Prescribed Burn Plan
It is the users responsibility to complete and follow the burn plan in accordance with ACT 695.
Landowner's Name
*
First Name
Last Name
Landowner's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Geolocation
County
*
Land Use Types
*
Native Grass/Pollenator
Old Field Habitat
Hardwood Forest
Glade
Non - Native Pasture
CRP/Wetland
Pine Stand
Other
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
*
Training
Hazard Reduction
Grazing Production
Forest Management
Wildlife Habitat
Other
Fire Break Preparations (Check all that apply)
*
Bare Ground (Handline, Disked, Bladed, Plowed)
Mowed/Wetlined
Natural Barrier
Roads and Trails
Other
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)
*
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)
*
Name
Assignment
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Crew Member
Holder
Ignitor
Medic
Weather
Burn Day Checklist
File Upload
Burn Map
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Smoke Map
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Screenshot of Weather
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Additional files
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of
Signatures
Name of Qualified Prescribed Burner
*
First Name
Last Name
Signature of Qualified Prescribed Burner
Date
*
-
Month
-
Day
Year
Date
Name of Landowner/Representative
First Name
Last Name
Signature of Landowner/Representative
*
Date
*
-
Month
-
Day
Year
Date
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