective fire streams during the mre advanced stages f fire within a building. Class I systems have 2-1/2 hse cnnectins r hse statins attached t the standpipe riser. The 2-1/2 hse cnnectins may be equipped with a reducer n the cap that allws fr the cnnectin f a 1-1/2 hse cupling. Class II: Trained Building Occupants Class II standpipe systems are primarily designed fr use by building ccupants wh are trained in their use f by firefighters. These systems are equipped with 1-1/2 hse, nzzle, and hse rack. The hse is typically a single-jacket linen type and the nzzle is lightweight with a twist-type shutff nzzle. Class III: Cmbinatin Class III standpipe systems cmbine the features f bth Class I and Class II systems. Class III systems have bth 2-1/2 hse cnnectins fr use by firefighters and 1-1/2 hse and cnnectins fr use by the building ccupants. The design f the system must allw bth Class I and Class II services t be used simultaneusly. The hse is usually remved due t maintenance and safety cncerns; if nt prperly maintained, the hse may dry rt and cause persnal injury when used in a fire emergency. Suppressin Type Cverage Cntrl Lcatin Utilities Checkmark if Applicable Type f Utility Natural Gas Prpane Shut-Off r Cntrl Lcatin Page 7 f 8

13 Fuel Oil Electric Emergency Pwer/Generatr Water (Public r Well) Steam Ht Water Slar Panels Phtvltaic Panels Page 8 f 8