Prescribed Burn Plan

Prescribed Burn Plan

It is the users responsibility to complete and follow the burn plan in accordance with ACT 695.
Landowner's Name*

First NameLast Name
Landowner's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Geolocation
Latitude of Property To Burn - Decimal Degrees - Example 35.66788
Longitude of Property to Burn - Decimal Degrees - Make sure to put "-" sign before the number. Example: -92.38488
County*
Land Use Types*

Native Grass/PollenatorOld Field HabitatHardwood ForestGladeNon - Native PastureCRP/WetlandPine StandOther
Description of Area to Be Burned*
Official Notifications Before Burn

Forestry Division Dispatch 1-800-830-8015
Sheriff's Office Phone Number*
Local Fire Dept Phone Number*
Neighbor Notifications (Within 1/4 Mile)
Name and Phone Number
Neighbor Notifications (Within 1/4 Mile)
Name and Phone Number
Neighbor Notifications (Within 1/4 Mile)
Name and Phone Number
Neighbor Notifications (Within 1/4 Mile)
Name and Phone Number
Prescribed Burn Preparations
Prescribed Burn Objectives*

TrainingHazard ReductionGrazing ProductionForest ManagementWildlife HabitatOther
Fire Break Preparations (Check all that apply)*

Bare Ground (Handline, Disked, Bladed, Plowed)Mowed/WetlinedNatural BarrierRoads and TrailsOther
Firing Techniques (Ex. Start ignition on the downwind side until black is built, etc.) *
Fire Sensitive Areas (Adjacent Young Pine Plantations, Buildings, Chicken Houses,etc)*
Smoke Sensitive Areas (Roads, Chicken Houses, Hospitals, Residences, Etc)*
Contingencies Including Safety Zones, Escape Routes, Mop up specifications Etc)*
Additional Info
Weather Information

Weather Parameters (Must Put One Character To Make List Show Up On PDF)*

Rows	Prescription For Unit
Seasonality of Burn
Air Temp (*F)
Relative Humidity (%)
Wind speed
Wind Direction
Smoke Category

Burning Assignments
Burn Boss *

Personnel Assignments (Must Put One Character To Make List Show Up On PDF)*

Rows	Name	Assignment
Crew Member
Crew Member
Crew Member
Crew Member
Crew Member
Crew Member
Crew Member
Crew Member
Crew Member
Crew Member
Crew Member
Crew Member

Burn Day Checklist
File Upload
Burn Map

Cancelof
Smoke Map

Cancelof
Screenshot of Weather

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Additional files

Cancelof
Signatures
Name of Qualified Prescribed Burner*

First NameLast Name
Signature of Qualified Prescribed Burner
Date*

MonthDayYear
Date
Name of Landowner/Representative

First NameLast Name
Signature of Landowner/Representative*
Date*

MonthDayYear
Date
Should be Empty:

Prescribed Burn Plan

Official Notifications Before Burn

Prescribed Burn Preparations

Weather Information

Burning Assignments

Burn Day Checklist

File Upload

Signatures