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Aiken County HazMat Team - Preplan Form

11.0 PROCEDURE

11.1 Production and Occupancy

Facility Address __________________

Name, phone number of escort and main contact (i.e., Safety/F.D. representative from facility)

_______________________________________________________________________________

Location _______________________________________________________________________________

Description of the facility's functions________________________________________________________

Number of employees that occupy the facility and times.

Day Shift: # of People: ____________ Hours: ___________to ____________

Off Shift: # of People: ____________ Hours: ___________to ____________

Weekend: # of People: ____________ Hours: ___________to ____________

11.2 Construction Characteristics

(Obtain a current floor plan if possible)

Outside Dimensions: Height________ Width_______ Length________

Total square footage___________________(Indicate irregular dimensions on attached floor

plan.)

Number of Levels______________

Frame: Steel_______ Wood ________Combination_______________________________________

Foundation: Concrete slab, other____________________________________

Roof type: Pitched, Flat other_______________________________________

Roof Access: Location and type ________________________________________________________

Roof Construction: Metal Deck - Wood Deck - Concrete Deck - EPDM

ballasted - (Rubber membrane with gravel or crush covering) EPDM unballasted (Rubber membrane with no gravel or crush covering) Corrugated Metal – Corrugated Transite

Other_________________________________________________________________________________

Exterior walls: Transite - Concrete - Brick Veneer - Corrugated Metal Stucco –

Other_________________________________________________________________________________

Facility is: Regulated, Partially regulated, Non-regulated (circle one), by ___________________ (e.g., RCRA, Clean Air Act, NPDES, etc.)

Type Construction I I II VI V

Combustible or Noncombustible (Consult Uniform Building Code, Chapter 17)

Interior walls: Sheetrock - Transite - Fiberboard - Plyboard -Prefab Metal panel’s -Combination Other_________________________________________________________

Ceiling height __________ Dropped ceilings? Location,. Type and height____________________

11.3 Utility Valve / Switch Locations

11.3.1 Ventilation

Obtain assistance from building custodian.

Description of facility HVAC system (AC window units, re-circulating

system, once-through ,etc.) Important: Do not include units that are

compressors only.

__________________________________________________________________________________________________________________________________________________________________

Does the system have fire detection, if so what type and what auxiliary

functions operate when activated. _____________________________________________________

11.3.2 Power

Exterior main electrical disconnect location______________________________________________

Interior electrical disconnect location __________________________________________________

(Include disconnects for emergency generator and Un-interruptible Power Supplies if

applicable)_________________________________________________________________________________________________________________________________________________________

11.3.3 Gas

Type of gas and location Disconnect location

11.3.4 Process Lines

Location in facility, what type and location of disconnect

______________________________________________________________________________________

11.4 Rally Point

This facility's emergency rally point is located at alternate rally point is located at.

_______________________________________ ___________________________________________

11.5 Incident - Command Post

11.5.1 Primary

The primary command post is located ________________________________________________

11.5.2 Secondary

The secondary command post is located_______________________________________________

11.6 Communications During Emergencies

(If possible perform a radio survey, to determine the best channel for communications).

Can portable radios be used: Yes No Channel 1 or 2

Does the facility have a local PA system?: Yes No

How can it be accessed? (Provide phone numbers if applicable)

______________________________________________________________________________________

11.7 Unusual Hazards

Include location, quantity and description of all hazards. (e.g., 440v and over, chemicals, Radiological Controlled Areas, flammable liquids, flammable liquid cabinets, pressurized cylinders, excessive Class A materials, bulk chemical storage, etc.)

LOCATION HAZARDS RECOMMENDED ACTION

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________

Type and location:

11.8 Vital Exposure

Facilities that would affect the operation of the site should they also become involved in fire:

11.9 Fire Equipment

11.9.1 Inside (indicate location on floor plan)

Halon system – Yes No Coverage area:____________________________________________

Sprinkler system: Type and coverage area:_____________________________________________ ______________________________________________________________________________________________________________________________________________________________

Sprinkler riser(s) location:__________________________________________________________

OS&Y? – Yes No Location:_____________________________________________________

Standpipe(s)? Type & Location:____________________________________________________

______________________________________________________________________________________________________________________________________________________________

Detection system: Type and coverage area:____________________________________________

______________________________________________________________________________________________________________________________________________________________

Fire Alarm Panel - Location:________________________________________________________

(Do Not Indicate Location of Autoterms)

Pull Station(s) Fire Alarm – Yes No Location:

______________________________________________________________________________________________________________________________________________________________

11.9.2 Outside (Indicate location on floor plan)

Fire Hydrant # _________ is located approximately _________ feet from the _________

side of the facility.

Fire Hydrant # _________ is located approximately _________ feet from the _________

side of the facility.

Fire Hydrant # _________ is located approximately _________ feet from the _________

side of the facility.

Fire Hydrant # _________ is located approximately _________ feet from the _________

side of the facility.

P1 valve # _________ controls water flow to ____________________and is

located approximately ________ feet from the ________ side of the facility.

P1 valve # _________ controls water flow to ____________________and is

located approximately ________ feet from the ________ side of the facility.

Fire Dept. connection is located on the _________ side of the facility

Fire Department connection is located on the _________ side of the facility.

11.10 Resource Allocation

11.10.1 Sprinkler System Fire Flow

Designed sprinkler flow if applicable: __________ gpm at_________ psi

11.10.2 FloorPlan

Indicate the following items on the floor plan obtained from the facility or on the attached floorplan worksheet Incident Command posts, power ventilation, process and gas disconnects, facility dimensions, fire alarm pull stations,, hydrants, emergency lights, fire alarm panels, OS&Y valves, sprinkler risers and PWs. Indicate north on floor plan.

12.0 PREPLAN OBSERVATION PERFORMED BY:

__________________________________ Date: _________________________

13.0 ATTACHMENTS

None.