City of Alexander Business Pre Fire 2.0

• Site conducted

  Select

• Business name:

• Business phone number:

• Occupation type:

  Occupied

  Under construction

  Idle; not routinely used

  Vacant & secured

  Vacant & unsecured

• Hours/ Days of operation

• Location:
  Address

• Business owner:

• Business e-mail:

• Conducted on

  Date

Needed Fire Flow

• Total square footage:

• GPM for 25%:

• GPM for 50%:

• GPM for 75%:

• GPM for 100%:

Hazardous Materials

• Are there hazardous materials that will affect our response?

  Yes, look at HAZMAT tab

  No

Special Needs

• Special equipment, apparatus, or service needs?

  Yes

  No

• Special equipment, apparatus, or service needed:

Needs

• What is needed?

  Select Elevated master stream/ Ariel's Tenders Drop tanks 2nd alarm response once a fire is verified HAZMAT Additional medical responce Law enforcement Red Cross Other

  • Elevated master stream/ Ariel's
  • Tenders
  • Drop tanks
  • 2nd alarm response once a fire is verified
  • HAZMAT
  • Additional medical responce
  • Law enforcement
  • Red Cross
  • Other

• Additional information about specific need:

Knox System

• Is there a Knox system for this business?

  Yes

  No

  N/A

• What type of Knox systems are in use?

  Select Knox box Knox padlock FDC Cap Standpipe lock

  • Knox box
  • Knox padlock
  • FDC Cap
  • Standpipe lock

Hazardous Materials

• Are there hazardous material items on site (Only if the amount released is mandatory to be reported or is a life hazard)?

  Yes

  No
Add hazardous materials:

Identification

• Chemical or registered name:

• UN number:

• Guide number:

Details

• Quantity and container type:

• Storage type:

  Select Above ground storage tank Below ground storage tank HAZMAT storage bin/ container Unapproved container/ method No storage container N/A

  • Above ground storage tank
  • Below ground storage tank
  • HAZMAT storage bin/ container
  • Unapproved container/ method
  • No storage container
  • N/A

• Pressure:

  Ambient pressure

  Greater than ambient pressure

  Less than ambient pressure

• Temperature:

  Select Ambient temperature Cryogenic conditions Greater than ambient temperature Less than ambient temperature

  • Ambient temperature
  • Cryogenic conditions
  • Greater than ambient temperature
  • Less than ambient temperature

• Location:

• Notes:

Additional Hazards

• Are there additional hazards?

  Yes

  No
Additional Hazards:

• Hazard type:

  Select Health Safety Fire Evacuation Physically impaired Construction

  • Health
  • Safety
  • Fire
  • Evacuation
  • Physically impaired
  • Construction

• Impairment type:

  Select Hearing impaired Mobility impaired Visually impaired

  • Hearing impaired
  • Mobility impaired
  • Visually impaired

• Hazard specifics:

• Photo of hazard:

  Media

Alarm System

• Is there alarm system?

  Yes

  No

  N/A

• Alarm company?

• Alarm company phone number:

• Alarm panel location:

Fire Suppression System

• Is there a suppression system?

  Yes

  No

  N/A

• Suppression type:

  Select Sprinkler system Cooking suppression system

  • Sprinkler system
  • Cooking suppression system

• Sprinkler shutoff location:

• Servicing sprinkler company: (NOTE- It is the business owners responsibility to update the Alexander FD of change of servicing company)

• Servicing sprinkler company phone number:

• Cooking suppression system type?

  Wet chemical

  Dry chemical

  Foam system

• Cooking suppression servicing company:

• Cooking suppression servicing company phone number:

Water

• Water company:

  Select Central Arkansas Water Woodland Hills Water Association

  • Central Arkansas Water
  • Woodland Hills Water Association

• Water shutoff location:

  Select A side B side C side D side Along street Inside building

  • A side
  • B side
  • C side
  • D side
  • Along street
  • Inside building

• Water shutoff location picture:

  Media

Gas

• Is there gas?<br>Center Point 24/7 # (800) 992-7552

  Yes

  No

• Gas type:

  Propane

  Natural gas

• Gas shutoff location:

  Select A side B side C side D side Along street Inside building

  • A side
  • B side
  • C side
  • D side
  • Along street
  • Inside building

• Shut off location picture:

  Media

Electric

• Electric shutoff location: Entergy 24/7 # (501) 379-6828

  Select A side B side C side D side Along street Inside building

  • A side
  • B side
  • C side
  • D side
  • Along street
  • Inside building

• Electric shutoff location in building:

  A

  B

  C

  D

• Electric shutoff location picture:

  Media

24/7 Key Holders

• 24 hour Key Holder #1:

• 24 hour Key Holder #1 phone number:

• 24 hour Key Holder #2:

• 24 hour Key Holder #2 phone number:

I Am Responding

• Are all markers i.e. gas & electric, FDC, Knox, entered into IAR and positioned correctly?

  Yes

  No

  N/A

• Was a rough stretch of the facility showing all rooms, doors and direction of swing, HAZMAT locations, windows, electrical and gas shut off, and any other hazards obtained?

  Yes

  No

  N/A