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APPENDIX F

SAMPLE CVECO CODE

NOTIFICATION CHECKLISTS

CHAPTER TITLE PAGE
   
1 Introduction ……………………………………………… Page 02
2 Overview of CVECO Code Notification Checklist …….. Page 03
3 Code 5 - Incident Outside Industry Boundary ………… Page 04
4 Code 6 - Traffic Control ……………………………….. Page 05
5 Code 7 - Bomb Threat …………………………………... Page 06
6 Code 8 - Unanticipated Noticeable Disturbance      
    - Emergency ……………………..…………. Page 07
    - Information Only .……………..…………. Page 08
7 Code 9 - Fire Department & Mutual Aid Assistance …. Page 09
8 Code Notification Checklist - Scoring …………………... Page 10

Index

1. INTRODUCTION:  
   
   
1.1 This document contains samples of completed CVECO notification checklists.
   
1.2 The checklists should completed with as much information as possible. As more information becomes available the checklist is updated and re-faxed to Sarnia Fire/Police Communications.
   
- Example Code 5: Although not required, the Dispatcher supplied how the incident would be noticeable.
   
- Example Code 6: Suncor provided the results of some gas testing. This would not have been recorded on the initial checklist but added and faxed later.
   
1.3 Details on completing a CVECO notification checklist can be found in Section 3 - Radio & Telephone Communications
   
1.4 Specific information on a Code 5 can be found in Section 5 - Incident Outside Industry Boundaries.
   
1.5 Specific information on a Code 6 can be found in Section 6 - Traffic Control
   
1.6 Specific information on a Code 7 can be found in Section 7 - Bomb Threat
   
1.7 Specific information on a Code 8 can be found in Section 8 - Unanticipated Noticeable Occurrence.
   
1.8 Specific information on a Code 9 can be found in Section 9 - Fire Department and Mutual Aid Assistance.
   
1.9 An overview of the checklist is provided on the next page. While the examples give specific information, the overview is intended to provide an idea of what the information will be used for and why it’s important.
CVECO CODE NOTIFICATION CHECKLIST - Overview Index

Company to provide appropriate checklist(s) to 9-1-1 within 10 minutes of reporting a

CVECO code. Fax list to 344-8779 after providing the initial information by phone or radio.

1 - INFORMATION REQUIRED FOR ALL CODES
SECTION 1 · For all codes, start here and provide the information to the municipality and other CVECO members of the nature of the event by answering the questions who, what, when and where. · If the event is a Code 8 (unanticipated noticeable disturbance), then sections 1 and 3 will be the only sections that need to be filled out. · Several boxes are provided to help provide more specific information if it is available.

2 - ADDITIONAL INFORMATION REQUIRED FOR CODES 5, 6, 7 OR 9
SECTION 2 · For events other than a Code 8, the municipal police or fire services and possibly other industrial responders may need to become involved. In order to get to your site safely, they will use the information contained in the first three boxes - weather, direction of safe approach & meeting / staging area. · The next box deals specifically with a Code 6. A Code 6 automatically deploys traffic control in the appropriate area indicated in Section 1. If evacuation or shelter-in-place is also recommended, the information here will give the municipality some idea of the extent of the affected area. · Lastly, a general box allows for any additional details that become available.

3 - ALL CLEAR FOR CODE: SECTION 3 - The last thing to be filled out.
CVECO CODE NOTIFICATION CHECKLIST - CODE 5 Index

Company to provide appropriate checklist(s) to 9-1-1 within 10 minutes of reporting a

CVECO code. Fax list to 344-8779 after providing the initial information by phone or radio.

1 - INFORMATION REQUIRED FOR ALL CODES
      Updates Provided: 1st 14:10________
Date: May 1/03 Event Start: 13:35___ Code Called: 13:40___ (Times) 2nd _____________
(mth/day/yr) (mth/day/yr) (Time) (Time) Additional _____________
Code (check appropriate) X 5 q 6 q 7 q Emergency q Information Only 8 q 9
Company name: Shell Canada Call Letters: XJF 737
Name of person calling: Tom Jones Phone #: (519) 555-5000 ext.
For Further Information: X Same as above or: Phone #: ( ) ext.
Event Location First check area of origin and then any area which has a potential to be impacted due to wind direction, proximity, etc. Area of Origin Area(s) Impacted LOCATION POLICE
  q 1 X 1 Sarnia (west of Indian Road) Sarnia Police
  X 2 q 2 St. Clair Township O.P.P.
  q 3 q 3 Sarnia (east of Indian Road) Sarnia Police
  q 4 q 4 Point Edward O.P.P.
NATURE OF PROBLEM Chemical Information: (if available)
Discharge to: q Water X Ground q Air Product Name: Unknown ______________________
q Fire q Explosion q High Flare q Loss of Flare UN #: Unknown _____________________________
q q q q Hazards: q Toxic q Corrosive q Flammable X Unknown Specify if possible:
q Unusual Activity q Smokey Stack q Loud Noise q Other q  
q q q q q  
Define: Unknown leak on the south side of LaSalle Road S/W of LaSalle Road Auto Wreckers. Pool is 1 meter in diameter and approximately 15 meters from the road. May be some on the north side of the road as well. q  
How would a member of the general public notice this event? X Sight q Sound X Smell q Feel q Taste Specify: Liquid is light brown in colour and is producing a slight odour.

2 - ADDITIONAL INFORMATION REQUIRED FOR CODES 5, 6, 7 OR 9
Local Weather Direction of Safe Approach: From the east on LaSalle Road Meeting Location/Staging Area: q Staging Area 1 q Staging Area 2 X Other: LaSalle Wreckers
Temperature: 18 ______ oC    
Wind out of the: N/E ____ At: 8 KPH    
CODE 6 SPECIFIC INFORMATION
Evacuation Recommended? q Yes q No For Code 6 fax MSDS to 911at: q 344-8779
Shelter-In-Place Recommended? q Yes q No and to hospital at: q 339-7264
Define Boundary of Affected Area:
Any Additional Information for Codes 5, 6, 7 or 9:

3 - All Clear for Code: X 5 q 6 q 7 q 8 9 Date: May 1/03 Time: 18:45

CVECO CODE NOTIFICATION CHECKLIST - CODE 6 Index

Company to provide appropriate checklist(s) to 9-1-1 within 10 minutes of reporting a

CVECO code. Fax list to 344-8779 after providing the initial information by phone or radio.

1 - INFORMATION REQUIRED FOR ALL CODES
      Updates Provided: 1st 22:00________
Date: Apr 8/03 Event Start: 21:35_____ Code Called: 21:40_____ (Times) 2nd 22:45________
(mth/day/yr) (mth/day/yr) (Time) (Time) Additional _____________
Code (check appropriate) q 5 X 6 q 7 q Emergency q Information Only 8 q 9
Company name: Suncor Energy Products Inc. Call Letters: XJF 738
Name of person calling: Roy McHugh Phone #: (519) 555-5000 ext.
For Further Information: qSame as above or: Shawn Harris Phone #: (519) 555-5002 ext.
Event Location First check area of origin and then any area which has a potential to be impacted due to wind direction, proximity, etc. Area of Origin Area(s) Impacted LOCATION POLICE
  X 1 q 1 Sarnia (west of Indian Road) Sarnia Police
  q 2 q 2 St. Clair Township O.P.P.
  q 3 q 3 Sarnia (east of Indian Road) Sarnia Police
  q 4 q 4 Point Edward O.P.P.
NATURE OF PROBLEM Chemical Information: (if available)
Discharge to: q Water X Ground q Air Product Name: Regular gasoline______________
q Fire q Explosion q High Flare q Loss of Flare UN #: UN 1203______________________________
q q q q Hazards: q Toxic q Corrosive X Flammable q Unknown Specify if possible:
q Unusual Activity q Smokey Stack q Loud Noise q Other q  
q q q q q  
Define: Gasoline released into dike on 14 tank. Vapours carrying north across River Road. 22:00 - gas testing shows 10% LEL at overpass but drops off further north. q  
How would a member of the general public notice this event? q Sight X Sound X Smell q Feel q Taste Specify: Gasoline smell to the north of the Suncor refinery. The refinery siren has been sounded.

2 - ADDITIONAL INFORMATION REQUIRED FOR CODES 5, 6, 7 OR 9
Local Weather Direction of Safe Approach: From the south on River Road. Meeting Location/Staging Area: X Staging Area 1 q Staging Area 2 q Other: __________________
Temperature: 12 ______ oC    
Wind out of the: S/W ____ At: 10 KPH    
CODE 6 SPECIFIC INFORMATION
Evacuation Recommended? q Yes X No For Code 6 fax MSDS to 911at: X 344-8779
Shelter-In-Place Recommended? q Yes X No and to hospital at: X 339-7264
Define Boundary of Affected Area: From the northern boundary of the Suncor refinery to the northern boundary of the Dow plant.
Any Additional Information for Codes 5, 6, 7 or 9: 22:00 - starting foam application to spill. 22:45 - foam blanket now covering spill. Gas testing shows 0% LEL at River Road. Starting clean up.

3 - All Clear for Code: q 5 X 6 q 7 q 8 9 Date: Apr 8/03 Time: 23:45
CVECO CODE NOTIFICATION CHECKLIST - CODE 7 Index

Company to provide appropriate checklist(s) to 9-1-1 within 10 minutes of reporting a

CVECO code. Fax list to 344-8779 after providing the initial information by phone or radio.

1 - INFORMATION REQUIRED FOR ALL CODES
      Updates Provided: 1st 15:00______
Date: Jul 3/03 Event Start: 14:35__ Code Called: 14:40___ (Times) 2nd _____________
(mth/day/yr) (mth/day/yr) (Time) (Time) Additional _____________
Code (check appropriate) q 5 q 6 X 7 q Emergency q Information Only 8 q 9
Company name: Dow Chemical Call Letters: XJF 739
Name of person calling: Erik White Phone #: (519) 555-5000 ext.
For Further Information: qSame as above or: Mike Osborne Phone #: (519) 555-5002 ext.
Event Location First check area of origin and then any area which has a potential to be impacted due to wind direction, proximity, etc. Area of Origin Area(s) Impacted LOCATION POLICE
  X 1 q 1 Sarnia (west of Indian Road) Sarnia Police
  q 2 q 2 St. Clair Township O.P.P.
  q 3 q 3 Sarnia (east of Indian Road) Sarnia Police
  q 4 q 4 Point Edward O.P.P.
NATURE OF PROBLEM Chemical Information: (if available)
Discharge to: q Water q Ground q Air Product Name: ______________________________
q Fire q Explosion q High Flare q Loss of Flare UN #: _____________________________________
q q q q Hazards: q Toxic q Corrosive q Flammable q Unknown Specify if possible:
q Unusual Activity q Smokey Stack q Loud Noise X Other q  
q q q q q  
Define: Bomb threat received. Threat does not appear credible - caller appeared intoxicated and was unable to identify location or type of bomb. Indicated time of explosion was given as 16:00. q  
How would a member of the general public notice this event? q Sight q Sound q Smell q Feel q Taste Specify:

2 - ADDITIONAL INFORMATION REQUIRED FOR CODES 5, 6, 7 OR 9
Local Weather Direction of Safe Approach: Meeting Location/Staging Area: q Staging Area 1 q Staging Area 2 X Other: Main Gate ______
Temperature: 11 ______ oC    
Wind out of the: S/W ____ At: 10 KPH    
CODE 6 SPECIFIC INFORMATION
Evacuation Recommended? q Yes q No For Code 6 fax MSDS to 911at: q 344-8779
Shelter-In-Place Recommended? q Yes q No and to hospital at: q 339-7264
Define Boundary of Affected Area:
Any Additional Information for Codes 5, 6, 7 or 9: Plant siren not sounded, but units evacuated as a precaution. * Note that in this example, the call to 911 would likely be made by phone and not by radio. The CVECO radio can be scanned and would not be used in order to prevent copycat threats. If the threat were credible and imminent, however, the radio would most definitely be used.

3 - All Clear for Code: q 5 q 6 X 7 q 8 9 Date: Jul 3/03 Time: 19:00
CVECO CODE NOTIFICATION CHECKLIST - CODE 8 (Emergency) Index

Company to provide appropriate checklist(s) to 9-1-1 within 10 minutes of reporting a

CVECO code. Fax list to 344-8779 after providing the initial information by phone or radio.

1 - INFORMATION REQUIRED FOR ALL CODES
      Updates Provided: 1st _____________
Date: Jul 31/03 Event Start: 14:35 _ Code Called: 14:37 __ (Times) 2nd _____________
(mth/day/yr) (mth/day/yr) (Time) (Time) Additional _____________
Code (check appropriate) q 5 q 6 q 7 X Emergency q Information Only 8 q 9
Company name: Suncor Energy Products Inc. Call Letters: XJF 738
Name of person calling: Mike Brown Phone #: (519) 555-5000 ext.
q For Further Information: qSame as above or: Paul Ouelette Phone #: (519) 555-5001 ext.
Event Location First check area of origin and then any area which has a potential to be impacted due to wind direction, proximity, etc. Area of Origin Area(s) Impacted LOCATION POLICE
  X 1 q 1 Sarnia (west of Indian Road) Sarnia Police
  q 2 q 2 St. Clair Township O.P.P.
  q 3 q 3 Sarnia (east of Indian Road) Sarnia Police
  q 4 q 4 Point Edward O.P.P.
NATURE OF PROBLEM Chemical Information: (if available)
Discharge to: q Water q Ground q Air Product Name: ______________________________
q Fire q Explosion X High Flare q Loss of Flare UN #: _____________________________________
q q q q Hazards: q Toxic q Corrosive q Flammable q Unknown Specify if possible:
q Unusual Activity q Smokey Stack q Loud Noise q Other q  
q q q q q  
Define: Major power dip has caused several unit upsets. Power back to normal, but units are still recovering. q  
How would a member of the general public notice this event? X Sight q Sound q Smell q Feel q Taste Specify: Refinery flare excessive and smoky.

2 - ADDITIONAL INFORMATION REQUIRED FOR CODES 5, 6, 7 OR 9
Local Weather Direction of Safe Approach: Meeting Location/Staging Area: q Staging Area 1 q Staging Area 2 q Other: __________________
Temperature: ________ oC    
Wind out of the: ________ At: KPH    
CODE 6 SPECIFIC INFORMATION
Evacuation Recommended? q Yes q No For Code 6 fax MSDS to 911at: q 344-8779
Shelter-In-Place Recommended? q Yes q No and to hospital at: q 339-7264
Define Boundary of Affected Area:
Any Additional Information for Codes 5, 6, 7 or 9:

3 - All Clear for Code: q 5 q 6 q 7 X 8 9 Date: Jul 31/03 Time: 19:00
CVECO CODE NOTIFICATION CHECKLIST - CODE 8 (Information Only) Index

Company to provide appropriate checklist(s) to 9-1-1 within 10 minutes of reporting a

CVECO code. Fax list to 344-8779 after providing the initial information by phone or radio.

1 - INFORMATION REQUIRED FOR ALL CODES
      Updates Provided: 1st _____________
Date: Aug 8/03 Event Start: 14:35 _ Code Called: 14:37 __ (Times) 2nd _____________
(mth/day/yr) (mth/day/yr) (Time) (Time) Additional _____________
Code (check appropriate) q 5 q 6 q 7 q Emergency X Information Only 8 q 9
Company name: Nova Chemicals - Corunna Call Letters: VCW 454
Name of person calling: Ed Patterson Phone #: (519) 555-5000 ext.
For Further Information: X Same as above or: Phone #: ( ) ext.
Event Location First check area of origin and then any area which has a potential to be impacted due to wind direction, proximity, etc. Area of Origin Area(s) Impacted LOCATION POLICE
  q 1 q 1 Sarnia (west of Indian Road) Sarnia Police
  X 2 q 2 St. Clair Township O.P.P.
  q 3 q 3 Sarnia (east of Indian Road) Sarnia Police
  q 4 q 4 Point Edward O.P.P.
NATURE OF PROBLEM Chemical Information: (if available)
Discharge to: q Water q Ground q Air Product Name: ______________________________
q Fire q Explosion q High Flare q Loss of Flare UN #: _____________________________________
q q q q Hazards: q Toxic q Corrosive q Flammable q Unknown Specify if possible:
q Unusual Activity X Smokey Stack q Loud Noise q Other q  
q q q q q  
Define: Unit upset q  
How would a member of the general public notice this event? X Sight q Sound q Smell q Feel q Taste Specify:

2 - ADDITIONAL INFORMATION REQUIRED FOR CODES 5, 6, 7 OR 9
Local Weather Direction of Safe Approach: Meeting Location/Staging Area: q Staging Area 1 q Staging Area 2 q Other: __________________
Temperature: ________ oC    
Wind out of the: ________ At: KPH    
CODE 6 SPECIFIC INFORMATION
Evacuation Recommended? q Yes q No For Code 6 fax MSDS to 911at: q 344-8779
Shelter-In-Place Recommended? q Yes q No and to hospital at: q 339-7264
Define Boundary of Affected Area:
Any Additional Information for Codes 5, 6, 7 or 9:

3 - All Clear for Code: q 5 q 6 q 7 X 8 9 Date: Aug 8/03 Time: 15:00
CVECO CODE NOTIFICATION CHECKLIST - CODE 9 Index

Company to provide appropriate checklist(s) to 9-1-1 within 10 minutes of reporting a

CVECO code. Fax list to 344-8779 after providing the initial information by phone or radio.

1 - INFORMATION REQUIRED FOR ALL CODES
      Updates Provided: 1st 15:00 _______
Date: Oct 8/03 Event Start: 14:35 __ Code Called: 14:39 __ (Times) 2nd _____________
(mth/day/yr) (mth/day/yr) (Time) (Time) Additional _____________
Code (check appropriate) q 5 q 6 q 7 q Emergency q Information Only 8 X 9
Company name: Imperial Oil Call Letters: XJF 742
Name of person calling: Terry Mercier Phone #: (519) 555-5000 ext.
For Further Information: qSame as above or: Clark Kent Phone #: (519) 555-5002 ext.
Event Location First check area of origin and then any area which has a potential to be impacted due to wind direction, proximity, etc. Area of Origin Area(s) Impacted LOCATION POLICE
  X 1 q 1 Sarnia (west of Indian Road) Sarnia Police
  q 2 q 2 St. Clair Township O.P.P.
  q 3 q 3 Sarnia (east of Indian Road) Sarnia Police
  q 4 q 4 Point Edward O.P.P.
NATURE OF PROBLEM Chemical Information: (if available)
Discharge to: q Water q Ground q Air Product Name: Kerosene _____________________
X Fire q Explosion q High Flare q Loss of Flare UN #: UN 1223 _________________________
q q q q Hazards: q Toxic q Corrosive X Flammable q Unknown Specify if possible:
q Unusual Activity q Smokey Stack q Loud Noise q Other q  
q q q q q  
Define: Fire on exchanger 1-1-E007A in #1 Crude unit. q  
How would a member of the general public notice this event? X Sight X Sound q Smell q Feel q Taste Specify: Column of smoke visible and refinery siren sounded.

2 - ADDITIONAL INFORMATION REQUIRED FOR CODES 5, 6, 7 OR 9
Local Weather Direction of Safe Approach: No offsite impact - normal approach OK. Meeting Location/Staging Area: X Staging Area 1 q Staging Area 2 q Other: __________________
Temperature: 6 ______ oC    
Wind out of the: North __ At: 10 KPH    
CODE 6 SPECIFIC INFORMATION
Evacuation Recommended? q Yes q No For Code 6 fax MSDS to 911at: q 344-8779
Shelter-In-Place Recommended? q Yes q No and to hospital at: q 339-7264
Define Boundary of Affected Area:
Any Additional Information for Codes 5, 6, 7 or 9:

3 - All Clear for Code: q 5 q 6 q 7 q 8 X 9 Date: Oct 8/03 Time: 15:45

Index

7. CODE NOTIFICATION CHECKLIST SCORING SHEET:  
   
   
7.1 The Response Review Committee will use the sheet on the following page when performing the monthly review of the codes called.
   
7.2 Each section in the scoring sheet made distinct by shading.
   
- Values for the individual parts of each section are shown in solid green numbers.
- Values for each section are shown in red outline numbers.
   
7.3 The Response Review Committee monthly report will show the score for each checklist in percentage and compliance for each company will be based on these scores.
   

 

 

CVECO CODE NOTIFICATION CHECKLIST - Scoring Sheet Index

Company to provide appropriate checklist(s) to 9-1-1 within 10 minutes of reporting a

CVECO code. Fax list to 344-8779 after providing the initial information by phone or radio.

1 - INFORMATION REQUIRED FOR ALL CODES
      Updates Provided: 1st _____________
Date: __________ Event Start: __________ Code Called: __________ (Times) 2nd _____________
(mth/day/yr) (mth/day/yr) (Time) (Time) Additional _____________
Code (check appropriate) q 5 q 6 q 7 q Emergency q Information Only 8 q 9
Company name: Call Letters:
Name of person calling: Phone #: ( ) - ext.
For Further Information: q Same as above or: Phone #: ( ) - ext.
Event Location First check area of origin and then any area which has a potential to be impacted due to wind direction, proximity, etc. Area of Origin Area(s) Impacted LOCATION POLICE
  q 1 q 1 Sarnia (west of Indian Road) Sarnia Police
  q 2 q 2 St. Clair Township O.P.P.
  q 3 q 3 Sarnia (east of Indian Road) Sarnia Police
  q 4 q 4 Point Edward O.P.P.
NATURE OF PROBLEM Chemical Information: (if available)
Discharge to: q Water q Ground q Air Product Name: ______________________________
q Fire q Explosion q High Flare q Loss of Flare UN #: _____________________________________
q q q q Hazards: q Toxic q Corrosive q Flammable q Unknown Specify if possible:
q Unusual Activity q Smokey Stack q Loud Noise q Other q  
q q q q q  
Define: q  
How would a member of the general public notice this event? q Sight q Sound q Smell q Feel q Taste Specify:

2 - ADDITIONAL INFORMATION REQUIRED FOR CODES 5, 6, 7 OR 9
Local Weather Direction of Safe Approach: Meeting Location/Staging Area: q Staging Area 1 q Staging Area 2 q Other: __________________
Temperature: ________ oC    
Wind out of the: ________ At: KPH    
CODE 6 SPECIFIC INFORMATION
Evacuation Recommended? q Yes q No For Code 6 fax MSDS to 911at: q 344-8779
Shelter-In-Place Recommended? q Yes q No and to hospital at: q 339-7264
Define Boundary of Affected Area:
Any Additional Information for Codes 5, 6, 7 or 9:

3- All Clear for Code: q 5 q 6 q 7 q 8 q 9 Date: Time: