FVFD Pre-Planning Worksheet

Please complete this worksheet for your business or businesses.

Submitter's Name:
Submitter's E-mail Address:
(Note that the submitter does not need to be the same as the contact person listed below, but we will use the submitter's name and email if we have follow-up questions or comments about your data.)

Basic Business Info

Business Name:   Town/Township:
Physical Address:
City:   ZIP:
Business Phone:   Contact Name:

Emergency Contact Info

Emergency Contact 1:   Phone Number:
Emergency Contact 2:   Phone Number:

About Your Facility

Number of Buildings:   If Residential, Number of Living Units:
Number of Employees or Occupants:
Height (In Stories):   Square Footage:
Approximate Number of Occupants during Business Hours:
Type of Alarm System(s):   If "Other," specify:
Alarm Power Supply:
Manual Pull Stations: YesNo  Alarm Connected to Phone Line for Reporting? YesNo
Alarm Company:   Phone Number:
Power:   Sprinkler System: YesNo  Type of Gas:

Hours of Business:

Do you have, or would you consider purchasing a secure Knox Box to provide keyed access for fire/EMS response? Would PurchaseWould Not PurchaseAlready Installed

Please create or provide a map of your building(s), being sure to note the locations of the following items: entry doors, electric shutoffs, gas shutoffs, alarm panel, sprinkler shutoff, fire department sprinkler connection, water shutoff, manual alarm pull stations and the locations of specific hazards (greater than household amounts of chemicals, fuel storage, MSDS location, etc.). If you have an image file, Word doc or PDF of your map, you can upload it here. Otherwise, return it to FVFD Station 1 (200 Plum St., Frankton) or fax it to (765) 754-1124.

Notes: (Please include any additional hazards or information you feel is pertinent to facility access or fire suppression.)

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Thank you for using our electronic pre-plan worksheet! Someone from FVFD will be in touch if we have any questions about your information or to set up a site visit.