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Complete one form for each building.

We recommend that you print this information before you send it to us.

Contact Information:

Name:

Title:

Telephone Nr:

Fax Nr.

E-mail address:

Building Location:

Building Id:

If one does not exist, assign a unique one. 

Location Id:

If one does not exist, assign a unique one.

Check all that apply for each building:

Hazardous Materials:

Are there any hazardous materials?  No  Yes, what type:

Are they registered with the proper authorities:  Yes  No

Fire Protection:

Sprinklers  Smoke/sensor  Dry system  Fire extinguisher  Halon  Other:

Security:

Are there any areas of the building that are secured? Yes  No

Please list:  

Security company:

Operating hours:   After hours access: Yes  No

Security guard? Hours?

Card access   Keypad  Other:

Who has access in the event of an emergency?

Parking lot drainage:

On site  Public sewer  Stream or lake  None

Storage tanks:

Water  Oil  Diesel  Chemicals  Gasoline  None

Dumpster:

Recycling  Top open  Front open  Compactor  Number of dumpsters:  Dumpster Sizes:

List of know physical hazards:

Earthquakes  Hurricanes  Civil Unrest  Hail  Hazardous Materials  Forest Fires  Tornado   Flooding

Other:

Evacuation Procedures:

Site   Area   Handicapped    High-Security   Other: