Residential Preplanning

La Cueva Volunteer Fire Department Pre-Emergency Planning Sheet

In order for the department to be best prepared to respond to an emergency at your residence, we request that you complete the form above and return it to us by mail or to a member.

Should we receive a 911 call to your property whether for a fire or medical emergency, we will be better prepared. For example, an obvious hazard would be running heavy fire trucks to a house fire without knowledge of the location of a buried propane tank or septic system. This knowledge will maximize everyone’s safety and minimize the damage to your property.

In addition to your name, address & contact numbers, please indicate the occupancy type (full-time resident, weekends, weekdays, summer only, etc.), type of construction and a sketch showing the location of access roads, septic tank & drain field, propane tank(s) and line, water well, overhead electric lines, power shut-off (outside or inside), bulk fuel storage, any other hazards such as: flammables, chemicals, ammunition, oxygen etc.

Information about hazards, construction, foundation, basement, power shut off, etc., is for firefighter safety.

The sketch below doesn’t have to be to scale, just a good representation; include any information that would assist the department. Consider that our response may be at night and possibly in smoky conditions.

Please note any special needs of which we should be aware in case of an emergency for a resident or potential guest.

This information will be kept confidentially at the fire department, and only used in the event of a response to the neighborhood.

Please have your address numerals posted near the road access to your property in reflective numerals so we can find it in an emergency.

The mailing address of LCVFD is: 122 Twisted Juniper, Jemez Springs, NM 87025

Thank you for your time on completing this important document!

La Cueva Volunteer Fire Department

DATE: _______

PROPERTY LOCATION: (circle one)

La Cueva Seven Springs Thompson Ridge Sierra de los Pinos Cochiti Mesa

Area 1 2 3 Other

ADDRESS: _____________________________________

Phone (at property): _______________________

OWNER’S NAME:____________________________________________________________

PHONE: ________________________________

Emergency #______________________________________

OWNER’S ADDRESS:_______________________________________________________________

OCCUPANCY TYPE: _______________________

SPECIAL HAZARDS:

______________________________________________________________________________

BUILDING DIMENSIONS (Approx.): Length__________ Width_________ Height_________

# Floors ______

BUILDING CONSTRUCTION: (circle all that apply)

Wood Frame Block Concrete Metal Other_________________________

ROOFING: Wood Composite Shingle Metal Concrete/Tile

Other __________________________

FLOOR CONSTRUCTION: Wood Concrete Other ________________________________

FOUNDATION: Slab Footings Piers

CRAWLSPACE? Yes No

BASEMENT? Yes No

If Partial Basement Give: Size_________ Location:____________________________

BASEMENT Windows? Yes No

In the space below, diagram your property; indicate, road/driveway , structures, septic location, propane tank, bulk fuel storage, overhead electrical lines, power shutoff, water well, which direction is north.