Forest home fire risk form

Surrounding Trees

Hardwoods (leafed trees)
No trees within 30'
10 trees within 30'
10–20 trees within 30'
20+ trees within 30'

Conifers (needled)
No trees within 30'
10 trees within 30'
10–20 trees within 30'
20+ trees within 30'

Mixed Wood
No trees within 30'
10 trees within 30'
10-20 trees within 30'
20+ trees within 30'

Ladder Fuels

Underbrush and low branches present?
Yes No

Type of Ground Cover

Majority of type of coverage within 30'.
Sand, Gravel, etc (Non-combustible)
Grasses up to 6" tall
Grasses 6"–12"
Grasses greater than 12"
Mosses
Shrubs with leaves
Shrubs with needles

Firewood or Fuel Storage

(e.g., propane/oil tanks)
None
0 to 3' from structure
3' to 30' from structure
30'+ from structure

Brush Piles

None
0 to 3' from structure
3' to 30' from structure
30'+ from structure

Gas Cans, Paint, etc.

None
0 to 3' from structure
3' to 30' from structure
30'+ from structure

Open burning practiced?

Yes No

Do you have a burn barrel, and is it up to standard?

Yes No

Outbuildings within 20' of structure?

Yes No

Total Site Hazard =

Site

Trees pruned up to 6'
Lot cleared of brush within 30'
Grass kept watered and short
Leaves/needles raked
3' of gravel or non-flammable material adjacent to structure

Structure

Regularly cleaned roof
Non-flammable skirting on decks
Clear of flammable material against structure

Other

Useable water supply nearby
Fire fighting equipment—hose, ladder, shovel
Communication system (phone, radio)
Knowledge of fire reporting number
Burn barrel/incinerator to standard
Outbuildings hazard-free

Total Hazard Reduction =