QFS WUI Structure Triage TFL. Form 19.11.16

• Fire Name/Number

• Evaluation No.

• Conducted on

  Date

• Task Force/Strike Team

• Task Force/Strike Team leader

• Prepared by

  Captain Hutchinson D.
• Location
  Address

• Triage Category

  Select 1 needs no work safety zone present 2 needs some work safety zone present 3 needs a lot of work no safety zone present 4 rescue drive by

  • 1 needs no work safety zone present
  • 2 needs some work safety zone present
  • 3 needs a lot of work no safety zone present
  • 4 rescue drive by

Check list

• Needed Resources

• Communications

• Radio channels

Safety Zone

• Safety zone Present

  Yes

  No

• Distance from location

  On site

  .5-1 km

  1-2 km

  Greater than 2 km or N/A

• Safety Zone access and size

  good (2+ pts of access more than 5 apparatus safely)

  moderate (2 ptsbof access less than 5 apparatus safely)

  poor (1 way in/out; low access fire vehicles)

  not available

Location

• Location type

  Subdivision close to town

  Subdivision away from town

  Rural

  Remote

Access

• Access

  more than 2 lanes each direction paved

  one lane each direction paved

  one lane each direction gravel

  less than one lane each direction gravel

• Bridges

  non combustible more than one lane each direction paved or N/A

  non combustible one lane each direction paved

  combustible one lane each direction

  combustible one way bridge

• Yes

  No

  N/A

Heli Spot

• Present<br>

  Yes

  No

  N/A
• Location
  Address

• Size

  Select Type 1 Type 2 Type 3 N/A

  • Type 1
  • Type 2
  • Type 3
  • N/A

• Address visable

  Yes

  No

• Driveway Condition

  greater than 6m wide improved with turn around or subdivision

  greater than 4m less than 6m wide improved with turn around

  greater than 4m less than 6m wide unimproved with turn around

  less than 4m unimproved without turn around

• Driveway Length

  less than 100m

  greater than 100m less than 200m

  greater than 200m less than 300m

  greater than 300m

• Grade

  0-5%

  5-10%

  10-15%

  Greater than 15%

• Water Source Present

  less than 20 m of location unlimited (lake, river or creek)

  20m - 40m of location unlimited ( lake, river or creek)

  up to 40m of location limited (pool, pond or hydrant)

  greater than 40m of location limited (pool, pond or hydrant)

• Location

  Alpha

  Bravo

  Charlie

  Delta

• Volume in gallons

• Draw site map

  Drawing

• Subdivision

  Yes

  No

  N/A

• Number of structures

• Primary

• Roof

  Non Combustible (metal, hardie board, stucco, brick)

  log construction

  Combination of non combustible and combustible

  natural wood/cedar siding or vinyl

• Roof litter

  Yes

  No

  N/A

• Siding

  Non Combustible (metal, hardie board, stucco, brick)

  log construction

  Combination of non combustible and combustible

  natural wood/cedar siding or vinyl

• Siding condition

  low, no ember traps

  moderate, has some ember traps

  high, many ember traps

  extreme, many ember traps and damaged or missing material

• Decking and or stairs

  concrete slab on grade or N/A

  raised less than 2m with non combustible materials

  raised less than 2m combustible materials

  multiple raised with combustible materials close to slope

• Actions Taken

  Select Mitigation Gel Foam Sprinkler House wrap

  • Mitigation
  • Gel
  • Foam
  • Sprinkler
  • House wrap

• Secondary

• Roof

  Metal, tile or non combustible

  Class A roofing (Asphalt or Fiberglass)

  Class A roofing in poor repair

  Cedar Shake or other combustible material

• Roof litter

  No roof litter

  Yes

• Siding

  Non Combustible (metal, hardie board, stucco, brick)

  log construction

  Combination of non combustible and combustible

  natural wood/cedar siding or vinyl

• Siding condition

  low, no ember traps

  moderate, has some ember traps

  high, many ember traps

  extreme, many ember traps and damaged or missing material

• Decking

  concrete slab on grade or N/A

  raised less than 2m with non combustible materials

  raised less than 2m combustible materials

  multiple raised with combustible materials close to slope

• Additional Hazards

  Select Wooden fence with gate Wooden fence without a gate Fire wood more than 5m from structure Firewood pile on deck or beside structure Propane tank greater than 10m from structure Propane tank beside structure Some Yard litter little or no hazard to responders Some yard litter posing some hazard to responders large amount of yard litter considerable risk to responders Overhead Power Vent screen missing or larger than1/4"

  • Wooden fence with gate
  • Wooden fence without a gate
  • Fire wood more than 5m from structure
  • Firewood pile on deck or beside structure
  • Propane tank greater than 10m from structure
  • Propane tank beside structure
  • Some Yard litter little or no hazard to responders
  • Some yard litter posing some hazard to responders
  • large amount of yard litter considerable risk to responders
  • Overhead Power
  • Vent screen missing or larger than1/4"

• Actions Taken

  Select Mitigation Gel Foam Sprinkler House wrap

  • Mitigation
  • Gel
  • Foam
  • Sprinkler
  • House wrap

Non- Combustible Zone 1A (0-5 ft)

• Combustible vegetation

  Veg no

  Low

  Moderate

  High

• Slope

  Flat

  0-10%

  10-20%

  Greater than 20%

• Aspect

  North

  East

  West

  South

Actions

• Select Mitigation Gel Foam Sprinkler House wrap

  • Mitigation
  • Gel
  • Foam
  • Sprinkler
  • House wrap

• Notes

• Add media

  Media

Zone 1 Vegetation (5-30+ ft)

• Combustible veg

  Veg no

  Low

  Moderate

  High

• Slope

  Flat

  0-10%

  10-20%

  Greater than 20%

• Aspect

  North

  East

  West

  South

Actions

• Select Thin trees Limb Trees Clean up debris Dig Guard Setup hose lay Setup sprinklers Foam combustible veg

  • Thin trees
  • Limb Trees
  • Clean up debris
  • Dig Guard
  • Setup hose lay
  • Setup sprinklers
  • Foam combustible veg

• Notes

• Add media

  Media

Zone 2 Vegetation (30 - 100+ ft)

• Combustible veg

  Veg no

  Low

  Moderate

  High

• Slope

  Flat

  0-10%

  10-20%

  Greater than 20%

• Aspect

  North

  East

  West

  South

Actions

• Select Thin trees Limb Trees Clean up debris Dig Guard Setup hose lay Setup sprinklers Foam combustible veg

  • Thin trees
  • Limb Trees
  • Clean up debris
  • Dig Guard
  • Setup hose lay
  • Setup sprinklers
  • Foam combustible veg

• Notes

• Add media

  Media

• Category

  1 needs no work safety zone present

  2 needs some work safety zone present

  3 needs a lot of work no safety zone present

  4 rescue drive by

• Hazard assessment
  
  0-25. Category 1
  25-50. Category 2
  50-75. Category 3
  75-100. Category 4

• Resource Request