ADRIAN FIRE DEPARTMENT
Emergency Response Information
(Please copy and fill out one for each building on site)
Fax #: 264-2782
I
Date:
Phone:Building Name:
Address:
Owner:
Address:
Persons To Contact – List Nearest Person First (key holder):
Title:Name:
Phone: Cell: __________
Title:Name: Phone: Cell: __________
Title:Name: Phone: Cell: __________
Principal Occupancy:
Hydrant Locations: ______________________________________________________________
Entry Points:
Ventilation Points:
No Sprinkler System: Yes Type/Location:
No Standpipe System Yes Type/Location:
No Alarm System Yes
Name & Phone # of Alarm Company:
_______________________________________________
Supra Box: Yes No Location: _________________________________________
Utility Shutoff Locations
:
Water: Electric: Gas:
Night: Number of People in Building: Day:
Construction Type
: (check one)
Brick/Wood Wood Frame Masonry Fire Resistive Other
Roof Construction: (check one)
Tile: Shingle: Metal: Wood Shingle: Other: ____________________
Basement
: Yes No Type: _____________________
Access Points________________________________________________________________
# of stories__________ Square foot per floor_______________________________________
Other information: ____________________________________________________________
Type/Location:
