Presurvey Information Request

Presurvey Information Request

for

Fire Department Information

The North Carolina Department of Insurance is responsible for the certification and rating of the fire departments in North Carolina. An important part of the information North Carolina Department of Insurance provides to insurers is a community’s Public Protection Classification or a rating number.

The following questionnaire will assist the Office of State Fire Marshal rating inspector in calculating the grade for the fire department.

Your cooperation in completing this questionnaire prior to the Office of State Fire Marshal rating inspector arriving will greatly assist in expediting the survey as well as helping to ensure that your community receives full benefits of all credit to which it is entitled.

Apparatus / Equipment on Existing Engine Companies

· Maintenance & Equipment Check Sheets - The department shall provide the last 12 months of apparatus maintenance and equipment check off sheets for the first out Engine and Tanker.

o The check off sheets will be reviewed by the inspector at the time of the inspection, copies are not needed for the file

· Pump Test – The pump test must be complete and accurate and have been run within 12 months prior to the fire department inspection. The test should be run the full 40 minutes, form filled out and signed.

o The inspector will need copies of the last 3 years of pump test for the files.

· Hose Test – The inspector will review the 3 most recent hose tests.

o The inspector will not need copies of the hose tests for the files.

· Weight Tickets – Weight tickets from a certified scale showing the gross (full) weight of the firefighting apparatus are required. Apparatus must have been weighed within the last 12 months of the inspection. Weight tickets must be stamped and signed by the weight master.

o The inspector will need copies of the weight tickets for the files.

· GVW Plate: The apparatus shall be equipped with a GVW (gross vehicle weight) plate from the manufacture attached to the vehicle or official verification of the apparatus GVW.

· Equipment and Hose: The inspector will verify the equipment on board the firefighting apparatus using Exhibit # 2

· Aerial Ladder or Elevating Platform Test: The inspector will review the 3 most recent aerial ladder tests. They will also be reviewing the most current Non-Destructive test for the apparatus.

o The inspector will not need copies of the aerial / ladder tests for the files. Ground ladder test will not be reviewed.

· Inspection and Fire Flow Testing of Hydrants: The department shall provide the last 3 years of hydrant inspections and flow test for the inspector to review. This will include all static water points if applicable.

o The inspector will not need copies of these records for files.

· Static Water Points: If departments utilize any static water points for grading purposes the inspector will need copies of the following information at the time of the inspection. Complete exhibit # 7

§ Water Use Agreement

§ Engineers Verification of Water Point

§ Demonstration of Static Water Point

§ List of all the Static Water Points with the following information:

Street Address

Reference Number for the Water Point

Type of Water Point, Suction Point, Dry Hydrant

Longitude/Latitude

Automatic Aid (AA)

Complete an Automatic Aid Company Information Sheet (Exhibit 3) for ALL departments that are dispatched on first alarm response to structure fires.

Ladder / Service Companies

Needed Ladder / Service Companies

(Complete information for each existing station if more than 6 station make copies of this sheet)

1. Station __ Response Area