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North Carolina Response Rating System
Community Risk
Communication
Fire Department
Water Supply
Pre Survey Package
Rating Inspection Check Sheet This sheet is to assist the fire department tracking the progress of completing the field worksheets
Completed Task Page Responsible Person
Contact information completed with phone numbers and email address 1,2,3
Fire station(s) location information completed 4,5
Map of district with station locations, hydrants and static water points 4,5
Tax ID number 7
Charter and amendments if this applies 7
Documentation the dept. is part of municipal government, if applies this 7
All current contracts for fire protection 7
Current Automatic Aid Agreements, if this applies 7
Confirmation of Current Workman’s Comp insurance coverage 7
Most current approved map including approval documentation 7
Population, Square Miles and Total Alarms 8
Turnout Gear inventory 8
Pager and Radio information 8
12 pervious months of maint. and equip. check sheets for 1st out apparatus 9
Three most recent years of Pump Test 9
Three most recent years of Hose Test 9
Most Current Weight Tickets 9
Apparatus and Equipment Sheets completed for all fire apparatus Exhibit 2
Three most recent years of Aerial Testing 9
Three most recent years of hydrant and water point inspections 9
Hydrant Flow tests conducted within the last 5 years 9
Apparatus Response Procedures or Response Plans 10
Structure fire response sheet completed 11
Automatic Aid response sheet completed 12
Staffing sheet completed 13
Training information, including EXHIBIT 3 completed 14 Exhibit 3
Pre-Plans for review 14
Standard Operation Procedures/Guidelines 14
Automatic Aid sheets completed 15 Exhibit 4
Water supply forms completed 17
Alternate water supply information completed, if this applies 19,20
Static water point form completed, if this applies Exhibit 5
Community Risk forms completed 21-24
North Carolina Response Rating Schedule Inspection Worksheets
Date of Inspection _______________________________________
Fire District Name _______________________________________
Department Name _______________________________________
Mailing Address _______________________________________
County (s) served _______________________________________
Department Phone _______________________________________
Department Fax _______________________________________
1
Contacts
Fire Chief Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
Board President Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
Fire Marshal (Complete an entry for each jurisdiction served by the department) Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
Fire Marshal (Complete an entry for each jurisdiction served by the department) Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
Mapping or GIS Contact Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
Rating Inspection Work Sheet
2
Contacts
County Manager (Complete an entry for each jurisdiction served by the department) Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
County Manager (Complete an entry for each jurisdiction served by the department) Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
City Manager or Mayor (Complete an entry for each jurisdiction served by the department) Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
City Manager or Mayor (Complete an entry for each jurisdiction served by the department) Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
Other Contact Name ________________________ Phone Work ________________________ Title ________________________ Phone Mobile ________________________ Organization ________________________ Fax ________________________ Address ________________________ E-mail ________________________ City ________________________ State____ Zip ____________
Rating Inspection Work Sheet
3
Fire Station Locations
Physical Address Station 1: __________________________ Latitude ____________ N Longitude ____________ W
__________________________ __________________________
Station Size _____________ Year Constructed ________ Type of Construction______________
Number of Bays ____ Heated: Yes No Emergency Power: Yes No If yes, documentation of the testing should be available for review
Department Personnel: On Duty On Call Combination
Physical Address Station 2: __________________________ Latitude ____________ N Longitude ____________ W
__________________________ __________________________
Station Size _____________ Year Constructed ________ Type of Construction______________
Number of Bays ____ Heated: Yes No Emergency Power: Yes No If yes, documentation of the testing should be available for review
Department Personnel: On Duty On Call Combination
Physical Address Station 3: __________________________ Latitude ____________ N Longitude ____________ W
__________________________ __________________________
Station Size _____________ Year Constructed ________ Type of Construction______________
Number of Bays ____ Heated: Yes No Emergency Power: Yes No If yes, documentation of the testing should be available for review
Department Personnel: On Duty On Call Combination
Physical Address Station 4: __________________________ Latitude ____________ N Longitude ____________ W
__________________________ __________________________
Station Size _____________ Year Constructed ________ Type of Construction______________
Number of Bays ____ Heated: Yes No Emergency Power: Yes No If yes, documentation of the testing should be available for review
Department Personnel: On Duty On Call Combination
Use WGS 84 Coordinates, decimal degrees Example 35.56738 N - 79.6532 W
Rating Inspection Work Sheet
4
If a department should have more than 8 station complete Exhibit 1
Fire Station Locations
Physical Address Station 5: __________________________ Latitude ____________ N Longitude ____________ W
__________________________ __________________________
Station Size _____________ Year Constructed ________ Type of Construction______________
Number of Bays ____ Heated: Yes No Emergency Power: Yes No If yes, documentation of the testing should be available for review
Department Personnel: On Duty On Call Combination
Physical Address Station 6: __________________________ Latitude ____________ N Longitude ____________ W
__________________________ __________________________
Station Size _____________ Year Constructed ________ Type of Construction______________
Number of Bays ____ Heated: Yes No Emergency Power: Yes No If yes, documentation of the testing should be available for review
Department Personnel: On Duty On Call Combination
Physical Address Station 7: __________________________ Latitude ____________ N Longitude ____________ W
__________________________ __________________________
Station Size _____________ Year Constructed ________ Type of Construction______________
Number of Bays ____ Heated: Yes No Emergency Power: Yes No If yes, documentation of the testing should be available for review
Department Personnel: On Duty On Call Combination
Physical Address Station 8: __________________________ Latitude ____________ N Longitude ____________ W
__________________________ __________________________
Station Size _____________ Year Constructed ________ Type of Construction______________
Number of Bays ____ Heated: Yes No Emergency Power: Yes No If yes, documentation of the testing should be available for review
Department Personnel: On Duty On Call Combination
Rating Inspection Work Sheet
5
Rating Inspection Work Sheet
Mapping
The departments will be required to provide a computer generated map with the following information.
• Maps must be labeled with the appropriate Fire District name• Maps must have a scale printed on the map, with 1” = 1,200’ the preferred scale,• The fire station physical location(s),• Road base with road names,• All pressure hydrants plotted• All static water points plotted and identified with ID number• Maps must include the Response District boundary of the Department• Maps must include the five-mile insurance district boundary line• Maps must include the total road miles located within the five-mile district, with no overlapping of
roadways between this station and any other station or Fire District. Do not include interstatehighways when calculating total road miles. Round all mileages to the nearest tenth mile.
The following information is needed if the GIS Department has the software capable of producing this data.
• Total road miles within 1-1/2 miles of each station, within the five-mile district and with nooverlapping of roadways between this station and any other station or Fire District. Round all mileagesto the nearest tenth mile.
• Total road miles within 2-1/2 miles of each station, within the five-mile district and with nooverlapping of roadways between this station and any other station or Fire District. Round all mileagesto the nearest tenth mile.
• We would request the GIS department provide SHAPE FILES for the fire district. The file shouldinclude Station Locations, Approved response district boundary line, 5-mile fire district line, hydrantlayer and static water point layer.
The inspector will be glad to talk with the GIS person if they should have any questions concerning the mapping requirements.
6
Governmental Information
Services Provided: Fire Rescue EMS First Responder
The following items must be available for review at the time of the inspection
____ Fire Department Tax ID Number or FEIN Number: _______________________________
____ Charter and Amendments for the rural fire protection district (s)
Date of Original Charter: ____________ Date (s) of Charter Amendments: ____________ ____________ ____________ ____________
(If applicable)
____ Municipal departments must provide documentation that the department is part of the Municipal Government
____ All contracts in place for fire protection services rendered, complete, signed and dated
____ All Automatic Aid Contracts in place for fire protection services
____ Confirmation of Workman's Compensation Insurance currently enforced
District Funding and Tax Rate ____ General Fund Service District Rural Fire Protection District Tax Rate______
County Contracts and County Maps
Current GIS Map - or – Current NC DOT Map and Written Description
County Map Approval Date Date of Contract Aut
Yes No
Yes No
Yes No
Yes No
Municipal Contracts Town or City in which the district provides protection
City or Town Date of Contract
Automatic Aid
Rating Inspection Work Sheet
7
___ ___ ___
General Fire Department Information Demographics If a Rural District contains a Municipality within its boundary and the districts are graded by different Methods (ex: Method 3 for a Rural District & a Method 1 for a Municipal District), complete the Demographic information for both Districts, otherwise just complete for the Rural District
Population of Rural District ______ Population of Municipality City or Town ______
Square Miles of Rural District ______ Square Miles of Municipality City or Town ______
Total Road Miles in 5 Five Mile Rural District ______ Total Road Miles in the Municipality ______
Road Miles with 1 ½ Miles of Road Miles with 2 ½ Miles of Number of 3 Story Buildings Station 1 ______ Station 1 ______ Station 1 ______
Station 2 ______ Station 2 ______ Station 2 ______
Station 3 ______ Station 3 ______ Station 3 ______
Station 4 ______ Station 4 ______ Station 4 ______
Station 5 ______ Station 5 ______ Station 5 ______
Station 6______ Station 6 ______ Station 6 ______
Station 7 ______ Station 7 ______ Station 7 ______
Station 8 ______ Station 8 ______ Station 8 ______
Alarms
Total Number of all Alarms ______ Year ______
Communications
Number of Pagers ______ Number of Portable Radios ______ Number of Mobile Radios ______
Method(s) of Alarm Receipt for Members Responding
Radio Pagers Station Radios Voice Amplification
Printer / Fax Telephone Siren, Other Outside Warning Device
Protective Clothing
Total # Coats: ________ Total # Bunker Pants: ________
Total # Helmets: ________ Total # Pr. Gloves: ________
Total # Pr. Boots: ________ Total # Hoods: ________
8
___ ___ ___
___ ___ ___
Apparatus and Equipment
The information below will be reviewed during the inspection.
_____ Maintenance & Equipment Check Sheets - The department shall provide the previous 12 months of apparatus maintenance and equipment check off sheets for the first out Engine and Tanker. The check sheets will be reviewed by the inspector at the time of the inspection, copies are not needed
_____ Pump Test – The pump test must be complete accurate and have been conducted within 12 months prior to the fire department inspection. The test should be run the full 40 minutes, form filled out and signed. The last 3 years of pump test records will be reviewed by the inspector at the time of the inspection, copies are not needed
Frequency of Test: 1 Year ____ 2 Year ____ 3 Year ____ 4 Year ____ 5 Years or Greater ____
_____ Hose Test – The inspector will review the 3 most recent hose tests.
The last 3 years of hose test records will be reviewed by the inspector at the time of the inspection, copies are not needed
Frequency of Test: 1 Year ____ 2 Year ____ 3 Year ____ 4 Year ____ 5 Years or Greater ____
_____ Weight Tickets – Weight tickets from a certified scale showing the gross (full) weight of the firefighting apparatus are required. Apparatus must have been weighed within the last 12 months of the inspection. Weight tickets must be stamped and signed by the weight master. The weight tickets will be reviewed by the inspector at the time of the inspection, copies are not needed
_____ GVW Plate: The apparatus shall be equipped with a GVW (gross vehicle weight) plate from the manufacturer attached to the vehicle or official verification of the apparatus GVW.
_____ Equipment and Hose: The inspector will verify the equipment on board the firefighting apparatus using Exhibit # 2
_____ Aerial Ladder or Elevating Platform Test: The inspector will review the 3 most recent aerial ladder tests. They will also be reviewing the most current Non-Destructive test for the apparatus. The inspector will not need copies of the aerial/ladder tests. Ground ladder test will not be reviewed.
Frequency of Test: 1 Year ____ 2 Year ____ 3 Year ____ 4 Year ____ 5 Years or Greater ____
_____ Inspection and Fire Flow Testing of Hydrants: The department shall provide the last 3 years of hydrant inspections and flow test records for the inspector to review. This will include all static water points if applicable.
The inspector will not need copies of these records.
Frequency of Test: 1 Year ____ 2 Year ____ 3 Year ____ 4 Year ____ 5 Years or Greater ____
Rating Inspection Work Sheet
Exhibit 2, Apparatus Sheet must be completed for each apparatus
9
Apparatus Response Procedures
Response Combination Considered
Apparatus Unit Numbers
Zone 1 Residential Fire Alarm Commercial Fire Alarm
Residential Structure Fire Commercial Structure Fire
Zone 2 Residential Fire Alarm Commercial Fire Alarm
Residential Structure Fire Commercial Structure Fire
Zone 3 Residential Fire Alarm Commercial Fire Alarm
Residential Structure Fire Commercial Structure Fire
Zone 4 Residential Fire Alarm Commercial Fire Alarm
Residential Structure Fire Commercial Structure Fire
Zone 5 Residential Fire Alarm Commercial Fire Alarm
Residential Structure Fire Commercial Structure Fire
Zone 6 Residential Fire Alarm Commercial Fire Alarm
Residential Structure Fire Commercial Structure Fire
If your department has only 1 station and responds to all calls in a like manner, complete data for ZONE 1 only.
If your department has only 1 station but responds in a different manner to various areas (ex: Hydranted area vs. Non-Hydranted area, etc.), complete the data for each Zone needed to describe your responses needs.
If your department has multiple stations and responds in a different manner to multiple areas (ex: Ladder Co. to some portions & a Service Co. to others, etc.), complete the data for each Zone needed to describe your various response needs.
Rating Inspection Work Sheet
10
Structure Fire Response: Start by listing each of your fire apparatus below unit #. Then record your structure fire responses that took place in the last 12 months or the last 20 structure fires, we must have at least 5 structure fire listed if you have to go back further than 12 months. List the number of responding firefighting personnel and place an “x” below all the apparatus that responded on first alarm. Your list should only include your department’s structure fire calls in your district and not automatic or mutual aid calls to other districts. Do not include personnel who stand by or wait at the station until needed. DO NOT INCULDE AUTOMATIC AID RESPONSE ON THIS FORM
# Date 00/00/00
Time 24 hr.
Format
Number of Firefighters
On-Duty at the
station
Number of Firefighters
On-Call
When listing your apparatus list all the engines first, then ladders or service trucks. Tankers should be listed last
Unit # Unit # Unit # Unit # Unit # Unit # Unit # Unit # Unit # Unit # Unit # Unit # Unit # Unit # Unit #
1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 16 17 18 19 20
Rating Inspection Work Sheet
11
Rating Inspection Work Sheet
Automatic Aid Fire Response:
# Date 00/00/00
Time 24 hr.
Format
List each Automatic Aid Fire Departments that responded on first alarm that is within 5 miles of your district line. List the number of responding firefighting personnel, indicate if personnel were on duty or on call. Do not include any personnel who was on standby at the station only personnel that responded should be listed on this from.
Auto Aid Dept Auto Aid Dept Auto Aid Dept Auto Aid Dept Auto Aid Dept Auto Aid Dept
Units On Call
On Duty Units On
Call On
Duty Units On Call
On Duty Units On
Call On
Duty Units On Call
On Duty Units On
Call On
Duty
1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 16 17 18 19
20
12
Department Membership and Staffing
Roster of department members: List all Officers, Drivers, Firefighters
Fire Force Members Fire Force Members
Chief Sergeants
Dep. Or Asst. Chief Drivers
Battalion Chief Firefighters
Captains Chief Aids
Lieutenants Non-Fire Force
Total Member
ON DUTY COMPANY PERSONNEL
On- Duty Strength
Day(s) Time Span Hours on Duty per Firefighter X Firefighters on
Duty X Days on Duty = Total Hours
X X =
X X =
X X =
X X =
X X =
X X =
X X =
X X =
X X =
X X =
TOTAL = Divided by 168 (hours in a week) 168
Average on Duty Deduct the following and show calculations
Vacation Time - Sick Time -
- On Duty Response =
Does the department have a minimum staffing policy: Yes ____ No _____
If yes, the department shall provide a copy for review at the time of the
inspection If yes, what is the minimum staffing level :_______________
Other Time Off
13
Rating Inspection Work Sheet
Training
For credit in the area of training the department must be able to provide documentation of the training and certification for each firefighter.
Facilities
Burn Building Yes ___ No ___
Drill Tower Yes ___ No ___ ____
Training Area Yes ___ No ___
If yes how many stories
If yes how many acres ____
If the department does not have a Training Facilities but the firefighters have trained at a facility in the last 12 months, list all the facilities that were used: _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________
Officer Certification How many of the departments Officers have their Fire Officer 1 certification or have had Chief’s 101 and one of the 12-hour National Fire Academy’s Leadership Classes. (Proof of Certification Required) _____
Recruit Training Per the departments policy how many hours of Recruit Training are required by the department the first 12 months for a new firefighter _____
New Driver Operator Training Per the departments policy how many hours of Driver Operator training are required by the department before a firefighter can drive an engine emergency traffic on a call. _____
Pre-Fire Planning Percentage of the completed per-plans of non-residential properties _____%
How offen are the per-plans updated _____
Operational Considerations Does the department have and utilize Standard Operating Procedures Guidelines? Yes ___ No ___
Does the department have and utilize an Incident Management System? Yes ___ No ___
Guidelines should include general emergency operations, including response of apparatus, operation of emergency vehicles, safety at emergency incidents, communications, apparatus inspection and maintenance, fire suppression, company operations, automatic operations, training, and personnel response.
Fire Department Must Complete Exhibit 3 for Training Credit
Complete an Automatic Aid Information sheet for all departments that provide Automatic Aid into your fire district, on first alarm basis, to structure fires. If the responding department has multiple stations which provide you Automatic Aid a sheet (exhibit 4) must be completed for each station that provides Automatic Aid.
Department Name _____________________________________________________________
Physical Address _______________________________________________________________
What is the distance from the Automatic Aid Station to your fire district line________ miles
List the Apparatus unit number of all units responding on a first alarm basis:
Engine (s) ______ / ______ Tanker (s) ______ / ______ /______ Ladder______ Other ______
Does the Automatic Aid department utilize the same communication center as your department Yes ____ No____
If you answer NO to the previous question:
Does the Automatic Aid department have common Mobile and Portable Radios communications with your department Yes____ No____
Does the Automatic Aid department have common Mobile or Portable Radios communications with your department Yes____ No____
What percentage of your fire district, on a first alarm basis does the Automatic Aid department provide coverage _______%
List the last four training sessions your department held with this Automatic Aid department:
Date Type of Training Hours
1. ____________ ________________________________________________ ______
2. ____________ ________________________________________________ ______
3. ____________ ________________________________________________ ______
4. ____________ ________________________________________________ ______
Rating Inspection Work Sheet
Exhibit 4, Automatic Aid Sheet must be completed for each station providing Automatic Aid
15
Individual Property Fire Suppression
Outside Aid Fire Companies
List at least 4 Engines Companies and 1 Ladder Company, within 15 miles, that could assist your department in the event of a large working fire. These apparatus can come from auto aid departments or can be from departments which wouldn't normally respond into your district on a first alarm basis.
Engine Companies
Distance from Fire Station to District Line
Pump Capacity Feet of 2 ½ “
or larger supply hose
Ladder Companies
Distance from Fire Station to
District Line
Length of Aerial Ladder or Elevated
Platform
Rating Inspection Work Sheet
16
Water Supply
1. Water System Name_________________________________________
Hydrant, Size and Type
Total number of hydrants and static water points ______
Number of hydrants with 2 – 2 ½” and 1 – 4 ½” outlet with 5 ¼” or larger barrel ______
Number of hydrants with 2 – 2 ½” and 1 – 4 ½” outlet with 4 ½” barrel ______
Number of hydrants on a 4-inch branch line or smaller OR any single 2 ½” hose outlet hydrant ______
Number of certified dry hydrants with 6” pipe or larger (certification documentation required for review) ______
Number of certified suction points (certification documentation required for review) ______
Pressure Hydrant and Static Water Point Inspection Program
Is there an inspection program Yes _____ No______
If yes, what frequency 1 Year ___ 2 Year ___ 3 Year ___ 4 Year ___ 5 Year ___ or greater
Are hydrants flushed during the inspection Yes _____ No ______
Are hydrants pressure tested during the inspection Yes _____ No ______
Pressure Hydrant and Static Water Point Flow Testing Program
Is there a flow testing program Yes _____ No ______
If yes, what frequency 5 years ___ 6 years ___ 7 years ___ 8 years ___ 9 years ___ 10 years or greater ___
Is a calibrated hydraulic modeling program used for this water system Yes _____ No ______ (certification documentation required for review)
Hydrant Marking System
Is there a hydrant marking system in place Yes _____ No ______
Exhibit 5 must be completed for all static water points
Rating Inspection Work Sheet
17
Water Supply
2. Water System Name_________________________________________
Hydrant, Size and Type
Total number of hydrants and static water points ______
Number of hydrants with 2 – 2 ½” and 1 – 4 ½” outlet with 5 ¼” or larger barrel ______
Number of hydrants with 2 – 2 ½” and 1 – 4 ½” outlet with 4 ½” barrel ______
Number of hydrants on a 4-inch branch line or smaller OR any single 2 ½” hose outlet hydrant ______
Number of certified dry hydrants with 6” pipe or larger (certification documentation required for review) ______
Number of certified suction points (certification documentation required for review) ______
Pressure Hydrant and Static Water Point Inspection Program
Is there an inspection program Yes _____ No______
If yes, what frequency 1 Year ___ 2 Year ___ 3 Year ___ 4 Year ___ 5 Year ___ or greater
Are hydrants flushed during the inspection Yes _____ No ______
Are hydrants pressure tested during the inspection Yes _____ No ______
Pressure Hydrant and Static Water Point Flow Testing Program
Is there a flow testing program Yes _____ No ______
If yes, what frequency 5 years ___ 6 years ___ 7 years ___ 8 years ___ 9 years ___ 10 years or greater ___
Is a calibrated hydraulic modeling program used for this water system Yes _____ No ______ (certification documentation required for review)
Hydrant Marking System
Is there a hydrant marking system in place Yes _____ No ______
Exhibit 5 must be completed for all static water points Exhibit 6 must be completed if the departments have more than 2 water systems
Rating Inspection Work Sheet
18
Alternate Water Supply Information
This information to be completed if a Fire District is being graded for a lower than class 9 rating and there are no recognized hydrants or certified water points with a 1000’ of any build upon area in the district.
What alternate method or methods of operation will be used in the Fire District.
Nurse Tanker ______ Drop Tank Operation ______ Hose Lay Operation over 1000’ ______ Other ______
Provide a brief description of the different methods that might be used by the fire department to provide a water supply during a structure fire in the district. The description should include information such as the number of tankers responding on first alarm, the method in which you plan to fill the tankers, how portable drop tanks will be used. If an extended hose lay operation is used, you must indicate the longest lay that will be needed and what equipment will be used in the operation.
The department must provide a description of a recent incident or training session where a certified water supply was more than 1,000 feet from the fire-site but 250 gpm or more was delivered continuously for more than one hour. Give the following information.
• Location of incident or training ____________________________________________________________• Date of fire or test ____________ • Number of water tankers used ____________ • Rate of flow delivered ____________ • Distance between the fire-site and the water supply site ____________ • Time duration where at least 250 gpm was able to be flowed continuously ____________
Rating Inspection Work Sheet
19
Alternate Water Supply Information
Apparatus Used During and Alternate Water Supply Operation
List all the apparatus that will be dispatched on first alarm response to a structure fire in the fire district.
Fire Scene Engines
Sta. # Unit # Pump
Capacity Tank
Capacity Drop Tank Capacity
Fill Site Engines
Sta. # Unit # Pump
Capacity Tank
Capacity
Tankers
Sta. # Unit # Tank
Capacity Drop Tank Capacity
Rating Inspection Work Sheet
20
Community Risk Reduction
Fire Prevention Code and Enforcement
Number of non-residential buildings within your inspection jurisdiction (If a county is doing inspections for a rural district they should include all the buildings in the county that they are responsible for inspecting) ____________
Fire prevention and Code Regulations
What fire prevention code is currently adopted by your jurisdiction ________________________
What edition of the adopted code is currently in effect ________________________
Fire Prevention Staffing Frequency of Inspections
Does the district use their own inspectors Yes ______ No _______
Enter the number of fire prevention inspectors _______
Enter the average yearly number of fire inspections completed over the past three years _______
Does the district use county fire prevention inspectors Yes ______ No _______
Enter the number of fire prevention inspectors _______
Enter the average yearly number of fire inspections completed over the past three years _______
Does the district use in-service personnel fire prevention inspectors Yes ______ No _______
Enter the number of fire prevention inspectors _______
Enter the average yearly number of fire inspections completed over the past three years _______
Fire Prevention Certification and Training
Fire Inspection Certification Enter the number of certified fire prevention inspector’s _______
Fire Prevention Inspector Continuing Education Is there a continuing education program for inspectors Yes ______ No _______
Enter the required number of continuing education hours per inspector per year. _______
Rating Inspection Work Sheet
21
Fire Prevention Programs
Plan Review What percentage of new nonresidential construction, including remodeling and additions, receive a plan review of fire prevention and fire suppression features _______%
Are records kept of all fire prevention inspections and used to document and track inspection activity Yes ______ No _______
Certificate of Occupancy Inspections
What percentage of new residential construction receives a fire prevention inspection prior to issuing the Certificate of Occupancy _______%
What percentage of new nonresidential construction receives a fire prevention inspection prior to issuing the Certificate of Occupancy _______%
Quality Assurance Program for Enforcement and Inspection Programs
Is there a Quality Assurance Program for fire prevention inspections Yes ______ No _______
How many inspectors participate in the Quality Assurance program _______
Code Compliance Follow-up What percentage of initial inspections, with violations, receives follow-up inspections to verify fire prevention code compliance _______%
Inspection of Private Fire Protection Equipment
What percentage of private fire protection equipment is inspected on a routine basis and in accordance with the adopted codes _______%
Fire Prevention Ordinances
Indicate which fire prevention ordinances below have been adopted: over and above the NC Building Code.
Ordinances Ordinance or Code Number Enforced
Fire Lane(s) ______________ Yes ______ No _______ Fireworks ______________ Yes ______ No _______ Hazardous Materials Route ______________ Yes ______ No _______ Wildland Urban Interface ______________ Yes ______ No _______ Weeds and Trash ______________ Yes ______ No _______ BBQ Grills ______________ Yes ______ No _______
Rating Inspection Work Sheet
22
Fire Department Training and Pre-Incident Planning Coordination
Yes ______ No _______ Is there a defined procedure to share information regarding fire prevention activities with training and pre-incident planning programs Public Fire Safety Education
_______ What is the number of certified fire safety educators
How many of the above Public Fire Safety Education personnel are trained in
Methods of Teaching _______
Fire Safety Education Continuing Education
Is there a required amount of continuing education hours per year Yes ______ No _______
If yes, enter the required number of continuing education hours per person per year. _______
Residential Fire Safety Program
What percentage of the population in the jurisdiction is reached with fire safety educational programs each year _______%
To receive credit in this area the department must provide documentation for review of fire education programs that have been offered in the last 12 months.
Yes ______ No _______
School Fire Exit Drills
Are the schools in the FPA conducting at least 1 fire drill per month during the
school session
If No, how many months is the school session and how many fire exit drills are they
conducting
Session length (in months) _______
Fire exit drills _______
Is developmentally appropriate classroom instruction presented on fire safety to all students in early childhood education Yes ______ No _______
If no, what is the percentage of students who received developmentally appropriate classroom instruction over the past three years ______%
Rating Inspection Work Sheet
23
Juvenile Fire Setter Intervention What percentage (averaged over the past three years) of juveniles identified as being involved in fire-play or fire-setting behavior are referred for intervention services _______%
Yes ______ No_______ Large Loss Potential Occupancies Does the fire department present fire safety education to all occupancies that have a large loss of life potential or hazardous conditions, such as high-rise buildings, hospitals, nursing homes, industrial facilities, other large commercial structures or community risk from wildfires
If no, what percentage of the properties like these in your jurisdiction do you reach with fire safety educational programs each year _______%
Fire Investigation
Fire Investigation Organization and Staffing
Is an agency established within the jurisdiction with responsibility to conduct fire Yes ______ No_______ cause investigations
Yes ______ No_______ Does the district utilize their investigators/SBI/County Fire Marshal Office/Local Law Enforcement to investigate suspicious fires
_______% According to the fire department procedures, what percentage of structure fires receive a cause and origin investigation
How many fire investigators are there _______
Fire Investigators Certification and Training
_______ How many existing fire investigators are certified as Basic Fire and Arson Investigator or higher following the criteria contained in NFPA 1033, Standard for Professional Qualifications for Fire Investigator
Fire Investigation Continuing Education Training
Is there a required amount of continuing education hours per year
If yes, enter the required number of continuing education hours per person per year.
Yes ______ No_______
_______
Use of the National Fire Incident Reporting System (NFIRS)
Does the department participate in the NFIRS program Yes ______ No_______
Rating Inspection Work Sheet
24
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