How To Pass A Fire Safety Plan Review

Transcription

1 Department of Emergency Services and Public Protec on Commission on Fire Preven on and Control CONNECTICUT FIRE ACADEMY IN ASSOCIATION WITH THE NATIONAL FIRE ACADEMY present Fire and Life Safety Plans Review SEPTEMBER 21 26, 2015 This course will assist the student in verifying that construc on documents comply with applicable building and fire codes for fire protec on and life safety requirements. Subjects addressed in the course include site plan reviews for emergency apparatus access, water supply, and hydrants for fire protec on; review of architectural drawings for construc on requirements, means of egress for life safety, and fire resis ve compartmentaliza on; evalua on of hea ng, ven la on, and air condi oning (HVAC), evalua on of exit illumina on and emergency power supplies, and assessment of the need for built in fire protec on systems and smoke control/management systems. This course is appropriate for individuals who are, or expect to be, responsible for verifying code compliance of construc on documents from a fire protec on standpoint. NOTE: Local jurisdic ons are encouraged to submit applica ons of both their fire and building plans examiners to a end a course together if both meet the selec on criteria. Prerequisites: ICS 100 and ICS 200 level training. Preferred courses are Q462 and Q463 available through NFA Online at Chief's signature a ests that the applicant has completed this required training. For the Fire Official: Cer fica on as Fire Inspector I by ICC, NFPA, individual State fire training organiza on or individual State fire marshal's Office; or comple on of NFA's Fire Inspec on Principles course and 18 months subsequent experience. For the Building Official: Comple on of Fire Inspec on Principles and 18 months subsequent experience; OR Cer fica on as Commercial Building Inspector or Commercial Plans Examiner by ICC, NFPA, or individual State fire training organiza on or building technology degree or cer ficate from an accredited community college. Classes will be held at the Connec cut Fire Academy. Lunch is included each day the class is in session. Student housing may be available at the Connec cut Fire Academy, check our website under contact us for lodging informa on. Most major hotel chains are also represented in the area. The Connec cut Fire Academy is located adjacent to Bradley Interna onal Airport (BDL). The Office of Educa on and Data Management has assigned 26 Fire Marshal credits to this class. Return both the CFA and NFA applica ons to the CFA Training Registrar at the address below. Total Class Hours: 48/ 8:30 4:30 each day Course Fee: $ CFA Course Number NFA Course Number N0132 Fire Marshal Credit: 26 Hours Connecticut Fire Academy 34 Perimeter Road Windsor Locks, CT Phone: Facsimile: State of Connec cut An Affirma ve Ac on/equal Employment Opportunity Employer ct.gov/cfpc

2 CFPC, 34 Perimeter Road Windsor Locks, CT Fax number: (860) Student Application Form Last Name First Name Home Address City State Zip Phone (Home) Work Cell Sponsored by the Connec cut Fire Academy, the Na onal Fire Academy and TRADE Region 1 ID Number - Your ID consists of the first (3) letters of your last name and the last (4) numbers of your social security number. Example: John Adams - SS # The new ID # will be ADA-5555 As Chief of the Fire Department or as Supervisor of the Organization I hereby authorize the above applicant to participate in the program below and, therefore, understand that the above-named individual will be covered by my organization s Worker s Compensation Insurance while participating in such training, and that the Commission on Fire Prevention and Control, its commissioners, officers, agents or employees shall not be liable for any injuries sustained during such training. This applicant is considered by my department s standards to be physically and emotionally fit to perform firefighting evolutions without special considerations, and where applicable, to meet the 29 CFR standard for the use of respirators (Self-Contained Breathing Apparatus). No application will be accepted without tuition, authorized signature and proof of prerequisite. (if needed) Connecticut Fire Academy Fire Department/Organization Check box if you would like to subscribe your address to the CFPC Listserv. Yes No Already Subscribed Are you 18 years of age or older? Yes No (No one under 18 is allowed to participate in hands-on programs). Acceptance notices with directions will be mailed approximately two (2) weeks prior to the start of the program. Students canceling at least seven (7) days in advance of a program will receive a full refund.. For more information, please contact Program Manager, Mark Salafia at ext. 286 or you can Mark at: mark.salafia@ct.gov Returned check policy: A $25.00 fee will be assessed to all returned checks (insufficient funds, stop payment, etc). In order to complete your registration after the receipt of a returned check, you must submit cash, money order, or a bank check including the amount of tuition and the returned check fee to the registrar. Chief or Supervisor Signature: Course Title: Fire and Life Safety Plan Review N0132 Course # Dates: September 21, 22, 23, 24, 25, 26, 2015 Tuition: $ Method of Payment - Payment is required at time of registration. Faxes must include Credit Card or Purchase Order number. Check made payable to CFPC Purchase Order # Visa Master Card # Print Card Holders name: Card Holder s Signature: Exp. Date

3 DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY GENERAL ADMISSIONS APPLICATION SHORT FORM See Reverse for Privacy Act Statement O.M.B. No Expires November 30, 2016 SECTION I - GENERAL INFORMATION 1. DATE OF BIRTH (Mo, Day, Yr.) 2. GENDER 3. U.S. CITIZEN If No, City and Country of Birth: FEMALE MALE YES NO PERMANENT RESIDENT 4. RACE (Please check all that apply) 1. AMERICAN INDIAN or ALASKAN NATIVE 2. ASIAN 3. BLACK or AFRICAN AMERICAN 4a. ETHNICITY HISPANIC or LATINO 4. WHITE 5. NATIVE HAWAIIAN or PACIFIC ISLANDER 5. PLEASE PRINT YOUR NAME (Last, First, Middle, Suffix) NOT HISPANIC or LATINO 6. STUDENT IDENTIFICATION (SID) NUMBER 7. HOME MAILING ADDRESS (Street, avenue, road no., P.O. box/city or town, and zip code) 8. Work Phone Number: 9. Home Phone Number: 10. FAX Number: 12a. ENTER COURSE CODE AND TITLE Fire and Life Safety Plans Review N ADDRESS 12b. COURSE LOCATION Windsor Locks, CT 12c. DATE 9/21/15 to 9/26/ DO YOU HAVE ANY DISABILITIES (Including special allergies or medical disabilities) WHICH WOULD REQUIRE SPECIAL CONSIDERATION DURING YOUR ATTENDANCE IN TRAINING? NO YES (If yes, indicate & describe any special considerations required on a separate sheet) SECTION II - EMPLOYMENT INFORMATION 14a. NAME AND COMPLETE ADDRESS OF ORGANIZATION BEING REPRESENTED 14b. NFIRS # 15. CURRENT POSITION AND NUMBER OF YEARS IN (NFA ONLY) POSITION 16. CHECK THE BOX(ES) BELOW THAT BEST DESCRIBE YOUR ORGANIZATION 16b. ORGANIZATION 16c. CURRENT STATUS 16a. JURISDICTION 1. PAID FULL TIME. 1. STATEWIDE 4. SPECIAL DISTRICT/TOWNSHIP 7. FOREIGN 1. ALL CAREER 2. PAID PART TIME 2. COUNTY GOVERNMENT 5. FEDERAL/MILITARY (non-dhs) 8. DHS/FEMA 2. ALL VOLUNTEER 3. VOLUNTEER 3. CITY/TOWN/VILLAGE 6. INDUSTRY/BUSINESS 9. TRIBAL NATION 3. COMBINATION 4. DISASTER RESERVIST SECTION III - ENDORSEMENT AND CERTIFICATION 17a. I certify that the information recorded on this application is correct. Falsification of information will result in denial of a course certificate and stipend (U.S.C. 1001). 17b. I hereby authorize the release of any and all information concerning my enrollment in this course to the chief officer in charge, or designee, of my organization. All requests for information shall be in writing from said chief officer or designee. 17c. Further, I understand that the National Emergency Training Center (NETC), the Mt. Weather Emergency Operations Center (MWEOC), and the Noble Training Facility (NTF) are not authorized to provide medical or health insurance for students. I maintain appropriate insurance on an individual basis. 17d. I agree to abide by the rules, policies, and regulations of NETC, MWEOC and NTF. Failure to do so will result in denial of the student stipend, expulsion from the course, and possible barring from future National Fire Academy (NFA) and Emergency Management Institute (EMI) courses. 18a. SIGNATURE OF APPLICANT 18b. DATE 19. APPROVAL BY THE HEAD OF THE SPONSORING ORGANIZATION (NOT REQUIRED FOR SELF STUDY PROGRAMS) By signing this application, I certify that my organization does not discriminate on the basis of age, gender, race, color, religious belief, national origin, economic status, or disability in providing educational opportunities for its employees. 19a. SIGNATURE 19b. PRINTED NAME AND TITLE 19c. DATE 20. ADDITIONAL ENDORSEMENTS FOR APPLICATION TO THE EMERGENCY MANAGEMENT INSTITUTE (NOT REQUIRED FOR SELF STUDY PROGRAMS) 20a. SIGNATURE AND DATE (State Office) 20b. SIGNATURE AND DATE (FEMA Regional Office) 21. SUBMIT APPLICATION TO APPROPRIATE SPONSOR FEMA Form , (2/12) PREVIOUS EDITION FF75-5A OBSOLETE

4 22a. DISPOSITION 22b. SIGNATURE OF REVIEWER 22c. DATE ACCEPTED REJECTED EQUAL OPPORTUNITY STATEMENT NFA and EMI are Equal Opportunity institutions. They do not discriminate on the basis of age, gender, race, color, religious belief, national origin, or disability in their admissions and studentrelated procedures. Both schools make every effort to ensure equitable representation of minorities and women in their student bodies. Qualified minority and women candidates are encouraged to apply for all courses. PRIVACY ACT STATEMENT GENERAL - This information is provided pursuant to Public Law (Privacy Act of 1974), Title 5 United States Code (U.S.C.), Section 552a, for individuals applying for admission to NFA Or EMI. AUTHORITY - Federal Fire Prevention and Control Act of 1974, as amended, Title 15 U.S.C., Sections 2201 et. seq.; Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended, Title 42 U.S.C., Sections 5121, et. seq.; Title 44 U.S.C. Section 3101; Executive Orders 12127, 12148, and 9397; Title VI of the Civil Rights Act of 1964; and Section 504 of the Rehabilitation Act of PURPOSES: To determine eligibility for participation in NFA and EMI courses. Information such as age, gender, and ancestral heritage are used for statistical purposes only. USES: Information may be released to: 1) FEMA staff to analyze application and enrollment patterns for specific courses, and to respond to student inquiries; 2) a physician to provide medical assistance to students who become ill or are injured during courses; 3) Members of the Board of Visitors for the purpose of evaluating programmatic statistics; 4) sponsoring states, local officials, or state agencies to update/evaluate statistics of NFA and EMI participants; 5) Members of Congress seeking first party information; and 6) Agency training program contractors and computer centers performing administrative functions. EFFECTS OF NONDISCLOSURE - Personal information is provided on a voluntary basis. Failure to provide information on this form, however, may result in a delay in processing your application and/or certifying completion of the course. PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 6 minutes. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA , Paperwork Reduction Project ( ) NOTE: Do not send your completed form to this address.

5 STATE OF CONNECTICUT DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION Connecticut Fire Academy Students applying for National Fire Academy training courses are required to register for a FEMA Student Identification Number (SID). This number is used in place of a Social Security Number on General Admissions Application forms. How to Register for a Student Identification Number: National Fire Academy students interested in applying for on-campus (10-/6-/2-day), off-campus (10- /6-/2-day) and NFA Online courses need to register for a FEMA Student Identification Number (SID). This number is used in place of a Social Security Number and is obtained through the Center for Domestic Preparedness (CDP). Applications for NFA courses that do not include a SID will not be processed. To obtain a SID 1. Register at 2. Select "Register for a FEMA SID?" in the center of the screen. 3. Follow the instructions to create your account. 4. You will receive an with your SID. Save this number in a secure location. This number will be used for all national Fire Academy classes, now and in the future. Use the SID in place of the Social Security Number (SSN) on the General Admissions Application Form (FEMA Form ). Additional Information General Admissions Application forms have been revised to eliminate the need for the SSN and include a field for the SID. To keep your Connecticut Fire Academy Transcript complete, please also complete the CFA Student Application for course number 16027, included in this application package. If you have a SID number from a previous class you should continue to use that number. Commission on Fire Prevention and Control 34 Perimeter Road Windsor Locks, CT Phone: (860) /Fax: (860) An Affirmative Action/Equal Employment Opportunity Employer ct.gov/cfpc