Occupancy Pre-plan Report

• Document No.

• Navajo Nation Fire Department POBox 3360 Window Rock, AZ (928)871-6915

  Select Fire Station 10 Fire Station 12 Fire Station 40 Fire Station 50 Fire Station 80 Fire Station Twin Arrows

  • Fire Station 10
  • Fire Station 12
  • Fire Station 40
  • Fire Station 50
  • Fire Station 80
  • Fire Station Twin Arrows

• Audit Title

• Client / Site

• Add media

  Media
• ADDRESS:
  Address

• Conducted on

  Date

• Prepared by

BUILDING CONTACTS:

• Building Occupant Name & Phone:

• Facility Manager Name & Phone:

• Facility Manager Name & Phone:

• Property Owner & Phone:

EMERGENCY CONTACTS - After Hours

• Primary Contact:

• Alternate Contact:

FIRE DEPARTMENT ACCESS

• FAP Location:

• Take Photo:

  Media

• FAP Key:

• Take Photo:

  Media

BUILDING INFORMATION

• Property Use:

• Hours of Operation:

• Occupant Load:

• Building Lengh:

• Building Width:

• TOTAL AREA:

• Number of Stories Above Ground:

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Number of Stories Below Ground:

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Type of Construction:

  I Fire Resistive

  II Protective Noncombustible

  III Unprotected Noncombustible

  IV Heavy Timber

  V Ordinary Contruction

• Structure Type:

• Type:

  Select Enclosed Building Fixed Portable/Mobile Structure Open Structure Connective Structure Structure Type, Other

  • Enclosed Building
  • Fixed Portable/Mobile Structure
  • Open Structure
  • Connective Structure
  • Structure Type, Other

• Building Status:

• Status:

  Normal Use

  Vacant & Unsecured

  Vacant & Secured

  Under Construction

  Abandon

• Roof Covering:

  Select Tile Composite Shingles Wood Shingles Metal Built-Up Other Not Determine

  • Tile
  • Composite Shingles
  • Wood Shingles
  • Metal
  • Built-Up
  • Other
  • Not Determine

• Points of Entry:

  Select North South East West

  • North
  • South
  • East
  • West

• Exposures:

  Select North South East West

  • North
  • South
  • East
  • West

Fire Detection Devices

• Smoke Detectors:

  Yes

  No

  N/A

• Heat Detectors:

  Yes

  No

  N/A

• Other Detectors/System:

  Yes

  No

  N/A

• Type of Detector/System:

Fire Suppression:

• Sprinklers:

  Yes

  No

  N/A

• FDC Location:

• Standpipe:

  Yes

  No

  N/A

• FDC Location:

• GPM Required for 25% involved in fire: formula- Length x Width = Divided by 3 x #of Stories x .25 = GPM

• GPM Required for 50% involved in fire: formula- Length x Width = Divided by 3 x #of Stories x .50= GPM

• GPM Required for 75% involved in fire: formula- Length x Width = Divided by 3 x #of Stories x .75 = GPM

• GPM Required for 100% involved in fire: formula- Length x Width = Divided by 3 x #of Stories = GPM

• Fire Hydrant #1 Location/Distance from building:

• Hydrant Class:

  Red >500 GPM

  Blue 1500> GPM

  Green 1000-1500 GPM

  Orange 500-1000 GPM

• Steamer Port Size:

• Fire Hydrant #2 Location/Distance from building:

• Hydrant GPM Rating:

  Red >500 GPM

  Blue 1500> GPM

  Green 1000-1500 GPM

  Orange 500-1000 GPM

• Steamer Port Size:

• Fire Hydrant #3 Location/Distance from building:

• Hydrant GPM Rating:

  Red >500 GPM

  Blue 1500> GPM

  Green 1000-1500 GPM

  Orange 500-1000 GPM

• Steamer Port Size:

• Fire Hydrant #4 Location/Distance from building:

• Hydrant GPM Rating:

  Red >500 GPM

  Blue 1500> GPM

  Green 1000-1500 GPM

  Orange 500-1000 GPM

• Steamer Port Size:

• Storage Tanks:

  Select Yes No Vertical Horizontal In Ground Above Ground

  • Yes
  • No
  • Vertical
  • Horizontal
  • In Ground
  • Above Ground

• Capacity:

• Construction:

• Content:

• Kitchen Hood System:

  Yes

  No

  N/A

• Type of Agent:

• Number of Heads:

• Dry Chemical System:

  Yes

  No

  N/A

• Halon System:

  Yes

  No

  N/A

• Location of Bottles/Shut-Off:

Utilities Shut-Off Location: describe the exact location.

• Electricity Shut-Off:

• Take Photo:

  Media

• Gas Shut-Off:

• Take Photo:

  Media

• Water Shut-Off:

• Take Photo:

  Media

• PIV Shut-Off:

• Take Photo:

  Media

Hazardous Materials: NFPA 704 Fire Symbol

• Take Photo:

  Media

• Hazard:

• Fire:

• Radiative:

• Special:

• Physical State Stored:

  Pure

  Mixture

  Soild

  Liquid

  Gas

• Hazard:

  Select Fire Pressure Reactive Acute Chronic

  • Fire
  • Pressure
  • Reactive
  • Acute
  • Chronic

• Inventory:

  Select 0-99 100-99 1,000-9,999 10,000-99,999 100,000-999,999 1,000,000+

  • 0-99
  • 100-99
  • 1,000-9,999
  • 10,000-99,999
  • 100,000-999,999
  • 1,000,000+

• Storage Type:

• Areas Of Concern:

• Reportable Chemical Storage:

  Yes

  No

  N/A

• Type:

• Take Photo:

  Media

Elevator:

• Elevator Present:

  Yes

  No

  N/A

• Elevator Fire Key Location:

• Elevator Control Room:

• Type of Elevator:

Additional Information:

• Additional Information:

• Draw if needed:

  Drawing

• Picture if needed:

  Media

Signature of Inspector and Business Representive:

• Inspector:

  Sign

• Business Representive:

  Sign