Residential Emergency Response Information


The Union Bay Volunteer Fire Department would appreciate each household in Union Bay to complete the following information. This data will be used to compile our Quick Response Fire Program. This program will enable rapid assessment of your property by the fire department in case of an emergency at that address.

Please help us by answering as many questions as possible and return the form as soon as possible. Fill out and email completed form. Thank you for your participation.

PERSONAL INFORMATION

Last Name:
First Name:
Residential Address:
Subdivision or Area Name:

House Number Location: On Dwelling  Other 
Number of People in Residence 
Is there any person that may have difficulty getting out of house in an emergency?  Yes, How many?   No

FIRE TRUCK ACCESS

Is there rear access to the property?  Yes  No
How long is the driveway? 
Width and depth of the property 

Can a fire truck turn around on your property?  Yes  No

Closest Fire Hydrant (Street Name and House number directly in front of hydrant: 

STRUCTURAL INFORMATION

Roof type: Asphalt  Wood  Metal  Other 

Do you have a chimney?  Yes  No

Chimney Type: Metal  Block  Brick 
Number of Levels in House (including basement) 
Do you have access to upper levels of the building from the exterior?  Yes  No
Where? 
Type of siding: 

HEATING

Electric  Wood  Propane  Wood/Electric  Oil 
Do you have a propane tank(s) or oil tank(s) on your property?  Yes  No
If yes, what size? 
How many feet from buildings? 
Location of Main Power Panel 
Location of Main Water Shutoff 
Any outbuildings on your property?  Yes  No
How far are outbuildings from the residence?

MISCELLANEOUS INFORMATION

Do you rent or lease property?  Yes  No
Please provide name of phone number of renter so we may contact them:
Name: 
Phone Number: 
Do you have an address or phone number that we can locate you in case you are not home?
 Yes  No
Address: 
Phone: 
Do you have any other residences (trailers, etc.) on your property?  Yes  No
Are they occupied?  Yes  No
If so, please supply their name and phone number:
Name: 
Phone: 

Do you have any substantial amount of chemicals, paints or fuels stored in or on your property, business, or residence?
 Yes  No
Any substance totaling more than 10 gallons or 20 litres please list:

Thank you, for your participation.