CAER - Community Awareness Emergency Response


HOME


WHAT IS CAER?

PERSONAL ACTION GUIDE


CAER NEWSLETTER


SARNIA'S INDUSTRY


COMMUNITY AWARENESS

- want to be involved?
- Risk Communication
CAER MEMBERS


S.A.D.S.


THE REAL THING


EMERGENCY SIRENS


MEMBERS INDEX

� 2003 CAER.
Web design by

Ken Hall Graphic Design

APPENDIX F

SAMPLE CVECO CODE

NOTIFICATION CHECKLISTS

CHAPTER

TITLE

PAGE

Introduction

��

Page

Overview of CVECO Code Notification Checklist

��..

Page

Code 5 - Incident Outside Industry Boundary

��

Page

Code 6 - Traffic Control

��..

Page

Code 7 - Bomb Threat

��...

Page

Code 8 - Unanticipated Noticeable Disturbance

- Emergency ��..��.

Page

- Information Only .��..��.

Page

Code 9 - Fire Department & Mutual Aid Assistance

�.

Page

Code Notification Checklist - Scoring

��...

Page

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: 1^st^{14:10________}

^{Date:
May 1/03}

^{Event Start:
13:35___}

^{Code
Called:
13:40___}

^{(Times) 2nd
_____________}

^{(mth/day/yr)
(mth/day/yr)}

^(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}

^{Sarnia
(east of Indian Road)}

^{Sarnia
Police}

^{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
_____________________________}

^{Hazards: q Toxic q
Corrosive q Flammable

X
Unknown}

^{Specify if
possible:}

^{q Unusual Activity}

^{q Smokey Stack}

^{q Loud Noise}

^{q Other}

^{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.}

^{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)

^{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}

^{St. Clair
Township}

^O.P.P.

^{q 3}

^{Sarnia
(east of Indian Road)}

^{Sarnia
Police}

^{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______________________________}

^{Hazards: q Toxic q
Corrosive

X Flammable q
Unknown}

^{Specify if
possible:}

^{q Unusual Activity}

^{q Smokey Stack}

^{q Loud Noise}

^{q Other}

^{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.}

^{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)

^{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}

^{St. Clair
Township}

^O.P.P.

^{q 3}

^{Sarnia
(east of Indian Road)}

^{Sarnia
Police}

^{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 #:
_____________________________________}

^{Hazards: q Toxic q
Corrosive q Flammable q
Unknown}

^{Specify if
possible:}

^{q Unusual Activity}

^{q Smokey Stack}

^{q Loud Noise}

^{X
Other}

^{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.}

^{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)

^{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}

^{St. Clair
Township}

^O.P.P.

^{q 3}

^{Sarnia
(east of Indian Road)}

^{Sarnia
Police}

^{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 #:
_____________________________________}

^{Hazards: q Toxic q
Corrosive q Flammable q
Unknown}

^{Specify if
possible:}

^{q Unusual Activity}

^{q Smokey Stack}

^{q Loud Noise}

^{q Other}

^{Define:
Major
power dip has caused several unit upsets. Power back to normal, but
units are still recovering.}

^{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)

^{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}

^{Sarnia
(west of Indian Road)}

^{Sarnia
Police}

^{X
2}

^{q 2}

^{St. Clair
Township}

^O.P.P.

^{q 3}

^{Sarnia
(east of Indian Road)}

^{Sarnia
Police}

^{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 #:
_____________________________________}

^{Hazards: q Toxic q
Corrosive q Flammable q
Unknown}

^{Specify if
possible:}

^{q Unusual Activity}

^{X
Smokey Stack}

^{q Loud Noise}

^{q Other}

^{Define:
Unit upset}

^{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)

^{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}

^{St. Clair
Township}

^O.P.P.

^{q 3}

^{Sarnia
(east of Indian Road)}

^{Sarnia
Police}

^{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
_________________________}

^{Hazards: q Toxic q
Corrosive

X Flammable q
Unknown}

^{Specify if
possible:}

^{q Unusual Activity}

^{q Smokey Stack}

^{q Loud Noise}

^{q Other}

^{Define:
Fire on
exchanger 1-1-E007A in #1 Crude unit.}

^{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)

^{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}

^{Sarnia
(west of Indian Road)}

^{Sarnia
Police}

^{q 2}

^{St. Clair
Township}

^O.P.P.

^{q 3}

^{Sarnia
(east of Indian Road)}

^{Sarnia
Police}

^{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 #:
_____________________________________}

^{Hazards: q Toxic q
Corrosive q Flammable q
Unknown}

^{Specify if
possible:}

^{q Unusual Activity}

^{q Smokey Stack}

^{q Loud Noise}

^{q Other}

^Define:

^{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: