ADMINISTRATION DIVISION AND FIRE PREVENTION DIVISION Fire Station #2 360 Laurier Blvd. Brockville, ON K6V 7J6 Tel. (613) 498-1261 Fax (613) 342-7791

FIRE DEPARTMENT

EMERGENCY 9-1-1

Pre-Fire Planning Questionnaire

What is the name of the business or building?

Name:

What is the property address?

Address:

Unit Number:

Postal Code:

Town:

Province:

Primary Phone:

Secondary Phone:

Fax:

E-Mail:

Website:

Building use:

☐Assembly

☐Institutional

☐Residential

☐Business

☐Personal Service

☐Mercantile

☐Industrial

☐Other

If other, please specify:

In case of an emergency, who is the primary contact/key holder?

First Name:

Last Name:

Position:

Primary Phone:

Secondary Phone:

E-Mail:

In case of an emergency, who is the secondary contact/key holder?

First Name:

Last Name:

Position:

Primary Phone:

Secondary Phone:

E-Mail:

Any additional key holders?

First Name:

Last Name:

Position:

Primary Phone:

Secondary Phone:

E-Mail:

Does the property have a Key Box (CHUBB)?

☐Yes

☐No

☐Not Sure

Does the property have a Master Key that will access all locations?

☐Yes

☐No

☐Not Sure

Does the property have an up to date tenant emergency contact list?

☐Yes

☐No

☐Not Sure

Is there on-site security/staff available?

24 Hours

☐Yes

☐No

☐Not Sure

Days

☐Yes

☐No

☐Not Sure

Nights

☐Yes

☐No

☐Not Sure

Weekends

☐Yes

☐No

☐Not Sure

What is the name of the security company (if applicable)?

Company Name:

Primary Phone:

Secondary Phone:

Email:

Does the property have a Fire Safety Plan?

☐Yes

☐No

☐Not Sure

Does the property have a Fire Alarm System?

☐Yes

☐No

☐Not Sure

If yes, is the Fire Alarm System monitored by an outside agency?

☐Yes

☐No

☐Not Sure

In case of emergency, what is the alarm monitoring agency contact information?

Company Name:

Primary Phone:

Secondary Phone:

Email:

Does the property contain any of the following Fire Suppression Systems?

Automatic Sprinklers

☐Yes

☐No

☐Not Sure

Fire Hose Cabinets

☐Yes

☐No

☐Not Sure

Extinguishing Systems

☐Yes

☐No

☐Not Sure

Does the property have any elevating devices (elevators/escalators)?

☐Yes

☐No

☐Not Sure