HAZ-SAFE BUILDINGS' PLANNING WORKSHEET

1.	Interested Party:
	Name:		Phone:
	Position/Title:		Cell:
	Organization/Company:		Fax:
	Street Address:		Email:
	City:		Website:
	State:		Zip Code:

2.	Potential Use For: (check all that apply)
	Manufacturing:		Storage:
	Processing:		Clean Room:
	Dispensing:		Cooler:
	Testing:		Freezer:
	Laboratory:		Hot Box:

3.	Materials in Building:
	Type:	Hazard Class:	Containers:	Quantity:
	(Chemical Name)	(Flammable - 1A, 1B, 1C; Combustible - 11, 111A, 111B, etc.)	(55-Gal. Drums, pallets, tote tanks, ___ gal. process vessels, etc.)
a.
b.
c.
d.

4.	Building / Room(s) Space Defined:
a.	Building
	Priority dimension	External	Internal
	Name	Width	Length	Height
b.	Room(s)
1.	Name	Width	Length	Height
2.	Name	Width	Length	Height
3.	Name	Width	Length	Height
c.	Send / Transmit Sketch(s)
	Plan View(s)	Elevation View(s)
	Attach a drawing or sketch of your plan

5.	Location on Site:
a.	Fire and Explosion threats only inside building Or inside and outside
b.	Outside - Distance from existing facility/fire rating:
	Attached / 4 hr.	Adjacent (0 - 10') / 4 hr.	Near (10' - 50') / 2 hr.	Distant (50' - 75') / 1 hr.
	(past 75') non-combustible steel non-rated
c.	Inside (inplant) - Inside existing or planned facility:
	Size of exterior door or opening x
	Existing overhead crane lift capability:		Yes No

6.	Cradle (base) of building: (choose one)
	Perimeter frame only (without floor) 1/4" thick steel plate floor (no sump) Elevated flooring with 10 gauge steel flat sump Elevated flooring with single sloped sump Elevated flooring with double sloped sump to "V" Elevated flooring with double sloped sump to sloped trench

7.	Lifting Capabilities:
	Pair 1/4" thick 4" x 12" steel forklift tubes under floor		Yes No
	Four (4) universal crane lugs welded to base		Yes No
	Four (4) standard wall/roof edge crane lugs		Yes No

8.	Elevated Flooring Type:
	Painted Steel Grate		Galvanized Steel Grate
	Stainless Steel Grate		Aluminum Grate
	Fiberglass Grate
	Grate Opening - Standard 1" x 4" – Upgrade 1/4" x 4" (smallest opening)
	Standard Load Capacity 250 lbs. – Higher lbs.

9.	Sump Depth:
	4" exceeds EPA 10% (shortest OSHA ramp length)
	6" exceeds EPA and FM 25% (longer ramp)
	8" or higher Reason

10.	Exterior Wall Finish:
	Standard white painted 10 gauge steel		Yes No
	Aggregate panel over above		Yes No
	Thin set brick over 10 gauge plate		Yes No
	Other, describe

11.	Wall Separation for Individual Rooms:
	42" high chain link fence framed in tube steel		Yes No
	Floor-to-ceiling chain link fence framed in tube steel		Yes No
	Floor-to-ceiling bi-directional fire and blast rated		Yes No

12.	Interior Finish:
	Standard porcelain enamel on steel sheet bonded to fire rated gypsum		Yes No
	Other, describe

13.	Doors:
	Non-Rated or	Fire Rated
	Single leaf, swing size x		Quantity:
	Double leaf, swing size x		Quantity:
	Lockset	Panic Device	Fusible Link closure/hold open device
	Overhead roll-up door size x		Quantity:
	Mounted between frame on exterior
	Motorized with explosion proof motor

14.	Low Level Ventilation System:
a.	Fire rated natural, gravity or passive air vent opening(s) through wall (mechanical ventilation requires both air intake and exhaust vent openings with fan(s) on opposite walls as in items #19g & #19h)			Quantity:
b.	Posi-ventilation tube integrated within elevated flooring (item #8) and over "V" or sloped trench (item #6) transitioned up to exhaust vent opening above			Quantity:

15.	Material Handling Expectations:
	User owned hand truck or drum lifter on standard grate with 1" wide x 4" long openings, 250 lbs. load elevated flooring (see item #8)		Yes No
	User owned forklift or pallet lifters (consider tighter gate openings and higher than 250 lbs. floor grate)		Yes No
	Swivel beam and hoist within building		Yes No
	Monorail beam and hoist within building		Yes No
	Crane with runway beams, bridge beam and hoist within building		Yes No

16.	Shelving:
	Width / Depth:		Total linear feet:

17.	Explosion Relief Systems:
a.	Bottom hinged wall panels	Size	Quantity
b.	Blast Shafts:
	Through existing wall or roof for inplant building		Yes No
	Wall mounted for exterior buildings within 50' of another user's facility		Yes No

18.	Rooftop Crane Lifting Lugs:
			Yes No

19.	Electricals Exterior:
a.	NEMA 3R enclosure Yes		Other
b.	Load center size		Mfg./Model
c.	Panelboard size		Mfg./Model
d.	Transformer required		Yes No
e.	Emergency power - on site:		Yes No , generator required
f.	Separate alarm and contol box		Yes No
g.	Single (#1 fan) on top of outside duct (requires item #13a and optional b)		Yes No
h.	Dual (#1 fan and #2 fan) same as above item g.		Yes No

20.	Electricals Interior:
a.	Non-classified industrial purpose
b.	Class 1, Division 1, Class C & D Standard		Other
c.	Voltage:	120V	208V	240V
d.	Phase:	Single	Three	Both
e.	Ceiling light fixtures:
	200 watt lamp incandescent, quantity
	Four 100 watt lamps fluorescent, quantity
f.	Sump liquid spill detection and alarm system. Requires drain pit in item #6.		Yes No
g.	Fan malfunction alarm system		Yes No
h.	Gas malfunction alarm system		Yes No

21.	Heating, Air Conditioners & Refrigeration:
	Heaters
	Fan Forced Ceiling Type
	Watt Capacity	Quantity	Maintain (°F)
	Convection Wall Hung Type
	Watt Capacity	Quantity	Maintain (°F)
	A/C Units
	Exterior Wall Hung Type
	BTU Capacity	Quantity	Maintain (°F)
	Exterior Through-the-Wall Type
	BTU Capacity	Quantity	Maintain (°F)
	Refrigeration
	Split Type System
	BTU Capacity	Quantity	Maintain (°F)

22.	General Components / Systems:
	Drain pit, pipe & hand valve		Exterior light fixtures
	Insulated under sump floor		Outside or inside electrical outlets
	Drum, pallet & tote tank racks		Insulation upgrades
	Loading ramps		Fire sprinkler piping assembly
	Lightning protection		Dry chemical fire suppression
	Grounding		Eye / face wash bowl
	Special paint or coatings		Shower with eye wash station