Owner/Manager/Maintainer:

Below you will find the questionnaire that we utilize for building pre-incident planning. This will enable us to perform efficiently if an emergency should arise. Pre-incident planning is the process of gathering and recording information that could be critical for public safety personnel making life-saving decisions at an incident, such as a fire, terrorist attack, or natural disaster. Property and lives can be saved when the Incident Commander has access to this critical information about the building and its contents. Please provide us with a floor by floor lay out. They can be sent electronically by using the uploader at the bottom of the form, via email or mailed to us at P.O. Box 1440, California, MD 20619.

If you have any questions, please feel free to contact us at (For Lexington Park area) Station3PrePlan@bdvfd.org or (For California area) Station9PrePlan@bdvfd.org.

We have also included KnoxBox information and applicable ordering process on the KnoxBox webpage.

Respectfully,

Keith Bussler
Deputy Fire Chief 3
Lexington Park Station
301-737-0654
Station3PrePlan@bdvfd.org

Nick Harrison
Deputy Fire Chief 9
California Station
301-863-8790
Station9PrePlan@bdvfd.org

Indicates Required Field

Please complete this worksheet for your business. If the business has multiple buildings, please fill out a work sheet for each building.
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.
We would like to follow-up annually via a phone call to determine if any substantial changes have been made
Basic Business Information
Business Name:
Physical Address:
City:
State:
Zip Code:
Business Phone:
Contact Name:
Hours of Business:
Emergency Contact Information
Emergency Contact #1:
Phone Number:
Emergency Contact #2:
Phone Number 2:
About Your Facility
If Residential, Number of Living Units:
Number of Employees or Occupants:
Number of Handicapped/ Special Needs:
Length:
Width:
Square Footage:
Does the building have a basement:		Select Below Yes No
If the building has a basement, does it have an outside entrance? If so, Where:
Height (In Stories):
Approximate Number of Occupants during normal Business Hours:
Type of Alarm System(s) - Check ALL that Apply:		None Burglar Carbon Monoxide Fire Heat Other Smoke
If OTHER, Please Specify:
Location of Fire Alarm Panel:
Location of Enunciator Panel:
Alarm Power Supply:		Select Below Battery Wired Wired w/Battery Back Up
Manual Pull Stations:		Select Below Yes No
Alarm Connected to Phone Line for Reporting? :		Select Below Yes No
Alarm Company:
Alarm Company Phone Number:
Building Power:		Select Below Single Phase Three Phase
Location of Breaker Panel:
Sprinkler System:		Select Below Yes No
Location of Sprinkler System Room:
Stand Pipe System:
Fire Department Connection (FDC):		Select Below Yes No
Location of FDC:
Type of Gas:		Select Below None Natural Gas Propane
Location of Gas Shut off (If equipped):
HVAC unit Location:
A/C unit Location:
Heating unit Location:
Access to the roof:		Select Below Yes No
Location of roof access (If present):
Elevator:		Select Below Yes No
Number of Elevators:
Elevator(s) Location:
Type of Elevator:		Select Below Hydraulic Cable Driven
Special Hazards (Explosives, Chemicals, Etc.):
KNOX BOX
Do you have, or would you consider purchasing a secure Knox Box to provide keyed access for fire/EMS response? :		Select Below Would Purchase Would Not Purchase Already Installed
Location of Knox Box (If present):
Attachments
Please provide any phototgraphs, diagrams or information that could be used.:		Add files...
If your business would like to know more about or purchase a Knoxbox, visit www.knoxbox.com or click on the link. In general we recommend a 3200 series box unless a larger box is needed. You can also visit our website for information on KnoxBox.