Town of Lisbon
Business Information Data Worksheet
*** Note: feel free to attach business cards, MSDS sheets, Maps, construction plans or any additional sheets where more room to answer is needed.
Contact Information
Company/ Business: Name, Address, Phone, Fax, E-mail, date occupied
Building owner &/or property manager: , Address, Phone, Fax, E-mail, date occupied
Daily duties (manager) contacts and emergency contacts (key holders): Phone, Fax, E-mail
Property Site Information
Please enclose a property map, construction plan or drawing with:
- Property and building dimensions
- Type of construction, roofing type and covering, wall construction, # stories (highest wall height), construction class
- Type of use, (mixed use, industrial, multi-family)
- Protection; (sprinkler, alarm, smoke detection systems) type, service records, installation
Chemical Storage and Use: for each chemical (MSDS may be helpful) please attach the following:
· CAS#, CAMEO#, NOAA#, DOT ID#, is MSDS on file in building
· Physical state of storage (dry, liquid, etc)
· Hazard (fire, explosion, pressure)
· Location of stored materials in building
· Amount, and how stored (UL rated cabinet, compressed cylinders, etc)
· Are placards properly utilized?
Storage Tanks (applicable/ not applicable) circle one
· Construction, (steel, concrete, etc.)
· Position (vertical, horizontal, above or below ground)
· Capacity (maximum for tank and amount usually in it)
· How many, where are they, what is in them
· What kind of base (elevated steel, concrete, etc.)
· Leak detection?
· Date built, installed, started/ stopped use
· Piping- type, above/below ground
On-Site Materials List where, how much and shelf life (revolving stock or long term)
1) Food and beverages, agricultural (crops, livestock, pets, fertilizer, pesticides etc.)
2) Personal & Home products (fabrics, furniture etc.)
3) Raw materials (wood, metals, fibers, animal products)
4) Paper products, rope (large volumes)
5) Flammables- fuels, chemicals, solids, gasses, radioactivity
6) Construction materials, machinery, metals (floor & wall coverings, const. supplies, paints, adhesives, oils, greases, fuels)
7) Appliances, electronics, medical, laboratory
8) Vehicles, parts and supplies
9) Others, containers, ordnance (explosives, fireworks), rec. arts, discarded materials (metal shavings, grease etc.)