RECEIVING AND HANDLING FIRE ALARMS_3_

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					                           Pre-survey Information Request
                                         for
                    Fire Department Features for Fire Suppression

NORTH CAROLINA DEPARTMENT OF INSURANCE is responsible for the certification and
rating of fire departments in North Carolina. An important part of the information the NORTH
CAROLINA DEPARTMENT OF INSURANCE, OFFICE OF STATE FIRE MARSHAL
provides to insurers is a community’s Public Protection Classification (NORTH CAROLINA
RESPONSE RATING SYSTEM) number. The NORTH CAROLINA RESPONSE RATING
SYSTEM program evaluates community fire suppression delivery systems according to a
uniform set of criterion, incorporating nationally recognized standards developed by the National
Fire Protection Association.

Because a community’s investment in fire mitigation is a proven and reliable predictor of future
fire losses, insurance companies rely upon NORTH CAROLINA RESPONSE RATING
SYSTEM program to help establish fair premiums for fire insurance – generally offering lower
premiums in communities with better fire protection.

The NORTH CAROLINA OFFICE OF STATE FIRE MARSHAL conducts evaluations of fire
department’s fire suppression features as part of the NORTH CAROLINA RESPONSE
RATING SYSTEM program. This section of the review constitutes 50% of the available
NORTH CAROLINA RESPONSE RATING SYSTEM score for the community.

Following is a eight-page questionnaire. Please record as much of the information as possible on
these forms. For questions that are not applicable to your community, please indicate “Does not
apply” or “DNA”.

Some questions indicate that an exhibit is necessary and imply the file name (e.g., “Exhibit 2A –
5 – Outside Aid Agreement”) that should be used. This nomenclature will assist OFFICE OF
STATE FIRE MARSHAL in their survey.

Certain questions may need multiple answers. For example, question 13 asks questions about
automatic aid departments and provides the space to record the data for a single automatic aid
fire department. Communities may receive automatic aid from multiple departments. To
accommodate the entry of multiple providers, a form has been provided in Appendix A for
additional information. When additional forms are needed, it is anticipated that the number
needed will be copied by the community.

Your cooperation in assembling this information prior to the OFFICE OF STATE FIRE
MARSHAL visit will greatly assist in expediting the survey as well as helping to ensure that
your community receives all of the credit to which it is entitled. Answers may need to be
changed if forms are updated from past inspection data. Be sure all information is current and up
to date for each time these forms are used.


     North Carolina
Office of State Fire Marshal                                                Edition 12/26/06
                   Survey of the Fire Department Features for Fire Suppression

Name of Fire Agency:                                                    Date of Information:
Background Information
    1. Indicate the points of contact for the community officials:
         Chief Administrative Official:                                      Title:
          Email:                                                             FAX:
          Street:
          City, State, Zip:                                                        Phone:

           County Fire Marshal:
           Email:                                                            FAX:
           Street:
           City, State, Zip:                                                       Phone:

           Fire Chief:
           Email:                                                            FAX:
           Street:
           City, State, Zip:                                                 Phone:

           Name of contact person for questions regarding the contents of this form :
           Name:                                                             Title:
           Email:                                                             Phone:

           President of Board of Directors:
           Email:                                                           FAX:
           Street:
           City, State, Zip:                                                Phone:

 2. Indicate the current population of the fire district served by the fire department:
        Square miles served:                 sq mi                     Date of the information:
        Population:                   Source of information:        Census:        Estimated:
                                                                    Other:
        Date of the information:
     Please provide an exhibit to document this information (Exhibit 2A – 2 – Population/Area Served).
2A*. Total number of road miles in insurance district          Total paved roads           Total unpaved
    * Only needed if Method 3 or 4 Inspection
 3. Indicate the number of alarms your fire department received, by type, over the last calendar year or
     previous 12 months:
   a. Period of time of the information:
   b. Number of first alarm dispatches to structure fires:                    In city/district only
   c. Number of EMS dispatches:
   d. Number of all other dispatched calls:
   e. Total of all dispatched calls:
     Please provide an exhibit to document this information (Exhibit 2A – 3 – Incident Summary).




4     North Carolina
Office of State Fire Marshal                    Page 1 of 10                                Edition 12/27/07
Distribution of Engine Companies and Ladder/ Service Companies
    4. For the OFFICE OF STATE FIRE MARSHAL to evaluate the first-due fire company distribution as
       defined in the Fire Suppression Rating Schedule, the location of fire hydrants to represent developed
       or developing areas are used. The number of fire hydrants (Method 1 or 2), road miles (Method 3 or
       4) within 1½ road miles of existing engine companies and 2½ road miles of existing ladder/service
       companies are counted and compared to developed areas within the fire district but beyond 1½ road
       miles of existing engine companies and 2½ road miles of existing ladder/service companies. Where
       indications are that there are areas that have 50% or more of the number of fire hydrants contained
       within a comparable area with an engine company or ladder/service company, additional company
       locations may be needed. In order to evaluate this, please provide a scaled street map of the fire
       district with the fire hydrants located on it (Exhibit 2A – 4 – Response Map). Another important item
       to include on this map is the location and height (stories) of any buildings three or more stories in
       height. Also include on the map the location of neighboring engine companies and/or ladder service
       companies when they respond as part of a first-alarm automatic aid agreement. If Method 3 or 4 all
       auto aid tankers station locations or mileage to district line also needs to be included. The map scale
       should be 1” = 1,000 feet or 1,200 feet.


    5. Does the fire district engine company(s) respond on first alarms to areas outside of their jurisdiction?
           Yes:        No:
       If the answer to the above question is yes, please indicate:
      a. Is there an automatic aid agreement or contract with each of these areas?              Yes:        No:
      b. What percent of the fire district’s annual fire alarms are outside of the jurisdiction?                %
      c. Indicate the number of engine companies that respond on first alarm incidents outside of the
           jurisdiction:               engine companies
       Please provide an exhibit of any contract, agreement, or administrative arrangement (Exhibit 2A – 5 –
       Outside Aid Agreement).


    6. Does the fire district ladder/service company(s) respond on first alarms to areas outside of their
           jurisdiction?      Yes:       No:
       If the answer to the above question is yes, please indicate:
      a. Is there an automatic aid agreement or contract with each of these areas?                Yes:      No:
      b. What percent of the fire district’s annual fire alarms are outside of the jurisdiction?                   %
      c. Indicate the number of ladder/service companies that respond on first alarm incidents
           outside of the jurisdiction:          ladder/service companies
       Please provide an exhibit of any contract, agreement, or administrative arrangement. (Exhibit 2A – 5–
       Outside Aid Agreement)
    7. Show the scheduled first alarm responses to all reported fires in buildings by fire station response zones,
       box areas or compass points. Use the “Apparatus Response” form found in Appendix A.


    8. Indicate the percent of the total number of annual first alarm responses to reported fires in
       structures in your jurisdiction that are less than:
      a. two engine companies:                        %
                Provide an explanation for responses of less than two engine companies:

       b. one ladder/service company:             %
                Provide an explanation for responses of less than one ladder/service company:


4     North Carolina
Office of State Fire Marshal                      Page 2 of 10                                    Edition 12/27/07
Apparatus and Equipment
    9. Show each existing pumper location, tools and equipment carried, hose carried, and test information.
       Use the “Apparatus and Equipment” form found in Appendix A. Note that the OFFICE OF STATE
       FIRE MARSHAL credits equivalencies to many of the equipment items. See the “Equipment
       Equivalencies List” in Appendix A.


10. Are hose tests conducted in accordance with the applicable NFPA Standards?            Yes:       No:
    Please provide an exhibit to document the hose test information (Exhibit 2A – 10 – Hose Tests). For
    NC RRS purposes, the exhibit should indicate by section of hose the size, the dates tested, the service
    test pressure, length of time of test, and whether it passed or failed.


11. Are apparatus tests conducted in accordance with the applicable NFPA Standards?       Yes:      No:
    Please provide an exhibit to document the apparatus test information (Exhibit 2A –11 – Apparatus
    Tests). For OFFICE OF STATE FIRE MARSHAL the exhibit for pump tests should indicate at a
    minimum - apparatus number or designation; apparatus manufacturer, year of manufacture, and
    Vehicle Identification Number (VIN); pump rated capacity; dates (month, day and year)of test; test
    capacity at 150psi, 200psi, and 250psi; and be signed. The exhibit for aerial device tests should
    indicate apparatus number or designation; apparatus manufacturer, year of manufacture, and Vehicle
    Identification Number (VIN); dates (month, day and year) of tests; non-destructive tests (every five
    years); and annual visual inspection, operational, load and water system tests.


Automatic Aid
12. Do you receive first-alarm responses to all reported structure fires in your jurisdiction, or portion
    thereof, from another fire department(s) and is it automatic ( not requiring from you
    any request for service or verification of need)?        Yes:       No:
    If the answer to the above question is yes, is the response according to a written agreement or
    demonstrated track record?         Yes:          No:
    Please provide an exhibit to document this information (Exhibit 9A – 13 – Automatic Aid Agreements).
    Demonstrated track records can be documented by fire incident reports, Computer Aided Dispatch
    system protocol, or dispatch running cards.
   a. Provide a scaled map to document the location of all automatic aid companies (Exhibit 2A – 12 –
        Automatic Aid Map). The map scale should be 1” = 1,000 feet or 1,200 feet.

If more than one Automatic Aid Department is to be considered please use separate forms for each
department. These can be found on the OSFM web site as NC RRS Automatic Aid Fire Department Forms.




4     North Carolina
Office of State Fire Marshal                  Page 3 of 10                                 Edition 12/27/07
     Automatic Aid
13. For each fire department providing automatic aid, please provide the following information:
    a. For the automatic aid companies that are within 5-road miles of the outer boundary of the area to
        which the response is required, please indicate the type and average number of personnel
        responding over the previous 12 month period of time:
          Name of Fire Department providing automatic aid:
          Company Name/No.                              On duty:                                 Volunteer:
          Company Name/No.                              On duty:                                 Volunteer:
          Company Name/No.                              On duty:                                 Volunteer:
          Company Name/No.                              On duty:                                 Volunteer:
          Company Name/No.                              On duty:                                 Volunteer:
    b. Is the fire apparatus dispatched on the initial alarm to a reported structure fire?     Yes:   No:
    c. Does the responding apparatus meet the general criteria of NFPA Standard 1901, “Standard on
        Automotive Fire Apparatus” including emergency lights and siren and, for apparatus
        used to pump water, a permanently mounted pump?                                        Yes:   No:
    d. Did the responding paid or volunteer automatic aid fire fighters receive a minimum of 12
        hours of structural fire fighting training within the last year?                       Yes:   No:
    e. Is each automatic aid structure fire apparatus housed in a building that protects it from the
        weather?                                                                               Yes:   No:
     f. Indicate how the automatic aid company receives its dispatch from the requesting agency:
          Dispatch from requesting agency by: Radio:            Alpha-numeric pager:       Telephone:
    g. Does the automatic aid fire department respond to all of the structure fire alarms received
        from the requesting agency?             Yes:       No:
   h. Does the automatic aid fire department dispatch their companies to the requesting agency’s
        structure fires by running cards or the equivalent?               Yes:     No:
   i. Provide an exhibit to demonstrate the frequency and duration of inter-departmental training
        (Exhibit 9A – 13 – Automatic Aid Training). For the last 12-months, indicate the companies
        involved; the subject of the training; the duration; type (e.g., hose evolutions, classroom, live fire,
        etc.); location; and date.
   j. Is there an inter-agency radio frequency capability that would permit communication
        between mobile apparatus?              Yes:       No:
        Is there an inter-agency radio frequency capability that would permit communication
        between portable radios?               Yes:       No:
   k. Is there a joint Communication/Dispatch Center that receives and dispatches all structure
        fire alarms?                           Yes:       No:
   l. For each automatic aid apparatus, show each existing apparatus location, tools and equipment
        carried, hose carried, and test information. Use the “Apparatus and Equipment” form found in
        Appendix A. Note that the OFFICE OF STATE FIRE MARSHAL credits equivalencies to many of
        the equipment items. See the “Equipment Equivalencies List” in Appendix A.

     For additional automatic aid information, please record the information on an attached page (see
     Appendix A).




4     North Carolina
Office of State Fire Marshal                   Page 4 of 10                                   Edition 12/27/07
    Personnel
    14. Please provide the total quantity and type of service for the positions indicated below:
           Position                                          Quantity/Type
           Chief              On-duty:               Volunteer:               Public Safety Officer:
           Deputy Chief       On-duty:               Volunteer:               Public Safety Officer:
           Assistant Chief On-duty:                  Volunteer:               Public Safety Officer:
           Battalion Chief On-duty:                  Volunteer:               Public Safety Officer:
           Captain            On-duty:               Volunteer:               Public Safety Officer:
           Lieutenant         On-duty:               Volunteer:               Public Safety Officer:
           Sergeant           On-duty:               Volunteer:               Public Safety Officer:
           Driver             On-duty:               Volunteer:               Public Safety Officer:
           Fire Fighter       On-duty:               Volunteer:               Public Safety Officer:
           Chief’s Aide       On-duty:               Volunteer:               Public Safety Officer:
           Non-fire Force On-duty:                   Volunteer:               Public Safety Officer:
                              On-duty:               Volunteer:               Public Safety Officer:
                              On-duty:               Volunteer:               Public Safety Officer:

         For additional positions, please record the information on an attached page (see Appendix A).


    15. Please provide the following existing (do not include vacant but budgeted for positions) company
        staffing

                                         On-Duty Membership                 Volunteer Membership
                           Fire      Company      Fire                  Company      Fire
            Company       Station    Officers   Fighters  Total         Officers   Fighters   Total




             TOTALS

         For additional personnel, please record the information on an attached page (see Appendix A).


    16. Does the department have a minimum staffing program in place with budgeted overtime to
        ensure that staffing levels are maintained?    Yes:         No:
            What is the minimum staffing level per day?             Personnel
        Please provide an exhibit to document the minimum staffing program (Exhibit 2A – 16 –
        Minimum Staffing Program).



4     North Carolina
Office of State Fire Marshal                  Page 5 of 10                                  Edition 12/27/07
    17.   Please provide the following information representing the yearly average for on-duty personnel:
          a. Average number of hours worked per week:                                    Hours
          b. Average number of personnel on-duty per day:
          c. Average number of personnel on vacation per day:
          d. Average number of personnel on holiday per day:
          e. Average number of personnel absent due to sickness per day:
           f. Average number of personnel absent due to details to non-fire
              suppression units per day:

    18. Please indicate how personnel are alerted to an emergency alarm:
        a. Number of on-duty staff that receive the alarm by: Station Radio:
                 Alphanumeric- pager:                  Voice-pager:              Portable radio:
                 Voice-amplification:                  Telephone:                Other:
        b. Number of volunteer staff that receive the alarm by:        Portable radio:
                 Voice-pager:                 Alpha-numeric pager:
                 Siren:                       Group-alert telephone:
                 Other:

    19. Please provide the following information for personnel that responded, on first alarm, to structural
        fire alarms within the jurisdiction during the previous 12 months, not to exceed 20 responses.
        Record, by company, the number that responded on each incident.
                                     V=VOLUNTEER, P=PAID ON DUTY
              Response Records                                  Company Name/Number
               Date     Time        Chief                                                          PV/Station
    Example    11/11/05     1321         1       4-P, 5-V       0       1-P, 2-V        3-V          2-P         4-V




                             Sum:

          Please provide the incident reports to document this information (Exhibit 2A – 19 – Personnel Fire Responses).
          For additional personnel, please record the information on an attached page (see Appendix A).
4     North Carolina
Office of State Fire Marshal                       Page 6 of 10                                       Edition 12/27/07
    Training
    20. Does the fire department have a training facility or have access to a regional training facility?
              Yes:     No:
        If the answer to the above question was yes, please provide the following information:
         a. What is the name of the facility?
         b. What is the location of the facility?
         c. Does the facility have a drill tower?                 Yes:     No:
                 i. What is the height if the drill tower?              Stories
         d. Does the facility have a fire building?               Yes:     No:
                 i. What is the construction type of the building?
                           Fire-resistive:        Joisted masonry or non-combustible:
          e. Does the facility have a flammable liquids pit?      Yes:     No:
                 i. What is the area of the flammable liquids pit?                sq. ft.
           f. Is multimedia training provided for tactics and strategies for extinguishment of flammable
               and combustible liquids fires?                     Yes:     No:
          g. How large are the training facility grounds?                 Acres
          h. Does the fire department have a training library? Yes:          No:
           i. Does the fire department provide multimedia training aids (e.g., CD, DVD, video tapes and
               players)                                             Yes:     No:
           j. Does the fire department provide pump cross-sectionals?          Yes:       No:
          k. Does the fire department provide hydrant cross-sectionals? Yes:              No:


    21. For each line personnel, provide training records for the previous 12 months that would include
        the personnel’s name, rank, and, for each training session, the date of the training, subject of the
        training, number of hours they attended the training session, whether it was a multi-company
        training exercise, and if the training was conducted at night (Exhibit 2A – 21 – Training Records).
        IF POSSIBLE PROVIDE ELECTRONICALLY. CONTACT YOUR INSPECTOR TO DISCUSS
        PROGRAM YOU HAVE YOUR TRAINING RECORDS IN.

    22. Does the fire department have a recruit training program or access to a regional recruit training
        program?       Yes:    No:
        If the answer to the above question is yes, please indicate the following:
          a. What are the number of hours of training per recruit?                hours
          b. What is the length of time allowed to complete the course?                 months
          c. What is the percent of recruits who participate in the training?              %


    23.   Provide a list of all courses attended by members of the department that were not included in
          question 21 during the previous 12 months. These may include classes provided by county,
          regional, or state training agencies, the National Fire Academy, etc. Indicate the number of hours
          for each class attended and provide copies of all certificates for these courses (Exhibit 2A – 23 –
          Outside Training).




4     North Carolina
Office of State Fire Marshal                   Page 7 of 10                                  Edition 12/27/07
     Pre-Fire Planning
     24. Does the fire department conduct pre-fire planning inspections for commercial, industrial,
         institutional, and other similar type occupancies? Yes:        No:
         If the answer to the above question is yes, please indicate the following:
           a. How many commercial, industrial, institutional, and other similar type occupancies
                are within your jurisdiction?                 Occupancies
           b. How many pre-fire plans have been developed?               0
           c. What is the frequency of pre-fire planning inspections?                 months
           d. What percent of the (total) fire company membership participates in the pre-fire planning
                inspections or training using pre-fire plans?            %
         Please provide the pre-fire plans for a minimum of five buildings. Also include records showing
         the dates of the pre-fire planning inspections and the names of the participants to document this
         information (Exhibit 2A – 24 – Pre-Fire Planning).

                               Auto-Aid/Mutual Aid Data Collection Sheet

                                  Miles
    Fire Department Name       Station from       Street(s) Enter       Pump        Feet of     Feet of        Number
    Apparatus Type & #         District line         District            Size      2.5” or 3    Larger           of
                                                                                    “ Hose       Hose          Ladders




4     North Carolina
Office of State Fire Marshal                   Page 8 of 10                                 Edition 12/27/07
Group the apparatus by station, and label the stations. Indicate each combination of planned responses to reported building fires by placing an X
in the appropriate column for each responding apparatus. Indicate under a new category (under “Area/Zone Responded To”) if the responses
vary due to location of fire (commercial, institution, residential, etc.), time of day, method of the receipt of the alarm, reported type of fire, etc.,

                                                    APPARATUS RESPONSE FORM

                                                                     Apparatus Responding From
                                                                               Station

    Area/Zone                                                   Engine (E) or Ladder/Service (L/S) Company
    Responded
       To




4     North Carolina
Office of State Fire Marshal                   Page 9 of 10                                    Edition 12/27/07

				
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