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The Colestin Rural Fire District is no longer operational. As a courtesy to our local community, this website will continue to be maintained on a limited basis and for a limited period of time; however, we are no longer liable for responding to fire calls, medical calls, or any other emergencies. We have not yet been annexed into Jackson County Fire District 5, although we will have their support during fire season, so at this time, District 5 is not primarily responsible for responses within our district. Instead, all calls should be directed to 9-1-1. The appropriate resources will be dispatched accordingly, and as they are available. Colestin Rural Fire District HOMEOWNERS
SURVEY for Community Fire Safety Plan CONTACT INFORMATION Name:___________________________________________________ Date:____________ Physical Address:___________________________________________________________ Mailing Address:____________________________________________________________ Home Phone:__________________________ Work Phone:__________________________ Cell Phone:____________________________ Email:_______________________________ Names and ages of children:____________________________________________________ _________________________________________________________________________ Names of other adults not specified
above but living on the premises: In case of emergency notify: Name:_______________________________________________________________ Address:_____________________________________________________________ Phone:_______________________________________________________________ Special Needs (blind / invalid
/ hearing impaired / other):________________________ LIVESTOCK AND PETS - TYPE NUMBER LOCATION
Dogs ________ ________________ Have you made arrangements for
your animals’ safety if you are not at home during a fire? Would you like more information
on providing for your animals’ safety in the event of a fire? Are you willing and able to move someone’s animals in the event of a fire? Yes No Do you have a horse/stock trailer
and are you willing to help others move their animals? Do you have a fenced pasture where
others could keep their livestock in the event of fire?
Is your address marked and visible
at the main road? Yes
No
How far is your home from the main road?________________________________________ Does your driveway have adequate room for a 28 ft fire truck to turn around? Yes No Are your driveway & access roads to structures at least 12 ft wide? Yes No Do you have turn-outs for two-way travel? Yes No Are your driveway and access roads clear 10ft either side of centerline? Yes No Is there at least a 13-foot vertical
clearance along your driveway and access roads? Do you have an alternate escape route if your driveway is impassable? Yes No Do you know your E.R.A. (Emergency Response Address)? Yes No
Does your home have fire-resistant roofing? Yes No Are all vents and openings screened? Yes No Are your roof and gutters free of debris? Yes No Are your decks enclosed or screened?
Yes
No
HAZARDS - (Please
fill out with Home Site Locator Sheets available from CRFD)
Explosives CHARACTER OF PROPERTY Open timber _______ % _______
% flat to gently sloping, 0-20% slope Do you have many standing dead
trees? (2+ average per acre) Yes
No
WATER SOURCES - TYPE CAPACITY
Well _________ Do you have: Portable pump ? Yes No Fire hose ? What size__________ How long________ Yes No Roof and area sprinklers to wet
down home site in event of wildfire? Yes
No
WILDFIRE FUEL HAZARD STATUS Do you have 100 feet of defensible
space around your home (brush removed: trees limbed up Do you have 100 ft of defensible
space around all other structures on your property? Are you interested in a fire safe inspection/consultation for your: Home ? Yes
No
Do you want to be part of a Neighborhood
Phone Tree for use in emergencies (notification Do you want to participate in
small Neighborhood Emergency Response Teams to help insure Do you have a large clear area
on your property where people can meet to do a head count in the Do you have special tools/equipment
that you would be willing to operate or lend to reduce the Would you like to volunteer some
time to make the District better prepared for fire? Do you have a current First Aid card? Yes No Do you have a current CPR card? Yes No Are you a licensed medical professional? Yes No If so, specify: __________________________________________________________________________ Are you willing to provide sandwiches, cookies, coffee etc. for firefighters? Yes No Do you have any other skills or
resources which you are willing to use to help in the event of __________________________________________________________________________ Are there specific fire risks
in our District that you feel should be considered in our Community Fire
__________________________________________________________________________ I hereby release the above information as needed ONLY for emergency purposes to emergency responders and to the CRFD Committee for Fire Plan Development.
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