The Utah and Intermountain Region Prescribed Fire Plan Template is
designed to be user friendly and to provide a standard format throughout
Utah for use by the Bureau of Land Management (BLM), National Park
Service (NPS), US Fish and Wildlife Service (USFWS), and Bureau of
Indian Affairs (BIA) and throughout the Intermountain Region of the USDA
Forest Service (USFS). This template meets the requirements established
in the Interagency Prescribed Fire Planning and Implementation
Procedures Reference Guide.

This Prescribed Fire Plan represents a standardized, electronic,
reproducible template form for the Prescribed Fire Plan development
process editable in MS Word. General direction from the Reference Guide
is provided within the template. For detailed direction on each element,
see the Reference Guide. While the template provides for all elements of
the burn plan, in several areas (these include the organization chart,
radio communications plan, and medical plan), units may desire to use
locally developed sections as long as they met standards developed in
the Interagency Prescribed Fire Planning and Implementation Procedures
Reference Guide.

Within the template, grey boxes identify areas requiring input into the
Prescribed Fire Plan. Wording in **red** are instructions to the
preparer for each element. Upon completion of the plan the preparer
should delete all items that appear in **red** and **should not** **be
included in the final document**. Those items underlined in
**[blue]{.underline}** are hyperlinks that will take the preparer to the
document referred to in the text or to an internet location. Items that
appear in **green** are recommended text and should be used to assist in
the development of the specifics for the prescribed fire plan, then
converted to black if utilized in the final burn plan. Text in **black**
are to remain as part of the plan.

While the template is intended to be Interagency in scope, agencies have
added national and regional supplemental direction to the Prescribed
Fire Plan template. Specific direction by agency is identified by the
following colors: Bureau of Land Management -- **brown**, US Forest
Service -- **purple**, National Park Service - **orange**. When
completing the template, one only needs to complete the additional
requirements for their respective agency and can delete the
non-applicable section or leave blank.

In the electronic MS Word version, the Project Name and Unit Name should
be entered in the document's header which will automatically appear on
each following page of the plan. Project Name is the name of the
prescribed fire and Unit Name is the name of the administrative unit.

To insert information into the document's header:

1.  Double-click in the header region (upper region of each page
    displayed on the screen).

2.  Type Project and/or Unit name.

3.  Double-click *outside* the header region in the body of the
    document.

You may also access the header under **View** \> **Headers and
Footers**. This will open the header region for edits automatically.
After entering the information, go again to **View** \> **Headers and
Footers** which will return you to being able to enter information into
the body of the document.

Revised: 20 March 2007 - JBW

![](media/image1.png){width="0.8854166666666666in" height="1.0in"}

**PRESCRIBED FIRE PLAN**

<table>
<colgroup>
<col style="width: 16%" />
<col style="width: 13%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 11%" />
<col style="width: 5%" />
<col style="width: 13%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 3%" />
<col style="width: 21%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="4"><strong><br />
ADMINISTRATIVE UNIT(S)</strong></td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="8"></td>
</tr>
<tr class="odd">
<td colspan="4"><strong>PRESCRIBED FIRE NAME</strong></td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="8"></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>PREPARED BY</strong></td>
<td colspan="7">Signature of qualified burn boss at the complexity of
the plan.</td>
<td colspan="2"><strong>DATE</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7">Name &amp; Qualification</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>ADDITIONAL PREPARER</strong></td>
<td colspan="7"></td>
<td colspan="2"><strong>DATE</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7">Name &amp; Qualification</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>FIRE MANAGEMENT OFFICER REVIEW</strong></td>
<td colspan="7">BLM/NPS Specific</td>
<td colspan="2"><strong>DATE</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7">Name &amp; Qualification</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><p><strong>TECHNICAL</strong></p>
<p><strong>REVIEW</strong></p></td>
<td colspan="7"></td>
<td colspan="2"><strong>DATE</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7">Name &amp; Qualification</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>RESOURCE MANAGEMENT</strong></td>
<td colspan="7">NPS Specific</td>
<td colspan="2"><strong>DATE</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7">Name &amp; Qualification</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>FIRE ECOLOGIST</strong></td>
<td colspan="7">NPS Specific</td>
<td colspan="2"><strong>DATE</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7">Name &amp; Qualification</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="5"><strong>Complexity Rating</strong></td>
<td colspan="5"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td><strong>EA Number</strong></td>
<td colspan="5"></td>
<td colspan="2"><strong>PROJECT NUMBER</strong></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"><strong>APPROVED BY</strong></td>
<td colspan="7"></td>
<td colspan="2"><strong>DATE</strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="7">Agency Administrator</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><strong>APPROVED BY</strong></td>
<td colspan="7"></td>
<td colspan="2"><strong>DATE</strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="7">Agency Administrator</td>
<td colspan="2"></td>
<td></td>
</tr>
</tbody>
</table>

![](media/image1.png){width="0.8854166666666666in" height="1.0in"}

**US FOREST SERVICE -- BURN BOSS REQUIREMENTS**

All elements of the Prescribed Burn Plan are as prescribed and are
predicted to remain in prescription during the expected life of the burn
(day of the burn go-no-go decision).

+--------------------+---------------------------+-----+--------------+
| **PRESCRIBED FIRE  | USFS Specific             | **  |              |
| BURN BOSS**        |                           | DAT |              |
|                    |                           | E** |              |
|                    |                           |     |              |
|                    |                           | **  |              |
|                    |                           | TIM |              |
|                    |                           | E** |              |
+--------------------+---------------------------+-----+--------------+
|                    | RXB1, RXB2, RXB3          |     |              |
|                    |                           |     |              |
|                    | (circle appropriate       |     |              |
|                    | qualification)            |     |              |
+--------------------+---------------------------+-----+--------------+

The burn unit should be checked on a regular basis following active
ignition until declared out. Documentation of conditions should be made
in a Unit Log with the below filled out following each check of the burn
unit.

  ----------------------- ----------------------- -----------------------
  **Date/Time Lines       **Who Checked**         **Method (air/ground)**
  Checked**                                       

                                                  

                                                  

                                                  
  ----------------------- ----------------------- -----------------------

+--------------------+---------------------------+-----+--------------+
| **PRESCRIBED BURN  | USFS Specific             | **  |              |
| DECLARED OUT**     |                           | DAT |              |
|                    |                           | E** |              |
|                    |                           |     |              |
|                    |                           | **  |              |
|                    |                           | TIM |              |
|                    |                           | E** |              |
+--------------------+---------------------------+-----+--------------+
|                    | RXB1, RXB2, RXB3          |     |              |
|                    |                           |     |              |
|                    | (circle appropriate       |     |              |
|                    | Qualification)            |     |              |
+--------------------+---------------------------+-----+--------------+

  -----------------------------------------------------------------------
  **Management Summary**

  The first paragraph of the Management Summary is intended as an overall
  project summary for internal and external use. The paragraph should be
  used on [www.utahfireinfo.gov](http://www.utahfireinfo.gov/) to
  summarize each burn project in Utah when scheduled for implementation.
  The (name of prescribed fire) Prescribed Fire project is located in XXX
  County, XXX miles (direction) of (name of community). Previous
  treatment on this project included XXX. The project consists of XXX
  acres located (geographical location). The primary objective of this
  burn is to reduce the existing wildland fire hazard and (include any
  other significant objectives), thus reducing potential negative effects
  from future wildland fire to both agency and adjacent private lands
  while restoring fire-adaptive ecosystems.
  -----------------------------------------------------------------------

**ELEMENT 2 - AGENCY ADMINISTRATOR PRE-IGNITION APPROVAL CHECKLIST**

Instructions: The Agency Administrator's Pre-Ignition Approval is the
intermediate planning review process (i.e. between the Prescribed Fire
Complexity Rating System Guide and Go-No-Go Checklist) that should be
completed before a prescribed fire can be implemented. The Agency
Administrator's Pre-Ignition Approval evaluates whether compliance
requirements, Prescribed Fire Plan elements, and internal and external
notifications have been or will be completed and expresses the Agency
Administrator's intent to implement the Prescribed Fire Plan. If
ignition of the prescribed fire is not initiated prior to expiration
date determined by the Agency Administrator, a new approval will be
required.

+----+----+------------------------------------------------------------+
| *  | ** | **KEY ELEMENT QUESTIONS**                                  |
| *Y | NO |                                                            |
| ES | ** |                                                            |
| ** |    |                                                            |
+----+----+------------------------------------------------------------+
|    |    | Is the Prescribed Fire Plan up to date?                    |
|    |    |                                                            |
|    |    | *Hints: amendments, seasonality.*                          |
+----+----+------------------------------------------------------------+
|    |    | Will all compliance requirements be completed?             |
|    |    |                                                            |
|    |    | *Hints: cultural, threatened and endangered species, smoke |
|    |    | management, NEPA.*                                         |
+----+----+------------------------------------------------------------+
|    |    | Is risk management in place and the residual risk          |
|    |    | acceptable?                                                |
|    |    |                                                            |
|    |    | *Hints: Prescribed Fire Complexity Rating Guide completed  |
|    |    | with rational and mitigation measures identified and       |
|    |    | documented?*                                               |
+----+----+------------------------------------------------------------+
|    |    | Will all elements of the Prescribed Fire Plan be met?      |
|    |    |                                                            |
|    |    | *Hints: Preparation work, mitigation, weather,             |
|    |    | organization, prescription, contingency resources*         |
+----+----+------------------------------------------------------------+
|    |    | Will all internal and external notifications and media     |
|    |    | releases be completed?                                     |
|    |    |                                                            |
|    |    | *Hints: Preparedness level restrictions*                   |
+----+----+------------------------------------------------------------+
|    |    | Will key agency staff be fully briefed and understand      |
|    |    | prescribed fire implementation?                            |
+----+----+------------------------------------------------------------+
|    |    | Are there any other extenuating circumstances that would   |
|    |    | preclude the successful implementation of the plan?        |
+----+----+------------------------------------------------------------+
|    |    | Have you determined if and when you are to be notified     |
|    |    | that contingency actions are being taken? Will this be     |
|    |    | communicated to the Burn Boss?                             |
+----+----+------------------------------------------------------------+
|    |    | Other:                                                     |
+----+----+------------------------------------------------------------+

+------------------+------------------------------+-----+-------------+
| **RECOMMENDED    |                              | **  |             |
| BY**             |                              | DAT |             |
|                  |                              | E** |             |
+------------------+------------------------------+-----+-------------+
|                  | FMO/Fuels                    |     |             |
|                  | Specialist/Prescribed Fire   |     |             |
|                  | Burn Boss                    |     |             |
+------------------+------------------------------+-----+-------------+
| **APPROVED BY**  |                              | **  |             |
|                  |                              | DAT |             |
|                  |                              | E** |             |
+------------------+------------------------------+-----+-------------+
|                  | Agency Administrator         |     |             |
+------------------+------------------------------+-----+-------------+
| **APPROVED BY**  |                              | **  |             |
|                  |                              | DAT |             |
|                  |                              | E** |             |
+------------------+------------------------------+-----+-------------+
|                  | Agency Administrator         |     |             |
+------------------+------------------------------+-----+-------------+
| **APPROVAL**     |                              |     |             |
|                  |                              |     |             |
| **EXPIRES        |                              |     |             |
| (date)**         |                              |     |             |
+------------------+------------------------------+-----+-------------+

**ELEMENT 2 - PRESCRIBED FIRE GO-NO-GO CHECKLIST**

+------------------------------------------------------------+----+----+
|                                                            | *  | ** |
|                                                            | *Y | NO |
|                                                            | ES | ** |
|                                                            | ** |    |
+------------------------------------------------------------+----+----+
| A.  Has the burn unit experienced unusual drought          |    |    |
|     conditions or contain above normal fuel loadings which |    |    |
|     were not considered in the prescription development?   |    |    |
|     If [NO]{.underline} proceed with checklist, if         |    |    |
|     [YES]{.underline} go to item B.                        |    |    |
+------------------------------------------------------------+----+----+
| B.  If [YES]{.underline} have appropriate changes been     |    |    |
|     made to the Ignition and Holding plan and the Mop Up   |    |    |
|     and Patrol Plans? If [YES]{.underline} proceed with    |    |    |
|     checklist below, if [NO]{.underline} STOP.             |    |    |
+------------------------------------------------------------+----+----+

  --------- -------- ------------------------------------------------------------
  **YES**   **NO**   **QUESTIONS**

                     Are ALL fire prescription elements met?

                     Are ALL smoke management specifications met?

                     Has ALL required current and projected fire weather forecast
                     been obtained and are they favorable?

                     Are ALL planned operations personnel and equipment on-site,
                     available, and operational?

                     Has the availability of ALL contingency resources been
                     checked, and are they available?

                     Have ALL personnel been briefed on the project objectives,
                     their assignment, safety hazards, escape routes, and safety
                     zones?

                     Have all the pre-burn considerations identified in the
                     Prescribed Fire Plan been completed or addressed?

                     Have ALL the required notifications been made?

                     Are ALL permits and clearances obtained?

                     In your opinion, can the burn be carried out according to
                     the Prescribed Fire Plan and will it meet the planned
                     objective?
  --------- -------- ------------------------------------------------------------

If ALL answers are YES, proceed with the test fire. Document the
conditions, location and results on the Test Fire Provision Worksheet
and Unit Log. Concurrence is documented by the signatures below. The
Go-No-Go Checklist will be completed each day of active ignition. The
separate Agency Administrator Pre-Ignition Approval Checklist is
required to document the agency administrator's final approval.

  ----------------- ------------ ----------------------------- ---------- ----------------
  **SIGNED**                                                   **DATE**   

                    Prescribed                                            
                    Fire Burn                                             
                    Boss                                                  

  **CONCURRENCE**                                              **DATE**   

                    Ignition                                              
                    Specialist                                            
                    Function                                              

  **CONCURRENCE**                                              **DATE**   

                                 Holding Specialist Function              
  ----------------- ------------ ----------------------------- ---------- ----------------

**ELEMENT 3 - COMPLEXITY ANALYSIS SUMMARY**

  -------------------------- -------------- --------------- --------------
  **ELEMENT**                **RISK**       **POTENTIAL     **TECHNICAL
                                            CONSEQUENCE**   DIFFICULTY**

  1\. Potential for escape                                  

  2\. The number and                                        
  dependence of activities                                  

  3\. Off-site Values                                       

  4\. On-Site Values                                        

  5\. Fire Behavior                                         

  6\. Management                                            
  organization                                              

  7\. Public and political                                  
  interest                                                  

  8\. Fire Treatment                                        
  objectives                                                

  9\. Constraints                                           

  10\. Safety                                               

  11\. Ignition procedures/                                 
  methods                                                   

  12\. Interagency                                          
  coordination                                              

  13\. Project logistics                                    

  14\. Smoke management                                     
  -------------------------- -------------- --------------- --------------

  ------------------------------------------------- ---------------------
  **COMPLEXITY RATING SUMMARY**                     

                                                    **OVERALL RATING**

  **RISK**                                          

  **POTENTIAL CONSEQUENCES**                        

  **TECHNICAL DIFFICULTY**                          

  **SUMMARY COMPLEXITY DETERMINATION**              

  **Rationale**                                     

  Place short narrative on general rationale used   
  in developing complexity analysis. All elements   
  with a "High" rating and those elements that are  
  higher than the summary rating in the complexity  
  analysis will be discussed and will identify      
  potential consequences and mitigating measures.   
  If Complexity Rating Worksheets develop a lower   
  complexity then selected, explain reason for      
  going with higher complexity.                     
  ------------------------------------------------- ---------------------

**ELEMENT 4 - DESCRIPTION OF PRESCRIBED FIRE AREA**

**A. Physical Description**

+-------------------+----+----------+----+-----------+----+-----------+
| Legal             | T  |          | R  |           | S  |           |
| description:      |    |          |    |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+
|                   | T  |          | R  |           | S  |           |
+-------------------+----+----------+----+-----------+----+-----------+
| Latitude          |    |          | L  |           |    |           |
|                   |    |          | on |           |    |           |
|                   |    |          | gi |           |    |           |
|                   |    |          | tu |           |    |           |
|                   |    |          | de |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+
| Project Acres     |    |          | Co |           |    |           |
|                   |    |          | un |           |    |           |
|                   |    |          | ty |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+
| Primary Unit      |    |          | Dr |           |    |           |
| Acres             |    |          | ai |           |    |           |
|                   |    |          | na |           |    |           |
|                   |    |          | ge |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+
| Low elevation     |    |          | A  |           |    |           |
|                   |    |          | ve |           |    |           |
|                   |    |          | ra |           |    |           |
|                   |    |          | ge |           |    |           |
|                   |    |          | as |           |    |           |
|                   |    |          | pe |           |    |           |
|                   |    |          | ct |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+
| High elevation    |    |          | A  |           |    |           |
|                   |    |          | ve |           |    |           |
|                   |    |          | ra |           |    |           |
|                   |    |          | ge |           |    |           |
|                   |    |          | s  |           |    |           |
|                   |    |          | lo |           |    |           |
|                   |    |          | pe |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+
|                   |    |          |    |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+
| **Project         |    |          |    |           |    |           |
| Boundary**        |    |          |    |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+
| **The project     |    |          |    |           |    |           |
| boundary defines  |    |          |    |           |    |           |
| that area where   |    |          |    |           |    |           |
| fire will be      |    |          |    |           |    |           |
| ignited and may   |    |          |    |           |    |           |
| be allowed to     |    |          |    |           |    |           |
| burn.** Describe  |    |          |    |           |    |           |
| the physical,     |    |          |    |           |    |           |
| natural and/or    |    |          |    |           |    |           |
| human made        |    |          |    |           |    |           |
| boundaries        |    |          |    |           |    |           |
| (including        |    |          |    |           |    |           |
| primary unit      |    |          |    |           |    |           |
| (area to be       |    |          |    |           |    |           |
| ignited) and area |    |          |    |           |    |           |
| fire is allowed   |    |          |    |           |    |           |
| to burn along     |    |          |    |           |    |           |
| with discussion   |    |          |    |           |    |           |
| on multiple       |    |          |    |           |    |           |
| compartments if   |    |          |    |           |    |           |
| applicable) of    |    |          |    |           |    |           |
| the prescribed    |    |          |    |           |    |           |
| fire project.     |    |          |    |           |    |           |
| This will be done |    |          |    |           |    |           |
| through maps and  |    |          |    |           |    |           |
| a narrative. The  |    |          |    |           |    |           |
| entire prescribed |    |          |    |           |    |           |
| fire project area |    |          |    |           |    |           |
| must be analyzed  |    |          |    |           |    |           |
| under NEPA.       |    |          |    |           |    |           |
|                   |    |          |    |           |    |           |
| The project area  |    |          |    |           |    |           |
| includes          |    |          |    |           |    |           |
| (narrative        |    |          |    |           |    |           |
| description of    |    |          |    |           |    |           |
| project area and  |    |          |    |           |    |           |
| boundary). The    |    |          |    |           |    |           |
| primary unit,     |    |          |    |           |    |           |
| where active      |    |          |    |           |    |           |
| ignition will     |    |          |    |           |    |           |
| occur, includes   |    |          |    |           |    |           |
| (narrative        |    |          |    |           |    |           |
| description of    |    |          |    |           |    |           |
| primary unit and  |    |          |    |           |    |           |
| boundary).        |    |          |    |           |    |           |
|                   |    |          |    |           |    |           |
| An amendment to   |    |          |    |           |    |           |
| the burn plan is  |    |          |    |           |    |           |
| not required for  |    |          |    |           |    |           |
| minor changes in  |    |          |    |           |    |           |
| burn unit         |    |          |    |           |    |           |
| boundaries to     |    |          |    |           |    |           |
| facilitate        |    |          |    |           |    |           |
| holding and/or    |    |          |    |           |    |           |
| ignition, as long |    |          |    |           |    |           |
| as the area in    |    |          |    |           |    |           |
| question has been |    |          |    |           |    |           |
| in the NEPA       |    |          |    |           |    |           |
| document,         |    |          |    |           |    |           |
| requires no       |    |          |    |           |    |           |
| change in holding |    |          |    |           |    |           |
| or ignition       |    |          |    |           |    |           |
| resources and is  |    |          |    |           |    |           |
| within the        |    |          |    |           |    |           |
| project           |    |          |    |           |    |           |
| boundaries.       |    |          |    |           |    |           |
| Changes to        |    |          |    |           |    |           |
| project area      |    |          |    |           |    |           |
| boundaries        |    |          |    |           |    |           |
| resulting in      |    |          |    |           |    |           |
| either an         |    |          |    |           |    |           |
| increase or       |    |          |    |           |    |           |
| decrease in area  |    |          |    |           |    |           |
| requires an       |    |          |    |           |    |           |
| amendment to the  |    |          |    |           |    |           |
| burn plan.        |    |          |    |           |    |           |
+-------------------+----+----------+----+-----------+----+-----------+

**B. Vegetation/Fuels Description**

+---+-------------+------+------+------------------------+-----+-----+
| * |             |      |      | **Adjacent Fuels       |     |     |
| * |             |      |      | Data**                 |     |     |
| O |             |      |      |                        |     |     |
| n |             |      |      |                        |     |     |
| - |             |      |      |                        |     |     |
| S |             |      |      |                        |     |     |
| i |             |      |      |                        |     |     |
| t |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| F |             |      |      |                        |     |     |
| u |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| l |             |      |      |                        |     |     |
| s |             |      |      |                        |     |     |
| D |             |      |      |                        |     |     |
| a |             |      |      |                        |     |     |
| t |             |      |      |                        |     |     |
| a |             |      |      |                        |     |     |
| * |             |      |      |                        |     |     |
| * |             |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
| F |             |      |      | FBPS Fuel Model(s)     |     |     |
| B |             |      |      |                        |     |     |
| P |             |      |      |                        |     |     |
| S |             |      |      |                        |     |     |
| F |             |      |      |                        |     |     |
| u |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| l |             |      |      |                        |     |     |
| M |             |      |      |                        |     |     |
| o |             |      |      |                        |     |     |
| d |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| l |             |      |      |                        |     |     |
| ( |             |      |      |                        |     |     |
| s |             |      |      |                        |     |     |
| ) |             |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
| N |             |      |      | NFDRS Fuel Model(s)    |     |     |
| F |             |      |      |                        |     |     |
| D |             |      |      |                        |     |     |
| R |             |      |      |                        |     |     |
| S |             |      |      |                        |     |     |
| F |             |      |      |                        |     |     |
| u |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| l |             |      |      |                        |     |     |
| M |             |      |      |                        |     |     |
| o |             |      |      |                        |     |     |
| d |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| l |             |      |      |                        |     |     |
| ( |             |      |      |                        |     |     |
| s |             |      |      |                        |     |     |
| ) |             |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
| F |             |      |      | Fire Regime(s)         |     |     |
| i |             |      |      |                        |     |     |
| r |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| R |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| g |             |      |      |                        |     |     |
| i |             |      |      |                        |     |     |
| m |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| ( |             |      |      |                        |     |     |
| s |             |      |      |                        |     |     |
| ) |             |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
| F |             |      |      | Fire Condition         |     |     |
| i |             |      |      | Class(es)              |     |     |
| r |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| C |             |      |      |                        |     |     |
| o |             |      |      |                        |     |     |
| n |             |      |      |                        |     |     |
| d |             |      |      |                        |     |     |
| i |             |      |      |                        |     |     |
| t |             |      |      |                        |     |     |
| i |             |      |      |                        |     |     |
| o |             |      |      |                        |     |     |
| n |             |      |      |                        |     |     |
| C |             |      |      |                        |     |     |
| l |             |      |      |                        |     |     |
| a |             |      |      |                        |     |     |
| s |             |      |      |                        |     |     |
| s |             |      |      |                        |     |     |
| ( |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| s |             |      |      |                        |     |     |
| ) |             |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
| > | 1 hour tlf  |      |      | General Description of |     |     |
|   |             |      |      | Adjacent Fuels         |     |     |
| F |             |      |      |                        |     |     |
| u |             |      |      |                        |     |     |
| e |             |      |      |                        |     |     |
| l |             |      |      |                        |     |     |
| > |             |      |      |                        |     |     |
|   |             |      |      |                        |     |     |
| L |             |      |      |                        |     |     |
| o |             |      |      |                        |     |     |
| a |             |      |      |                        |     |     |
| d |             |      |      |                        |     |     |
| i |             |      |      |                        |     |     |
| n |             |      |      |                        |     |     |
| g |             |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
|   | 10 hour tlf |      |      | Describe the fuels     |     |     |
|   |             |      |      | outside of the primary |     |     |
|   |             |      |      | burn unit with         |     |     |
|   |             |      |      | consideration of this  |     |     |
|   |             |      |      | used in developing     |     |     |
|   |             |      |      | minimum workforce and  |     |     |
|   |             |      |      | equipment needs.       |     |     |
+---+-------------+------+------+------------------------+-----+-----+
|   | 100 hour    |      |      |                        |     |     |
|   | tlf         |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
|   | 1000 hour   |      |      |                        |     |     |
|   | tlf         |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
|   | Litter      |      |      |                        |     |     |
|   | depth       |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
|   | Duff depth  |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
|   | Live woody  |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
|   | Live        |      |      |                        |     |     |
|   | herbaceous  |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
|   | Total fuel  |      |      |                        |     |     |
|   | loading     |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
| * |             |      |      |                        |     |     |
| * |             |      |      |                        |     |     |
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| * |             |      |      |                        |     |     |
+---+-------------+------+------+------------------------+-----+-----+
| I |             |      |      |                        |     |     |
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+---+-------------+------+------+------------------------+-----+-----+

**C. Description of Unique Features**

  -----------------------------------------------------------------------
  List and discuss special features, hazards, regulations, issues,
  constraints, etc. Examples may include: fences, power poles,
  historical/cultural sites, threatened and endangered species or habitat
  to protect, etc.

  -----------------------------------------------------------------------

**ELEMENT 5 - GOALS AND OBJECTIVES**

**A. Goals**

  -----------------------------------------------------------------------
  Short summary description that identifies the purpose of the prescribed
  fire and the resource management goals from the supporting
  Land/Resource Management Plans, Fire Management Plans, and/or NEPA
  documents. Will identify desired future conditions of the prescribed
  fire project. This should be consistent with the appropriate land
  management goals. Include a discussion of future Fire Regime Condition
  Class (FRCC) post-treatment conditions if applicable.

  -----------------------------------------------------------------------

**B. Objectives**

  -----------------------------------------------------------------------
  1\. Resource Objectives

  Describe in clear, concise statements the specific measurable resource
  and prescribed fire objectives for this project. Objectives will be
  measurable and quantifiable so prescription elements can be developed
  to meet those objectives and the success of the project can be
  determined following implementation.

  2\. Prescribed Fire Objectives

  -----------------------------------------------------------------------

**ELEMENT 6 - FUNDING**

+--------+-------+-------+-------+--------+-------+-------+-------+
| F      |       |       |       |        |       |       |       |
| unding |       |       |       |        |       |       |       |
| Sou    |       |       |       |        |       |       |       |
| rce(s) |       |       |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+
| Phase  | Fuels | Wil   | Range | Recr   | T     | Other | Sub   |
|        |       | dlife |       | eation | imber |       | total |
+--------+-------+-------+-------+--------+-------+-------+-------+
| Pl     |       |       |       |        |       |       |       |
| anning |       |       |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+
| Clea   |       |       |       |        |       |       |       |
| rances |       |       |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+
| Burn   |       |       |       |        |       |       |       |
| Plan   |       |       |       |        |       |       |       |
| Prepa  |       |       |       |        |       |       |       |
| ration |       |       |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+
| Site   |       |       |       |        |       |       |       |
| Prepa  |       |       |       |        |       |       |       |
| ration |       |       |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+
| Ig     |       |       |       |        |       |       |       |
| nition |       |       |       |        |       |       |       |
| &      |       |       |       |        |       |       |       |
| H      |       |       |       |        |       |       |       |
| olding |       |       |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+
| Mop-up |       |       |       |        |       |       |       |
|        |       |       |       |        |       |       |       |
| &      |       |       |       |        |       |       |       |
| Patrol |       |       |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+
| Su     |       |       |       |        |       |       |       |
| btotal |       |       |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+
| *      |       | \*    |       |        |       |       |       |
| *Grand |       | Enter |       |        |       |       |       |
| T      |       | S     |       |        |       |       |       |
| otal** |       | ubact |       |        |       |       |       |
|        |       | ivity |       |        |       |       |       |
|        |       | code  |       |        |       |       |       |
|        |       | at    |       |        |       |       |       |
|        |       | top   |       |        |       |       |       |
|        |       | of    |       |        |       |       |       |
|        |       | c     |       |        |       |       |       |
|        |       | olumn |       |        |       |       |       |
|        |       | (i.e. |       |        |       |       |       |
|        |       | Wildl |       |        |       |       |       |
|        |       | ife-1 |       |        |       |       |       |
|        |       | 050). |       |        |       |       |       |
|        |       | These |       |        |       |       |       |
|        |       | esti  |       |        |       |       |       |
|        |       | mated |       |        |       |       |       |
|        |       | costs |       |        |       |       |       |
|        |       | are   |       |        |       |       |       |
|        |       | for   |       |        |       |       |       |
|        |       | the   |       |        |       |       |       |
|        |       | e     |       |        |       |       |       |
|        |       | ntire |       |        |       |       |       |
|        |       | burn  |       |        |       |       |       |
|        |       | impl  |       |        |       |       |       |
|        |       | ement |       |        |       |       |       |
|        |       | ation |       |        |       |       |       |
|        |       | and   |       |        |       |       |       |
|        |       | could |       |        |       |       |       |
|        |       | be in |       |        |       |       |       |
|        |       | one   |       |        |       |       |       |
|        |       | or    |       |        |       |       |       |
|        |       | more  |       |        |       |       |       |
|        |       | suba  |       |        |       |       |       |
|        |       | ctivi |       |        |       |       |       |
|        |       | ties. |       |        |       |       |       |
+--------+-------+-------+-------+--------+-------+-------+-------+

**ELEMENT 7 - PRESCRIPTION**

+---------------------+-----------+-----------+------------+----------+
| A.  **Environmental | #         |           |            | *        |
|     Prescription**  | ## **Acce |           |            | *Outside |
|                     | ptable Pr |           |            | area at  |
|                     | escriptio |           |            | critical |
|                     | n Range** |           |            | holding  |
|                     |           |           |            | point**  |
|                     |           |           |            |          |
|                     |           |           |            | *        |
|                     |           |           |            | *minimum |
|                     |           |           |            | ac       |
|                     |           |           |            | ceptable |
|                     |           |           |            | mo       |
|                     |           |           |            | isture** |
+---------------------+-----------+-----------+------------+----------+
|                     | **Low     | **Desired | **High     |          |
|                     | Fire**    | Fire**    | Fire**     |          |
|                     |           |           |            |          |
|                     | **In      | **In      | **I        |          |
|                     | tensity** | tensity** | ntensity** |          |
+---------------------+-----------+-----------+------------+----------+
| **Temperature       |           |           |            |          |
| (°F)**              |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **Relative humidity |           |           |            |          |
| (%)**               |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **Mid-flame wind    |           |           |            |          |
| speed**             |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **Wind direction    |           |           |            |          |
| (azimuth°)**        |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **1-hr fuel         |           |           |            |          |
| moisture (%)**      |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **10-hr fuel        |           |           |            |          |
| moisture (%)**      |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **100-hr fuel       |           |           |            |          |
| moisture (%)**      |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **1000-hr fuel      |           |           |            |          |
| moisture (%)**      |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **Live fuel         |           |           |            |          |
| moisture (%)**      |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **Duff moisture     |           |           |            |          |
| (%)**               |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+
| **Soil moisture     |           |           |            |          |
| (%)**               |           |           |            |          |
+---------------------+-----------+-----------+------------+----------+

+-----------------------------------------------------------------------+
| **Additional Information**                                            |
+-----------------------------------------------------------------------+
| If a weather or fuel element is not a consideration as an             |
| environmental prescription, place N/A in the blank and do not leave   |
| empty. Identify vegetation species and timing for collecting. Fuel    |
| moistures should be collected from the burn site. If computed fuel    |
| moisture is used in determining guidance parameter verses actual      |
| sample, then such should be indicated as parameter.                   |
|                                                                       |
| Separate prescriptions may be needed for multiple fuel model          |
| conditions to address seasonal differences and/or types of ignition   |
| (black lining, aerial ignition, etc). Separate prescriptions may      |
| result in multiple complexity ratings and burn organizations. For     |
| example, a separate prescription is needed for black-lining           |
| operations if conditions will be significantly different from the     |
| primary prescription. Separate prescriptions may result in the need   |
| to identify multiple levels of management, organizational structures, |
| implementation measures, and pre-burn considerations.                 |
+-----------------------------------------------------------------------+

+-----------------------+----------+----------+----------+----------+
| B.  **Fire Behavior   | **Ac     |          |          | *        |
|     Prescription**    | ceptable |          |          | *Outside |
|                       | Fire     |          |          | area at  |
|                       | Behavior |          |          | critical |
|                       | Range**  |          |          | holding  |
|                       |          |          |          | points** |
+-----------------------+----------+----------+----------+----------+
|                       | **Low    | *        | **High   |          |
|                       | Fire     | *Desired | Fire     |          |
|                       | Int      | Fire     | Int      |          |
|                       | ensity** | Int      | ensity** |          |
|                       |          | ensity** |          |          |
+-----------------------+----------+----------+----------+----------+
| **Fuel Model(s)**     |          |          |          |          |
+-----------------------+----------+----------+----------+----------+
| **Rate of Spread**    |          |          |          |          |
| (chains/hour)         |          |          |          |          |
+-----------------------+----------+----------+----------+----------+
| **Flame Length** (in  |          |          |          |          |
| feet)                 |          |          |          |          |
+-----------------------+----------+----------+----------+----------+
| **Scorch Height** (in |          |          |          |          |
| feet)                 |          |          |          |          |
+-----------------------+----------+----------+----------+----------+
| **Probability of      |          |          |          |          |
| Ignition** (%)        |          |          |          |          |
+-----------------------+----------+----------+----------+----------+
| **Spotting Distance** |          |          |          |          |
| (in miles)            |          |          |          |          |
+-----------------------+----------+----------+----------+----------+
| **Prescription is     |          |          |          |          |
| defined as the        |          |          |          |          |
| measurable criteria   |          |          |          |          |
| that define a range   |          |          |          |          |
| of conditions during  |          |          |          |          |
| which a prescribed    |          |          |          |          |
| fire may be ignited   |          |          |          |          |
| and held as a         |          |          |          |          |
| prescribed fire. The  |          |          |          |          |
| plan prescription     |          |          |          |          |
| will describe a range |          |          |          |          |
| of low to high limits |          |          |          |          |
| for the environmental |          |          |          |          |
| (weather, topography, |          |          |          |          |
| fuels, etc.) and fire |          |          |          |          |
| behavior (flame       |          |          |          |          |
| lengths, rate of      |          |          |          |          |
| spread, spotting      |          |          |          |          |
| distance, etc.)       |          |          |          |          |
| parameters required   |          |          |          |          |
| to meet Prescribed    |          |          |          |          |
| Fire Plan objectives  |          |          |          |          |
| while meeting smoke   |          |          |          |          |
| management and        |          |          |          |          |
| control objectives.   |          |          |          |          |
| Parameters are        |          |          |          |          |
| quantitative          |          |          |          |          |
| variables expressed   |          |          |          |          |
| as a range that       |          |          |          |          |
| result in acceptable  |          |          |          |          |
| fire behavior and     |          |          |          |          |
| smoke management.**   |          |          |          |          |
|                       |          |          |          |          |
| **Attach BehavePlus   |          |          |          |          |
| Worksheets**          |          |          |          |          |
+-----------------------+----------+----------+----------+----------+
| **Fire Behavior       |          |          |          |          |
| Narrative**           |          |          |          |          |
+-----------------------+----------+----------+----------+----------+
| Separate              |          |          |          |          |
| Environmental and     |          |          |          |          |
| Fire Behavior         |          |          |          |          |
| Prescriptions may     |          |          |          |          |
| need to be developed  |          |          |          |          |
| for each separate     |          |          |          |          |
| phase (primary burn   |          |          |          |          |
| phase & black         |          |          |          |          |
| lining). Separate     |          |          |          |          |
| Environmental and     |          |          |          |          |
| Fire Behavior         |          |          |          |          |
| Prescriptions may     |          |          |          |          |
| need to be developed  |          |          |          |          |
| if potential exists   |          |          |          |          |
| for burning to occur  |          |          |          |          |
| in different seasons  |          |          |          |          |
| (i.e. fall vs.        |          |          |          |          |
| spring).              |          |          |          |          |
+-----------------------+----------+----------+----------+----------+

**ELEMENT 8 - SCHEDULING**

+--------------------------------+-------------------------------------+
| A.  **Ignition Time            |                                     |
|     Frames/Season(s)**         |                                     |
+--------------------------------+-------------------------------------+
| B.  **Projected Duration**     |                                     |
+--------------------------------+-------------------------------------+
| C.  **Constraints**            |                                     |
+--------------------------------+-------------------------------------+
| These constraints and          |                                     |
| considerations are specific to |                                     |
| burn scheduling (i.e. cannot   |                                     |
| burn from 1 May to 31 July due |                                     |
| to nesting birds, local event  |                                     |
| occurs on the first weekend of |                                     |
| a specific month and burning   |                                     |
| to not occur, a spring burn is |                                     |
| preferred to a fall burn to    |                                     |
| reduce the impact to the       |                                     |
| residual vegetation).          |                                     |
+--------------------------------+-------------------------------------+

**ELEMENT 9 - PRE-BURN CONSIDERATIONS**

A.  **Considerations**

+-----------------------------------------------------------------------+
| **1. On Site**                                                        |
+-----------------------------------------------------------------------+
| Describe on-site actions and considerations that need to be conducted |
| prior to implementation. Examples include clearances, line to be      |
| built, preparation of critical holding points, snags to be felled or  |
| protected, equipment to be pre-positioned, special features to be     |
| protected, warning signs to be placed, portable weather stations to   |
| be put in place, fuels moisture sampling, and monitoring needs.       |
| Include who is responsible and timeframes for completion.             |
+-----------------------------------------------------------------------+
| **2. Off Site**                                                       |
+-----------------------------------------------------------------------+
| Describe off-site actions and considerations that need to be          |
| conducted prior to implementation.                                    |
|                                                                       |
| Prior to implementing the prescribed fire, the responsible dispatch   |
| office **will** be given a complete copy of the Prescribed Fire Plan. |
+-----------------------------------------------------------------------+

**B. Method and Frequency for Obtaining Weather and Smoke Management
Forecast(s)**

+-------------------------+-----+------+-----+------------------------+
| **Proximity to nearest  | Id  |      |     |                        |
| RAWS**                  | ent |      |     |                        |
|                         | ify |      |     |                        |
|                         | n   |      |     |                        |
|                         | ear |      |     |                        |
|                         | est |      |     |                        |
|                         | R   |      |     |                        |
|                         | AWS |      |     |                        |
|                         | w   |      |     |                        |
|                         | ith |      |     |                        |
|                         | dis |      |     |                        |
|                         | tan |      |     |                        |
|                         | ce/ |      |     |                        |
|                         | dir |      |     |                        |
|                         | ect |      |     |                        |
|                         | ion |      |     |                        |
|                         | f   |      |     |                        |
|                         | rom |      |     |                        |
|                         | U   |      |     |                        |
|                         | nit |      |     |                        |
+-------------------------+-----+------+-----+------------------------+
| **Need for on-site      |     | Yes  |     | No                     |
| RAWS**                  |     |      |     |                        |
+-------------------------+-----+------+-----+------------------------+
| **Additional            |     |      |     |                        |
| Information**           |     |      |     |                        |
+-------------------------+-----+------+-----+------------------------+
| Describe any fuel       |     |      |     |                        |
| sampling and weather    |     |      |     |                        |
| data that may need to   |     |      |     |                        |
| be obtained. This data  |     |      |     |                        |
| should be taken at the  |     |      |     |                        |
| project site. If this   |     |      |     |                        |
| is not possible, use    |     |      |     |                        |
| the closest             |     |      |     |                        |
| representative site.    |     |      |     |                        |
| Identify requirements   |     |      |     |                        |
| for a spot weather      |     |      |     |                        |
| forecast and associated |     |      |     |                        |
| National Weather        |     |      |     |                        |
| Service Forecast        |     |      |     |                        |
| Office.                 |     |      |     |                        |
|                         |     |      |     |                        |
| **A Spot Weather        |     |      |     |                        |
| Forecast from the       |     |      |     |                        |
| National Weather        |     |      |     |                        |
| Service is required     |     |      |     |                        |
| prior to ignition, for  |     |      |     |                        |
| each day active         |     |      |     |                        |
| ignition is occurring   |     |      |     |                        |
| on the burn.** The      |     |      |     |                        |
| National Weather        |     |      |     |                        |
| Service (Salt Lake      |     |      |     |                        |
| City/Grand              |     |      |     |                        |
| Junction/P              |     |      |     |                        |
| ocatello/Boise/Elko/Las |     |      |     |                        |
| Vegas/Reno) Forecast    |     |      |     |                        |
| Office can be reached   |     |      |     |                        |
| at (801-524-5066        |     |      |     |                        |
| (SLC)/970-256-9463      |     |      |     |                        |
| (GJT)/208-232-9316 or   |     |      |     |                        |
| 9357 (PIH)/208-334-9862 |     |      |     |                        |
| (BOI)/775-778-6720      |     |      |     |                        |
| (LKN)/702-263-9750      |     |      |     |                        |
| (VEF)/775-673-8109      |     |      |     |                        |
| (REV)) or a spot        |     |      |     |                        |
| weather forecast can be |     |      |     |                        |
| requested online at     |     |      |     |                        |
| (<http://sp             |     |      |     |                        |
| ot.nws.noaa.gov/cgi-bin |     |      |     |                        |
| /spot/spotmon?site=slc> |     |      |     |                        |
| /                       |     |      |     |                        |
| <http://sp              |     |      |     |                        |
| ot.nws.noaa.gov/cgi-bin |     |      |     |                        |
| /spot/spotmon?site=gjt> |     |      |     |                        |
| /                       |     |      |     |                        |
| <http://sp              |     |      |     |                        |
| ot.nws.noaa.gov/cgi-bin |     |      |     |                        |
| /spot/spotmon?site=pih> |     |      |     |                        |
| /                       |     |      |     |                        |
| <http://sp              |     |      |     |                        |
| ot.nws.noaa.gov/cgi-bin |     |      |     |                        |
| /spot/spotmon?site=boi> |     |      |     |                        |
| /                       |     |      |     |                        |
| <http://sp              |     |      |     |                        |
| ot.nws.noaa.gov/cgi-bin |     |      |     |                        |
| /spot/spotmon?site=lkn> |     |      |     |                        |
| /                       |     |      |     |                        |
| <http://sp              |     |      |     |                        |
| ot.nws.noaa.gov/cgi-bin |     |      |     |                        |
| /spot/spotmon?site=vef> |     |      |     |                        |
| /                       |     |      |     |                        |
| <http://spot            |     |      |     |                        |
| .nws.noaa.gov/cgi-bin/s |     |      |     |                        |
| pot/spotmon?site=rev>). |     |      |     |                        |
|                         |     |      |     |                        |
| Projected weather       |     |      |     |                        |
| beyond the ignition     |     |      |     |                        |
| operation and need from |     |      |     |                        |
| additional spot weather |     |      |     |                        |
| forecasts should be     |     |      |     |                        |
| taken into account in   |     |      |     |                        |
| order to minimize the   |     |      |     |                        |
| risk of a later escape. |     |      |     |                        |
| Local weather phenomena |     |      |     |                        |
| and considerations      |     |      |     |                        |
| include (entered local  |     |      |     |                        |
| weather information).   |     |      |     |                        |
|                         |     |      |     |                        |
| Within Utah, a Clearing |     |      |     |                        |
| Index must be obtained  |     |      |     |                        |
| from the National       |     |      |     |                        |
| Weather Service         |     |      |     |                        |
| responsible for area    |     |      |     |                        |
| burn is occurring.      |     |      |     |                        |
+-------------------------+-----+------+-----+------------------------+

**C. Notifications**

  -----------------------------------------------------------------------
  The Notification Plan will include a list of agencies, organizations
  (including media), and individuals that are to be notified prior to
  ignition, with information necessary to make the contacts. Reasonable
  efforts will be made to notify adjacent land owners (or their agents)
  and other potentially impacted publics. Attempts and/or actual
  notifications will be documented with date and method and placed in the
  Project File.

  -----------------------------------------------------------------------

+-----------+-------+-----+-----------+----------+---+------+--------+
| **Who**   |       | **  | **Phone   | **       |   | **Da | **C    |
|           |       | Whe | Number    | Responsi |   | te** | ontact |
|           |       | n^1 | and/or    | bility** |   |      | Typ    |
|           |       | ^** | e-mail**  |          |   |      | e^2^** |
+-----------+-------+-----+-----------+----------+---+------+--------+
| J.        |       | B,  | 801       | Burn     |   |      |        |
| Bradley   |       | A   | -539-4246 | Boss     |   |      |        |
| Washa --  |       |     |           |          |   |      |        |
| Utah BLM  |       |     | 801       |          |   |      |        |
| State     |       |     | -558-6998 |          |   |      |        |
| Fuels     |       |     |           |          |   |      |        |
| S         |       |     |           |          |   |      |        |
| pecialist |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
| Greg      |       | B,  | 801       | Burn     |   |      |        |
| Zs        |       | A   | -539-4151 | Boss     |   |      |        |
| chaechner |       |     |           |          |   |      |        |
| --        |       |     | 801       |          |   |      |        |
| In        |       |     | -550-9871 |          |   |      |        |
| teragency |       |     |           |          |   |      |        |
| Smoke     |       |     |           |          |   |      |        |
| M         |       |     |           |          |   |      |        |
| anagement |       |     |           |          |   |      |        |
| S         |       |     |           |          |   |      |        |
| pecialist |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
| ww        |       | B   | 435       | Fire     |   |      |        |
| w.utahfir |       |     | -259-2184 | E        |   |      |        |
| einfo.gov |       |     |           | ducation |   |      |        |
|           |       |     | Heathe    | and      |   |      |        |
| Heather   |       |     | r_O'Hanlo | Mi       |   |      |        |
| O'Hanlon  |       |     | n@blm.gov | tigation |   |      |        |
|           |       |     |           | Sp       |   |      |        |
|           |       |     |           | ecialist |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
|           |       |     |           |          |   |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+
| ^1^ When  | B     |     |           | ^2^      | P |      |        |
| to Notify | efore |     |           | Contact  | h |      |        |
|           | **(   |     |           | Type     | o |      |        |
|           | B)**: |     |           |          | n |      |        |
|           | The   |     |           |          | e |      |        |
|           | day   |     |           |          | C |      |        |
|           | prior |     |           |          | o |      |        |
|           | to    |     |           |          | n |      |        |
|           | burn  |     |           |          | t |      |        |
|           | day.  |     |           |          | a |      |        |
|           |       |     |           |          | c |      |        |
|           | Day   |     |           |          | t |      |        |
|           | of    |     |           |          | ( |      |        |
|           | **(   |     |           |          | P |      |        |
|           | D)**: |     |           |          | C |      |        |
|           | Prior |     |           |          | ) |      |        |
|           | to    |     |           |          |   |      |        |
|           | ign   |     |           |          | P |      |        |
|           | ition |     |           |          | h |      |        |
|           | on    |     |           |          | o |      |        |
|           | burn  |     |           |          | n |      |        |
|           | day.  |     |           |          | e |      |        |
|           |       |     |           |          | M |      |        |
|           | After |     |           |          | e |      |        |
|           | **(   |     |           |          | s |      |        |
|           | A)**: |     |           |          | s |      |        |
|           | After |     |           |          | a |      |        |
|           | burn  |     |           |          | g |      |        |
|           | is    |     |           |          | e |      |        |
|           | compl |     |           |          | ( |      |        |
|           | eted. |     |           |          | P |      |        |
|           |       |     |           |          | M |      |        |
|           |       |     |           |          | ) |      |        |
|           |       |     |           |          |   |      |        |
|           |       |     |           |          | D |      |        |
|           |       |     |           |          | i |      |        |
|           |       |     |           |          | r |      |        |
|           |       |     |           |          | e |      |        |
|           |       |     |           |          | c |      |        |
|           |       |     |           |          | t |      |        |
|           |       |     |           |          | C |      |        |
|           |       |     |           |          | o |      |        |
|           |       |     |           |          | n |      |        |
|           |       |     |           |          | t |      |        |
|           |       |     |           |          | a |      |        |
|           |       |     |           |          | c |      |        |
|           |       |     |           |          | t |      |        |
|           |       |     |           |          | ( |      |        |
|           |       |     |           |          | D |      |        |
|           |       |     |           |          | C |      |        |
|           |       |     |           |          | ) |      |        |
|           |       |     |           |          |   |      |        |
|           |       |     |           |          | E |      |        |
|           |       |     |           |          | - |      |        |
|           |       |     |           |          | m |      |        |
|           |       |     |           |          | a |      |        |
|           |       |     |           |          | i |      |        |
|           |       |     |           |          | l |      |        |
|           |       |     |           |          | ( |      |        |
|           |       |     |           |          | E |      |        |
|           |       |     |           |          | M |      |        |
|           |       |     |           |          | ) |      |        |
+-----------+-------+-----+-----------+----------+---+------+--------+

**ELEMENT 10 - BRIEFING**

**Operational Briefing** (Responsibility -- Prescribed Fire Burn Boss)

-   Introduction of Burn Organization

    -   Make Crew and Equipment Assignments

-   Provide Maps

-   Review Burn Objectives and Constraints

-   Review Spot Weather Forecast

-   Discuss Weather Data Collection Procedures

    -   Make Weather Observer Assignment and Set Collection Schedule

-   Review Predicted Fire Behavior

-   Review Burn Prescription and Critical Weather that Will Terminate
    Burn

-   Review Ignition Plan and Possible Problems

-   Review Aerial Ignition Plan and appropriate safety procedures (if
    applicable)

-   Review Holding Plan and Possible Problems

-   Review Contingency and Wildfire Conversion Plan

    -   Identify High Value and Areas of Special Concern

    -   Identify Mitigation Measures, Procedures, Project Boundary, Etc.

-   Review Safety Plan, Risk Assessment/JHA and Medical Evacuation Plan

    -   Identify On-Site Personnel with Medical and Helitack
        Qualifications

-   Review LCES and Identify Lookout Assignments

-   Discuss Communication Plan

**Crew Briefing** (Responsibility - Ignition Specialist and Holding
Special­ist Functions)

-   Make Crew Assignments, Record Names, and Review Chain of Command

-   Make Equipment Assignments and Physically Test Equipment Prior to
    Ignition

-   Assign Radio Frequencies and Physically Test All Radios Prior to
    Ignition

-   Review Contingency Plan, Wildfire Conversion, Procedures, and
    Mitigation

-   Review Everyone\'s Personal Protective Equipment

-   Discuss Probable Starting and Ending Times

-   Assure Everyone Knows Position, Responsibility, and Procedures

  ------------ ----------------------------------- ---------- ----------------
  **SIGNED**                                       **DATE**   

               Prescribed Fire Burn Boss                      
  ------------ ----------------------------------- ---------- ----------------

**ELEMENT 11 - ORGANIZATION AND EQUIPMENT**

+-----------------+---------+-----+------+-----+------+-----+------+
| **Minimum       |         |     |      |     |      |     |      |
| Workforce &     |         |     |      |     |      |     |      |
| Equipment**     |         |     |      |     |      |     |      |
|                 |         |     |      |     |      |     |      |
| **Needed to     |         |     |      |     |      |     |      |
| Conduct Burn**  |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| A.              |         |     |      |     |      |     |      |
|   **Positions** |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
|                 |         | *   |      | **  |      | **  |      |
|                 |         | *Lo |      | Des |      | Hig |      |
|                 |         | w** |      | ire |      | h** |      |
|                 |         |     |      | d** |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| **Position**    | **ICS   | *   | **   | *   | **   | *   | **   |
|                 | Code or | *To | Line | *To | Line | *To | Line |
|                 | Unit of | tal | Buil | tal | Buil | tal | Buil |
|                 | Me      | Am  | ding | Am  | ding | Am  | ding |
|                 | asure** | oun | Ra   | oun | Ra   | oun | Ra   |
|                 |         | t** | te** | t** | te** | t** | te** |
+-----------------+---------+-----+------+-----+------+-----+------+
| Prescribed Fire | RXBX    |     | 0    |     |      |     |      |
| Burn Boss       |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Ignition        | Specify |     |      |     |      |     |      |
| Specialist      | Qual.   |     |      |     |      |     |      |
| Function        |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Holding         | Specify |     |      |     |      |     |      |
| Specialist      | Qual.   |     |      |     |      |     |      |
| Function        |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Fire Effects    | FEMO    |     |      |     |      |     |      |
| Monitor         |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Lookout         | Specify |     |      |     |      |     |      |
|                 | Qual.   |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Engine Boss,    | EN      |     |      |     |      |     |      |
| Operator, and   | GB/ENOP |     |      |     |      |     |      |
| Crew            |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Ignition Crew   | FFT2    |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Holding Crew    | FFT2    |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
|                 |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
|                 |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| **B.            |         |     | 0    |     | 0    |     | 0    |
| Equipment**     |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Engine (Type)   |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Engine (Type)   |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Dozer (Type)    |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
|                 |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
|                 |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Helicopter      |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Helitorch       |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Plastic Sphere  |         |     |      |     |      |     |      |
| Dispenser       |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| **C. Supplies** |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Drip Troches    |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Chain Saws      |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Hand Tools      |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Fuel            |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Portable Water  |         |     |      |     |      |     |      |
| Tanks           |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
|                 |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| **Total Line    |         |     | *    |     | *    |     | *    |
| Production      |         |     | *0** |     | *0** |     | *0** |
| Rate**          |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+
| Line production |         |     |      |     |      |     |      |
| rates from      |         |     |      |     |      |     |      |
| personnel       |         |     |      |     |      |     |      |
| should not be   |         |     |      |     |      |     |      |
| duplicated for  |         |     |      |     |      |     |      |
| equipment (i.e. |         |     |      |     |      |     |      |
| holding crew    |         |     |      |     |      |     |      |
| members that    |         |     |      |     |      |     |      |
| are assigned to |         |     |      |     |      |     |      |
| an engine       |         |     |      |     |      |     |      |
| should not be   |         |     |      |     |      |     |      |
| included in     |         |     |      |     |      |     |      |
| personnel       |         |     |      |     |      |     |      |
| total). MS Word |         |     |      |     |      |     |      |
| will perform    |         |     |      |     |      |     |      |
| production rate |         |     |      |     |      |     |      |
| calculations by |         |     |      |     |      |     |      |
| right clicking  |         |     |      |     |      |     |      |
| on each numeric |         |     |      |     |      |     |      |
| field at bottom |         |     |      |     |      |     |      |
| of table and    |         |     |      |     |      |     |      |
| selecting       |         |     |      |     |      |     |      |
| "update field." |         |     |      |     |      |     |      |
| For MS Word to  |         |     |      |     |      |     |      |
| do the          |         |     |      |     |      |     |      |
| calculations,   |         |     |      |     |      |     |      |
| all boxes need  |         |     |      |     |      |     |      |
| to have a       |         |     |      |     |      |     |      |
| number in them  |         |     |      |     |      |     |      |
| (i.e. place a   |         |     |      |     |      |     |      |
| zero "0" if     |         |     |      |     |      |     |      |
| there no rate   |         |     |      |     |      |     |      |
| of production). |         |     |      |     |      |     |      |
| Place any       |         |     |      |     |      |     |      |
| assumptions     |         |     |      |     |      |     |      |
| made when       |         |     |      |     |      |     |      |
| identifying     |         |     |      |     |      |     |      |
| production      |         |     |      |     |      |     |      |
| rates. Fireline |         |     |      |     |      |     |      |
| Handbook        |         |     |      |     |      |     |      |
| production      |         |     |      |     |      |     |      |
| rates and/or    |         |     |      |     |      |     |      |
| documented      |         |     |      |     |      |     |      |
| empirical       |         |     |      |     |      |     |      |
| evidence to     |         |     |      |     |      |     |      |
| justify minimum |         |     |      |     |      |     |      |
| holding         |         |     |      |     |      |     |      |
| resources       |         |     |      |     |      |     |      |
| required. Line  |         |     |      |     |      |     |      |
| production      |         |     |      |     |      |     |      |
| rates should be |         |     |      |     |      |     |      |
| compared to     |         |     |      |     |      |     |      |
| fire behavior   |         |     |      |     |      |     |      |
| outputs when    |         |     |      |     |      |     |      |
| identifying     |         |     |      |     |      |     |      |
| resource needs. |         |     |      |     |      |     |      |
|                 |         |     |      |     |      |     |      |
| Calculations    |         |     |      |     |      |     |      |
| were taken from |         |     |      |     |      |     |      |
| the Fireline    |         |     |      |     |      |     |      |
| Handbook        |         |     |      |     |      |     |      |
| Appendix A      |         |     |      |     |      |     |      |
| based on fuel   |         |     |      |     |      |     |      |
| model xx.       |         |     |      |     |      |     |      |
+-----------------+---------+-----+------+-----+------+-----+------+

**Organization Chart**

+-----------------------------------------------------------------------+
| This is an example organization chart, locally developed              |
| organizational chart can be used in place of this chart. Add boxes as |
| needed for additional personnel assigned for each operational period. |
| Organization chart may be completed on the day of the burn and must   |
| be completed for each operational period. Aerial Ignition operations  |
| will require an additional organization chart within the air          |
| operations plan in accordance with the Interagency Aerial Ignition    |
| Guide.                                                                |
|                                                                       |
| Additional resources may be assigned to the project without amending  |
| the burn plan if the addition of these resources does not change the  |
| complexity of the burn or require additional supervisory positions.   |
| These changes must be documented in the daily briefing. Reduction in  |
| resource capabilities identified as required in the plan requires an  |
| amendment.                                                            |
+-----------------------------------------------------------------------+

**ELEMENT 12 - COMMUNICATION**

A.  **Radio Frequencies**

+------+-----------+----+------+------+-----------+----------------+
| **C  | **F       | *  |      | **   | **Ass     | **Remarks**    |
| hann | unction** | *F |      | Band | ignment** |                |
| el** |           | re |      | Wid  |           |                |
|      |           | qu |      | th** |           |                |
|      |           | en |      |      |           |                |
|      |           | cy |      |      |           |                |
|      |           | ** |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
| COM  |           |    |      |      |           |                |
| MAND |           |    |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           |    |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           |    |      |      |           |                |
|      |           | T  |      |      |           |                |
|      |           | on |      |      |           |                |
|      |           | e: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           |    |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           |    |      |      |           |                |
|      |           | T  |      |      |           |                |
|      |           | on |      |      |           |                |
|      |           | e: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
| TACT |           |    |      |      |           |                |
| ICAL |           |    |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
| AIR  |           |    |      |      |           |                |
| OP   |           |    |      |      |           |                |
| ERAT |           |    |      |      |           |                |
| IONS |           |    |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
| O    |           |    |      |      |           |                |
| THER |           |    |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
|      |           | T  |      |      |           |                |
|      |           | X: |      |      |           |                |
|      |           | R  |      |      |           |                |
|      |           | X: |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
| REM  |           |    |      |      |           |                |
| ARKS |           |    |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+
| \*   |           |    |      |      |           |                |
| If   |           |    |      |      |           |                |
| ae   |           |    |      |      |           |                |
| rial |           |    |      |      |           |                |
| igni |           |    |      |      |           |                |
| tion |           |    |      |      |           |                |
| is   |           |    |      |      |           |                |
| u    |           |    |      |      |           |                |
| sed, |           |    |      |      |           |                |
| as   |           |    |      |      |           |                |
| sign |           |    |      |      |           |                |
| a    |           |    |      |      |           |                |
| spec |           |    |      |      |           |                |
| ific |           |    |      |      |           |                |
| r    |           |    |      |      |           |                |
| adio |           |    |      |      |           |                |
| f    |           |    |      |      |           |                |
| requ |           |    |      |      |           |                |
| ency |           |    |      |      |           |                |
| for  |           |    |      |      |           |                |
| use  |           |    |      |      |           |                |
| bet  |           |    |      |      |           |                |
| ween |           |    |      |      |           |                |
| airc |           |    |      |      |           |                |
| raft |           |    |      |      |           |                |
| and  |           |    |      |      |           |                |
| Pr   |           |    |      |      |           |                |
| escr |           |    |      |      |           |                |
| ibed |           |    |      |      |           |                |
| Fire |           |    |      |      |           |                |
| Burn |           |    |      |      |           |                |
| Boss |           |    |      |      |           |                |
| an   |           |    |      |      |           |                |
| d/or |           |    |      |      |           |                |
| Igni |           |    |      |      |           |                |
| tion |           |    |      |      |           |                |
| Sp   |           |    |      |      |           |                |
| ecia |           |    |      |      |           |                |
| list |           |    |      |      |           |                |
| F    |           |    |      |      |           |                |
| unct |           |    |      |      |           |                |
| ion. |           |    |      |      |           |                |
| Also |           |    |      |      |           |                |
| inc  |           |    |      |      |           |                |
| lude |           |    |      |      |           |                |
| any  |           |    |      |      |           |                |
| requ |           |    |      |      |           |                |
| ired |           |    |      |      |           |                |
| t    |           |    |      |      |           |                |
| elep |           |    |      |      |           |                |
| hone |           |    |      |      |           |                |
| num  |           |    |      |      |           |                |
| bers |           |    |      |      |           |                |
| in   |           |    |      |      |           |                |
| the  |           |    |      |      |           |                |
| rem  |           |    |      |      |           |                |
| arks |           |    |      |      |           |                |
| sect |           |    |      |      |           |                |
| ion. |           |    |      |      |           |                |
+------+-----------+----+------+------+-----------+----------------+

##  ELEMENT 13 - PUBLIC AND PERSONNEL SAFETY AND MEDICAL

A.  **Safety Hazards**

+-----------------------------------------------------------------------+
| **Firefighter**                                                       |
+-----------------------------------------------------------------------+
| Identify and analyze the safety hazards unique to the individual      |
| prescribed fire project and specify personnel safety procedures.      |
| Include safety hazards (including smoke exposure and impacts) as      |
| identified in the Risk Assessment/Job Hazard Analysis.                |
|                                                                       |
| All personnel who are within the active burn area are required to     |
| wear personal protective equipment.                                   |
+-----------------------------------------------------------------------+
| **Public**                                                            |
+-----------------------------------------------------------------------+
| Identify and analyze the safety hazards unique to the individual      |
| prescribed fire project and potential impacts to public safety.       |
| Identify procedures for non-operational personnel (i.e. media,        |
| researchers, cooperators, agency administrators, dignitaries, other   |
| agency personnel, etc.) visiting prescribed fire project.             |
+-----------------------------------------------------------------------+

B.  **Measures Taken to Reduce the Hazards**

  -----------------------------------------------------------------------
  Identify mitigating measures taken to reduce safety hazards identified
  above. Describe provisions to be made for public safety (include
  closure of area, signs placed on roads, etc.).

  -----------------------------------------------------------------------

C.  **Emergency Medical Procedures**

  -----------------------------------------------------------------------
  In the event of serious accidents or injuries, the burn boss shall be
  notified immediately. Individuals with medical qualifications (i.e.
  First Responder, EMT, Paramedic) and helitack qualified should be
  identified at the pre-burn briefing. The burn boss will initiate
  on-site response (if not already in progress) and coordinate additional
  response needs (listed below) through:

  EMS will be activated through contacting dispatch (or from on-site
  personnel through 911).
  -----------------------------------------------------------------------

D.  **Emergency Evacuation Methods**

+-----------------------------------------------------------------------+
| The first option is to transport the injured person(s) via on-site    |
| vehicles to (identify medical facilities and describe directions to   |
| emergency facilities).                                                |
+-----------------------------------------------------------------------+
| For minor injuries, individuals who are ambulatory will be            |
| transported to (identify nearest and preferred medical facility).     |
| Directions from the burn unit to the medical facility are as follows: |
| (described directions to medical facility).                           |
|                                                                       |
| Medical facility will be contacted and advised of injuries and eta    |
| for transport of injured individual.                                  |
+-----------------------------------------------------------------------+
| The second option is to transport the injured person(s) to meet an    |
| ambulance at (describe a location known to both project personnel and |
| emergency services).                                                  |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| The third option is to transport the injured person(s) to the nearest |
| helispot to be evacuated via air ambulance.                           |
+-----------------------------------------------------------------------+
| The helispot location is (describe the location relative to the       |
| project area and for the air ambulance include a Lat/Long).           |
+-----------------------------------------------------------------------+
| The fourth option is to care for and protect the injured person(s)    |
| while emergency services respond on-site to extract and transport the |
| injured. Send personnel to meet and lead emergency services to the    |
| site.                                                                 |
+-----------------------------------------------------------------------+
| The project area location is (describe directions for responding      |
| emergency services and include a Lat/Long). Individual from the burn  |
| project will be sent to (described location) to lead in EMS.          |
+-----------------------------------------------------------------------+

**E. Emergency Facilities**

<table>
<colgroup>
<col style="width: 19%" />
<col style="width: 8%" />
<col style="width: 15%" />
<col style="width: 0%" />
<col style="width: 9%" />
<col style="width: 8%" />
<col style="width: 4%" />
<col style="width: 6%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 8%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="13"><strong>EMERGENCY TRANSPORTATION</strong></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"><strong>NAME</strong></td>
<td rowspan="2"><strong>TELEPHONE</strong></td>
<td colspan="8" rowspan="2"><strong>LOCATION</strong></td>
<td colspan="2"><strong>PARAMEDICS</strong></td>
</tr>
<tr class="odd">
<td><strong>YES</strong></td>
<td><strong>NO</strong></td>
</tr>
<tr class="even">
<td colspan="2">At least one air ambulance</td>
<td></td>
<td colspan="8"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">must be identified</td>
<td></td>
<td colspan="8"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td></td>
<td colspan="8"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td></td>
<td colspan="8"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><strong>HELISPOT CLOSEST TO PROJECT</strong></td>
<td><strong>LAT.</strong></td>
<td colspan="4"></td>
<td colspan="2"><strong>LONG.</strong></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="13"><strong>HOSPITALS &amp; MEDICAL
FACILITIES</strong></td>
</tr>
<tr class="even">
<td rowspan="2"><strong>NAME</strong></td>
<td colspan="3" rowspan="2"><strong>ADDRESS AND LATITUDE AND
LONGITUDE</strong></td>
<td colspan="2"><p><strong>TRAVEL TIME</strong></p>
<p><strong>( MIN)</strong></p></td>
<td colspan="2" rowspan="2"><strong>PHONE</strong></td>
<td colspan="3"><strong>HELIPAD</strong></td>
<td colspan="2"><strong>BURN CENTER</strong></td>
</tr>
<tr class="odd">
<td><strong>AIR</strong></td>
<td><strong>GROUND</strong></td>
<td colspan="2"><strong>YES</strong></td>
<td><strong>NO</strong></td>
<td><strong>YES</strong></td>
<td><strong>NO</strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>University of Utah Medical Center</td>
<td colspan="3"><p>50 North Medical Drive</p>
<p>Salt Lake City, Utah</p>
<p>40°46.01 N x 111°50.19</p></td>
<td></td>
<td></td>
<td colspan="2">801-581-2121</td>
<td colspan="2">X</td>
<td></td>
<td>X</td>
<td></td>
</tr>
<tr class="even">
<td>St Mary’s Hospital</td>
<td colspan="3"><p>2635 N. 7<sup>th</sup> StreetNumber range CHAPTER</p>
<p>Grand Junction, CO</p>
<p>39Number range CHAPTER° 05.42 X 108° 33.74</p></td>
<td></td>
<td></td>
<td colspan="2">970-244-2273</td>
<td colspan="2"><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**ELEMENT 14 - TEST FIRE**

A.  **Test Fire Provisions and Planned Location**

  -----------------------------------------------------------------------
  Provisions for a test fire are required and results must be recorded.
  The test fire must be ignited in a representative location and in an
  area that can be easily controlled. The purpose of the test fire is to
  verify that the prescribed fire behavior characteristics will meet
  management objectives and to verify predicted smoke dispersion. In many
  applications, analysis of the initial ignitions may provide adequate
  test fire results. On multiple-day projects, evaluation of current
  active fire behavior, in lieu of a test fire, may provide a comparative
  basis for continuing and must be documented. If in doubt however,
  initiate a separate test fire and evaluate results.

  -----------------------------------------------------------------------

B.  **Test Fire Documentation**

  -----------------------------------------------------------------------
  **Location:**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  **Date and Time:**

  -----------------------------------------------------------------------

  ------------------- ---------------------------------------------------
  **Weather/Fuels     
  Conditions**        

  **Cloud Cover %**   

  **Temperature**     

  **Relative          
  Humidity**          

  **Fine Dead Fuel    
  Moisture**          

  **Wind Speed**      

  **Fuels**           
  ------------------- ---------------------------------------------------

  ------------------- ---------------------------------------------------
  **Test Fire         
  Results**           

  **Flame Length**    

  **Rate of Spread**  

  **Smoke             
  Dispersion**        

  **Other**           
  ------------------- ---------------------------------------------------

  ------------------------------------------ --------- -------- -------- -------
  **The test fire meets the prescription     **Yes**            **No**   
  parameters**                                                           

  ------------------------------------------ --------- -------- -------- -------

  ------------ -- ----------------------------------- ---------- --------------- --
  **SIGNED**                                          **DATE**                   

                  Prescribed Fire Burn Boss                                      
  ------------ -- ----------------------------------- ---------- --------------- --

**ELEMENT 15 - IGNITION PLAN**

+-----------------------------------------------------------------------+
| A.  **Firing Methods & Devices**                                      |
+-----------------------------------------------------------------------+
| The means by which a fire is ignited, such as hand-held drip torch,   |
| helitorch, or backpack propane tanks. If aerial ignition is specified |
| in the Prescribed Fire Plan, an Air Operations Plan will be included  |
| as Appendix F to the Prescribed Fire Plan. The aerial ignition        |
| organization will be included with the implementation organization    |
| chart (Element 11). For additional details reference the *Interagency |
| Helicopter Operations Guide and Interagency Aerial Ignition Guide.*   |
| Major changes to ignition methods including ground ignition to aerial |
| ignition; aerial ignition to hand ignition; hand drip torch ignition  |
| to use of terra torch ignition (includes ATV mounted ignition         |
| devices) require an amendment to the burn plan.                       |
+-----------------------------------------------------------------------+
| B.  **Ignition Techniques**                                           |
+-----------------------------------------------------------------------+
| Any method of igniting a wildland area to consume the fuel in a       |
| prescribed pattern (e.g., heading, backing, or flanking fire).        |
|                                                                       |
| Overall, strip head firing or dot firing will be utilized to bring    |
| fire down through the unit. This may need to be in a general backing  |
| fashion to minimize impacts to the residual stand. Flame length and   |
| intensity will dictate ignition technique and strip width.            |
+-----------------------------------------------------------------------+
| C.  **Patterns & Sequences**                                          |
+-----------------------------------------------------------------------+
| The overall progression of ignition events to apply fire to a given   |
| area and the manner in which a prescribed fire is ignited. The        |
| distance between ignition lines or points and the sequence of         |
| igniting them is determined by weather, fuel, topography, ignition    |
| technique, and other factors which influence fire behavior and fire   |
| effects should be discussed. If multiple compartments within the      |
| project are to be ignited, this should be further discussed on the    |
| preferred sequence of igniting the compartments.                      |
|                                                                       |
| The Ignition Specialist and Holding Specialist functions are expected |
| to work closely together to see that the ignition pattern and         |
| sequence do not present concern for control of the burn. The (wind or |
| slope and aspect) should be the dominant influence for fire behavior  |
| and the primary factor in establishing the ignition pattern and       |
| sequence for the unit. The ignition pattern and sequence found below  |
| and on the attached map are suggested and can be modified to better   |
| suit the current conditions experienced on the day of the burn        |
|                                                                       |
| Ideally, the test fire would be ignited (location). Following the     |
| test fire, ignition can continue along (location). Once a sufficient  |
| blackline (headstrip) is established as an anchor, flanking fire can  |
| be taken initially down the (location) fireline and flank. This would |
| then be followed with igniting off the (location) flank of the        |
| compartment. As the flanks become secure, fire should be backed down  |
| the interior of the unit towards (location).                          |
+-----------------------------------------------------------------------+
| **D. Ignition Staffing**                                              |
+-----------------------------------------------------------------------+
| Identify positions within the ignition organization to be utilized.   |
| Relationship to holding organization should be further identified     |
| including use of holding crew for transporting fuel and use of        |
| ignition crew for holding activities, if required. If aerial ignition |
| is occurring, a brief discussion on staffing should occur in this     |
| section along with full details within the Air Operations Plan found  |
| in Appendix F.                                                        |
+-----------------------------------------------------------------------+

**ELEMENT 16 - HOLDING PLAN**

+-----------------------------------------------------------------------+
| A.  **General Procedures for Holding**                                |
+-----------------------------------------------------------------------+
| Describe general procedures to be used for operations to maintain the |
| fire within the primary unit and project area and meet project        |
| objectives until the fire is declared out.                            |
+-----------------------------------------------------------------------+
| B.  **Critical Holding Points and Actions**                           |
+-----------------------------------------------------------------------+
| Describe critical holding points (if any) and mitigation actions. If  |
| line building production rates of on site resources, identified in    |
| Element 11, do not exceed expected perimeter increase (i.e. light     |
| flashy fuels), mitigation actions need to be identified here.         |
+-----------------------------------------------------------------------+
| C.  **Minimum Organization or Capabilities Needed**                   |
+-----------------------------------------------------------------------+
| Minimum capabilities needed for holding are identified under Element  |
| 11 - Organization and Equipment. The Holding Specialist function will |
| be held at the (ICS position) level based on complexity of burn and   |
| holding operation. On burn day and subsequent days of the prescribed  |
| fire, a mix of the number and kinds of hand crews and engines may be  |
| modified as long as stated production capabilities are not            |
| compromised. As the prescribed fire progresses from ignition to       |
| holding to mop up and patrol, specified capabilities and/or types of  |
| resources may be adjusted. If flexibilities are built into the        |
| Prescribed Fire Plan, there must be a clear statement as to the work  |
| capability requirements of the resources at the various stages of the |
| prescribed fire.                                                      |
+-----------------------------------------------------------------------+
| **D. Mop-up and Patrol**                                              |
+-----------------------------------------------------------------------+
| The Mop-up and Patrol portion of the Holding Plan will provide a      |
| description of the procedures to be implemented between the time of   |
| ignition and the time the prescribed fire is declared out. Identify   |
| who is responsible and actions to be taken. Conditions for leaving    |
| burn unstaffed prior to being declared out should be identified.      |
|                                                                       |
| This section should contain a specific description of what the        |
| standards are for mop-up (see mop-up categories R4 FSM 5142.2) and    |
| what type/kind of equipment will be assigned to patrol, who will be   |
| in charge and duration and the standards for when the burn will be    |
| declared out and by whom. Documentation needs to be completed on a    |
| daily basis until the fire is declared out, and included in the final |
| project file.                                                         |
+-----------------------------------------------------------------------+

**ELEMENT 17 - CONTINGENCY PLAN**

+---------------------+----------------------+--------+-------+-------+
| **A. Trigger        |                      |        |       |       |
| Points**            |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
| Contingency         |                      |        |       |       |
| planning is the     |                      |        |       |       |
| determination of    |                      |        |       |       |
| initial actions and |                      |        |       |       |
| additional          |                      |        |       |       |
| resources needed if |                      |        |       |       |
| the prescribed fire |                      |        |       |       |
| is not meeting,     |                      |        |       |       |
| exceeds, or         |                      |        |       |       |
| threatens to exceed |                      |        |       |       |
| the potential       |                      |        |       |       |
| trigger points      |                      |        |       |       |
| (i.e. project or    |                      |        |       |       |
| unit boundary,      |                      |        |       |       |
| objectives,         |                      |        |       |       |
| prescription        |                      |        |       |       |
| parameters, minimum |                      |        |       |       |
| implementation      |                      |        |       |       |
| organization, smoke |                      |        |       |       |
| impacts, other      |                      |        |       |       |
| Prescribed Fire     |                      |        |       |       |
| Plan elements).     |                      |        |       |       |
|                     |                      |        |       |       |
| If any of the       |                      |        |       |       |
| following           |                      |        |       |       |
| situations occur,   |                      |        |       |       |
| contingency action  |                      |        |       |       |
| will take place:    |                      |        |       |       |
|                     |                      |        |       |       |
| 1.  Fire threatens  |                      |        |       |       |
|     the project     |                      |        |       |       |
|     boundary.       |                      |        |       |       |
|                     |                      |        |       |       |
| 2.  More than three |                      |        |       |       |
|     simultaneous    |                      |        |       |       |
|     spot fires      |                      |        |       |       |
|     and/or slop     |                      |        |       |       |
|     overs occur,    |                      |        |       |       |
|     each greater    |                      |        |       |       |
|     than xx acres   |                      |        |       |       |
|     or smaller.     |                      |        |       |       |
|                     |                      |        |       |       |
| 3.  Fire outside of |                      |        |       |       |
|     the primary     |                      |        |       |       |
|     unit boundary.  |                      |        |       |       |
|                     |                      |        |       |       |
| 4.  Smoke impacting |                      |        |       |       |
|     sensitive       |                      |        |       |       |
|     areas.          |                      |        |       |       |
|                     |                      |        |       |       |
| 5.  Potential for   |                      |        |       |       |
|     costs to        |                      |        |       |       |
|     control exceed  |                      |        |       |       |
|     available       |                      |        |       |       |
|     project funds.  |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
| **B. Actions        |                      |        |       |       |
| Needed**            |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
| If the objectives   |                      |        |       |       |
| are not being met,  |                      |        |       |       |
| the Contingency     |                      |        |       |       |
| Plan is             |                      |        |       |       |
| implemented.        |                      |        |       |       |
| Describe action to  |                      |        |       |       |
| be taken.           |                      |        |       |       |
|                     |                      |        |       |       |
| If the contingency  |                      |        |       |       |
| actions are         |                      |        |       |       |
| successful at       |                      |        |       |       |
| bringing the        |                      |        |       |       |
| project back within |                      |        |       |       |
| the scope of the    |                      |        |       |       |
| Prescribed Fire     |                      |        |       |       |
| Plan, the project   |                      |        |       |       |
| may continue.       |                      |        |       |       |
| Contingency actions |                      |        |       |       |
| will include        |                      |        |       |       |
| (described actions  |                      |        |       |       |
| to be taken). If    |                      |        |       |       |
| contingency actions |                      |        |       |       |
| are not successful  |                      |        |       |       |
| by the end of the   |                      |        |       |       |
| next burning        |                      |        |       |       |
| period, then the    |                      |        |       |       |
| prescribed fire     |                      |        |       |       |
| will be converted   |                      |        |       |       |
| to a wildfire.      |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
| **C.** **Additional |                      |        |       |       |
| Resources and       |                      |        |       |       |
| Maximum Response    |                      |        |       |       |
| Time(s)**           |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
| **Resource**        | **Agency &           | **Max  | **Co  |       |
|                     | Location**           | imum** | nform |       |
|                     |                      |        | ation |       |
|                     |                      | **Re   | of    |       |
|                     |                      | sponse | A     |       |
|                     |                      | Time** | vaila |       |
|                     |                      |        | bilit |       |
|                     |                      |        | y\*** |       |
+---------------------+----------------------+--------+-------+-------+
|                     |                      |        | **Yes | **D   |
|                     |                      |        | /No** | ate** |
+---------------------+----------------------+--------+-------+-------+
|                     |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
|                     |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
|                     |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
|                     |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
|                     |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
|                     |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+
| \* To be completed  |                      |        |       |       |
| within one day of   |                      |        |       |       |
| the burn and        |                      |        |       |       |
| adjusted during     |                      |        |       |       |
| course of extended  |                      |        |       |       |
| burning conditions  |                      |        |       |       |
+---------------------+----------------------+--------+-------+-------+

**ELEMENT 18 - WILDFIRE CONVERSION**

+-----------------------------------------------------------------------+
| A.  **Wildfire Declared By**                                          |
+-----------------------------------------------------------------------+
| The Prescribed Fire Plan will specify who has the authority to        |
| declare a wildfire. A prescribed fire must be declared a wildfire by  |
| those identified in the plan when that person(s) determines that the  |
| contingency actions have failed or are likely to fail and cannot be   |
| mitigated by the end of the next burning period.                      |
|                                                                       |
| The Prescribed Fire Burn Boss will have the authority to declare the  |
| prescribed fire a wildfire. If any of the following situations occur, |
| the burn will be declared a wildfire, initial attack will occur, and  |
| appropriate management response will take place.                      |
|                                                                       |
| 1.  Contingency actions have failed or are likely to fail and cannot  |
|     be mitigated.                                                     |
|                                                                       |
| 2.  Fire outside of the project area.                                 |
|                                                                       |
| 3.  Costs for control exceed available project funds.                 |
|                                                                       |
| After wildfire declaration, a project cannot be returned to a         |
| prescribed fire.                                                      |
+-----------------------------------------------------------------------+
| B.  **IC Assignment**                                                 |
+-----------------------------------------------------------------------+
| Identify who will be the IC and what positions will be used to        |
| transition to an ICS organization.                                    |
|                                                                       |
| Should a wildfire be declared, the Prescribed Fire Burn Boss will     |
| become the Incident Commander until relieved or replaced. The IC will |
| organize all on-site resources for a safe and aggressive response.    |
| Personnel within the prescribed fire organization will transition     |
| into ICS wildfire positions they are qualified to carry out. The IC   |
| will order additional suppression resources identified in the         |
| Contingency Plan as well as any other required resources necessary to |
| support the suppression effort.                                       |
|                                                                       |
| Upon a wildfire conversion occurring, all overhead personnel will     |
| begin to document actions taken on a Unit Log. After the incident is  |
| contained, the Prescribed Fire Burn Boss will submit a post fire      |
| report documenting weather, resources on site, ignition operations,   |
| holding actions, and other pertinent data.                            |
+-----------------------------------------------------------------------+
| C.  **Notifications**                                                 |
+-----------------------------------------------------------------------+
| Identify the notifications to be made upon wildfire conversion and    |
| who will make them.                                                   |
|                                                                       |
| The Prescribed Fire Burn Boss/IC will notify (specify Dispatch        |
| Center) and the (specify unit) Fire Management Officer (FMO) of the   |
| escape and identify himself/herself as the IC. FMO will then notify   |
| the (specify Field Manager/District Ranger/Park Superintendent/Refuge |
| Manager) and the (State/Regional) Fuels Specialist. (Dispatch Center) |
| will notify contacts listed on the notification plan of the escape    |
| and the current situation.                                            |
|                                                                       |
| Burn boss will notify regional fire management officer within 24      |
| hours of an escape, threat of an escape, or activation of contingency |
| resources identified in the plan, or any prescribed fire that         |
| requires additional resources or operational time not accounted for   |
| in the IAP.                                                           |
+-----------------------------------------------------------------------+
| D.  **Extended Attack Actions and Opportunities to Aid in Fire        |
|     Suppression**                                                     |
+-----------------------------------------------------------------------+
| Describe the containment strategy, identifying any containment        |
| opportunities along with high value and special areas of concern.     |
| Suppression activity for a wildfire that has not been contained or    |
| controlled by initial attack or contingency forces and for which more |
| firefighting resources are arriving, en route, or being ordered by    |
| the initial attack incident commander is defined as Extended Attack.  |
| A Wildland Fire Situation Analysis (WFSA) is required when a wildfire |
| escapes initial attack. The WFSA is a decision making process that    |
| evaluates alternative wildfire suppression strategies against         |
| selected environmental, social, political, and economic criteria and  |
| provides a record of those decisions.                                 |
|                                                                       |
| The appropriate management response will be used in order to flank    |
| the fire with engines until the forward rate of spread is stopped.    |
| The containment strategy will be to utilize safe anchor points and    |
| create direct fire line where feasible and indirect fire line,        |
| including burning out, depending upon location of natural barriers    |
| and roads. The FMO and/or IC, Resource Advisor, and Agency            |
| Administrator may develop a WFSA which will determine the appropriate |
| management response to the escaped fire. The Wildland Fire Situation  |
| Analysis (WFSA) process is required when a wildfire escapes initial   |
| attack.                                                               |
|                                                                       |
| Opportunities to aid in fire suppression include: utilize existing    |
| roads (identify specific roads) in the vicinity of the burn unit,     |
| moist drainages, and changes in fuels (i.e. transition from brush     |
| field into timber fuel models).                                       |
|                                                                       |
| Areas of high value and special concerns include: (identify areas of  |
| high value or special concern).                                       |
+-----------------------------------------------------------------------+

**ELEMENT 19 - SMOKE MANAGEMENT AND AIR QUALITY**

+-------------------+---+---+------+-------------------+------+------+
| A                 |   |   |      |                   |      |      |
| .  **Compliance** |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| Describe how the  |   |   |      |                   |      |      |
| project will      |   |   |      |                   |      |      |
| comply with State |   |   |      |                   |      |      |
| and Federal air   |   |   |      |                   |      |      |
| quality           |   |   |      |                   |      |      |
| regulations.      |   |   |      |                   |      |      |
|                   |   |   |      |                   |      |      |
| Utah Specific -   |   |   |      |                   |      |      |
| This burn plan    |   |   |      |                   |      |      |
| complies with the |   |   |      |                   |      |      |
| Utah Smoke        |   |   |      |                   |      |      |
| Management Plan   |   |   |      |                   |      |      |
| and is designed   |   |   |      |                   |      |      |
| to meet the       |   |   |      |                   |      |      |
| requirements of   |   |   |      |                   |      |      |
| State of Utah     |   |   |      |                   |      |      |
| Title R307, state |   |   |      |                   |      |      |
| administrative    |   |   |      |                   |      |      |
| rule for air      |   |   |      |                   |      |      |
| quality; Regional |   |   |      |                   |      |      |
| Haze Rule, 40 CFR |   |   |      |                   |      |      |
| 51.309(d)(6); and |   |   |      |                   |      |      |
| the policies of   |   |   |      |                   |      |      |
| the U.S.          |   |   |      |                   |      |      |
| Environmental     |   |   |      |                   |      |      |
| Protection        |   |   |      |                   |      |      |
| Agency's (EPA)    |   |   |      |                   |      |      |
| Interim Air       |   |   |      |                   |      |      |
| Quality Policy on |   |   |      |                   |      |      |
| Wildland and      |   |   |      |                   |      |      |
| Prescribed Fires  |   |   |      |                   |      |      |
| (Interim Policy). |   |   |      |                   |      |      |
|                   |   |   |      |                   |      |      |
| A National        |   |   |      |                   |      |      |
| Weather Service   |   |   |      |                   |      |      |
| Clearing Index    |   |   |      |                   |      |      |
| above 500 is      |   |   |      |                   |      |      |
| required prior to |   |   |      |                   |      |      |
| ignition. For de  |   |   |      |                   |      |      |
| minimus           |   |   |      |                   |      |      |
| prescribed        |   |   |      |                   |      |      |
| burning, ignition |   |   |      |                   |      |      |
| can occur when    |   |   |      |                   |      |      |
| the Clearing      |   |   |      |                   |      |      |
| Index is between  |   |   |      |                   |      |      |
| 400 and 500 with  |   |   |      |                   |      |      |
| approval of the   |   |   |      |                   |      |      |
| executive         |   |   |      |                   |      |      |
| secretary of the  |   |   |      |                   |      |      |
| Utah Air Quality  |   |   |      |                   |      |      |
| Board. De minimus |   |   |      |                   |      |      |
| burning is        |   |   |      |                   |      |      |
| limited to piles  |   |   |      |                   |      |      |
| up to 30,000      |   |   |      |                   |      |      |
| cubic feet/day or |   |   |      |                   |      |      |
| up to 20          |   |   |      |                   |      |      |
| acres/day. When   |   |   |      |                   |      |      |
| burning within    |   |   |      |                   |      |      |
| the de minimus    |   |   |      |                   |      |      |
| category, the     |   |   |      |                   |      |      |
| Burn Boss is      |   |   |      |                   |      |      |
| required to (1)   |   |   |      |                   |      |      |
| notify the        |   |   |      |                   |      |      |
| executive         |   |   |      |                   |      |      |
| secretary by fax, |   |   |      |                   |      |      |
| e-mail, or phone  |   |   |      |                   |      |      |
| by 0800 on burn   |   |   |      |                   |      |      |
| day prior to      |   |   |      |                   |      |      |
| ignition of the   |   |   |      |                   |      |      |
| burn and (2)      |   |   |      |                   |      |      |
| record and submit |   |   |      |                   |      |      |
| hourly            |   |   |      |                   |      |      |
| photographs, a    |   |   |      |                   |      |      |
| record of any     |   |   |      |                   |      |      |
| complaints,       |   |   |      |                   |      |      |
| hourly            |   |   |      |                   |      |      |
| meteorological    |   |   |      |                   |      |      |
| conditions and an |   |   |      |                   |      |      |
| hourly            |   |   |      |                   |      |      |
| description of    |   |   |      |                   |      |      |
| the smoke plume   |   |   |      |                   |      |      |
| (Smoke Form 9).   |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| B.  **Permits to  |   |   |      |                   |      |      |
|     be Obtained** |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| **Smoke           |   |   |      |                   |      |      |
| Management        |   |   |      |                   |      |      |
| Number:**         |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| Identify what     |   |   |      |                   |      |      |
| permits, if any,  |   |   |      |                   |      |      |
| need to be        |   |   |      |                   |      |      |
| obtained.         |   |   |      |                   |      |      |
|                   |   |   |      |                   |      |      |
| **Utah Division   |   |   |      |                   |      |      |
| of Air Quality    |   |   |      |                   |      |      |
| Documentation:**  |   |   |      |                   |      |      |
|                   |   |   |      |                   |      |      |
| **Two Weeks       |   |   |      |                   |      |      |
| Prior - [Form     |   |   |      |                   |      |      |
| 3](http://www.    |   |   |      |                   |      |      |
| utahsmp.net/FORMS |   |   |      |                   |      |      |
| /2form_3.htm)** - |   |   |      |                   |      |      |
| Pre-burn          |   |   |      |                   |      |      |
| Information -     |   |   |      |                   |      |      |
| place in project  |   |   |      |                   |      |      |
| file. Burn Plan   |   |   |      |                   |      |      |
| to be submitted   |   |   |      |                   |      |      |
| two weeks prior   |   |   |      |                   |      |      |
| to ignition to    |   |   |      |                   |      |      |
| Utah Division of  |   |   |      |                   |      |      |
| Air Quality -     |   |   |      |                   |      |      |
| Interagency Smoke |   |   |      |                   |      |      |
| Management        |   |   |      |                   |      |      |
| Program.          |   |   |      |                   |      |      |
|                   |   |   |      |                   |      |      |
| **Two Days        |   |   |      |                   |      |      |
| Prior** - [**Form |   |   |      |                   |      |      |
| 4**](http://ww    |   |   |      |                   |      |      |
| w.utahsmp.net/FOR |   |   |      |                   |      |      |
| MS/2form_4.htm) - |   |   |      |                   |      |      |
| Burn Request/and  |   |   |      |                   |      |      |
| Reporting - place |   |   |      |                   |      |      |
| in project file.  |   |   |      |                   |      |      |
|                   |   |   |      |                   |      |      |
| State of Utah     |   |   |      |                   |      |      |
| Approval -        |   |   |      |                   |      |      |
| <http://www.uta   |   |   |      |                   |      |      |
| hsmp.net/1Level/1 |   |   |      |                   |      |      |
| -1approvals.htm>. |   |   |      |                   |      |      |
|                   |   |   |      |                   |      |      |
| **Morning After   |   |   |      |                   |      |      |
| Burn** (by        |   |   |      |                   |      |      |
| 08:00) - **[Form  |   |   |      |                   |      |      |
| 5](http://        |   |   |      |                   |      |      |
| www.utahsmp.net/F |   |   |      |                   |      |      |
| ORMS/2form_5.htm) |   |   |      |                   |      |      |
| -** Daily         |   |   |      |                   |      |      |
| Emissions         |   |   |      |                   |      |      |
| Report - place in |   |   |      |                   |      |      |
| project file.     |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| C.  **Smoke       |   |   |      |                   |      |      |
|     Sensitive     |   |   |      |                   |      |      |
|     Areas**       |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| **Identify any    |   |   |      |                   |      |      |
| non-attainment or |   |   |      |                   |      |      |
| Class I airsheds  |   |   |      |                   |      |      |
| within 15         |   |   |      |                   |      |      |
| miles:**          |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| **Receptor**      | * |   | **Di | **Receptor**      | *    | **Di |
|                   | * |   | stan |                   | *Dir | stan |
|                   | D |   | ce** |                   | ecti | ce** |
|                   | i |   |      |                   | on** |      |
|                   | r |   |      |                   |      |      |
|                   | e |   |      |                   |      |      |
|                   | c |   |      |                   |      |      |
|                   | t |   |      |                   |      |      |
|                   | i |   |      |                   |      |      |
|                   | o |   |      |                   |      |      |
|                   | n |   |      |                   |      |      |
|                   | * |   |      |                   |      |      |
|                   | * |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
|                   |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
|                   |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| D.  **Impacted    |   |   |      |                   |      |      |
|     Areas**       |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| Identify smoke    |   |   |      |                   |      |      |
| sensitive areas   |   |   |      |                   |      |      |
| including         |   |   |      |                   |      |      |
| population        |   |   |      |                   |      |      |
| centers,          |   |   |      |                   |      |      |
| recreation areas, |   |   |      |                   |      |      |
| hospitals,        |   |   |      |                   |      |      |
| airports,         |   |   |      |                   |      |      |
| transportation    |   |   |      |                   |      |      |
| corridors,        |   |   |      |                   |      |      |
| schools,          |   |   |      |                   |      |      |
| non-attainment    |   |   |      |                   |      |      |
| areas, Class I    |   |   |      |                   |      |      |
| air sheds, and    |   |   |      |                   |      |      |
| restricted areas  |   |   |      |                   |      |      |
| that may be       |   |   |      |                   |      |      |
| impacted in       |   |   |      |                   |      |      |
| addition to the   |   |   |      |                   |      |      |
| above identified  |   |   |      |                   |      |      |
| receptors.        |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| E.  **Mitigation  |   |   |      |                   |      |      |
|     Strategies    |   |   |      |                   |      |      |
|     and           |   |   |      |                   |      |      |
|     Techniques to |   |   |      |                   |      |      |
|     Reduce Smoke  |   |   |      |                   |      |      |
|     Impacts**     |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+
| Include           |   |   |      |                   |      |      |
| mitigation        |   |   |      |                   |      |      |
| strategies and    |   |   |      |                   |      |      |
| techniques to     |   |   |      |                   |      |      |
| reduce the        |   |   |      |                   |      |      |
| impacts of smoke  |   |   |      |                   |      |      |
| production.       |   |   |      |                   |      |      |
+-------------------+---+---+------+-------------------+------+------+

**ELEMENT 20 - MONITORING**

+-----------------------------------------------------------------------+
| A.  **Fuels Information (forecast and observed) Required and          |
|     Procedures**                                                      |
+-----------------------------------------------------------------------+
| Prescribed fire monitoring is the collection and analysis of repeated |
| observations or measurements to evaluate changes in condition and     |
| progress toward meeting a management objective. Describe the          |
| monitoring that will be required to ensure that Prescribed Fire Plan  |
| objectives are met. For the prescribed fire, at a minimum specify the |
| weather, fire behavior and fuels information (forecast and observed)  |
| and smoke dispersal monitoring required during all phases of the      |
| project and the procedures for acquiring it, including who will       |
| conduct the monitoring and when monitoring is to be preformed.        |
+-----------------------------------------------------------------------+
| B.  **Weather Monitoring Required and Procedures**                    |
+-----------------------------------------------------------------------+
| Weather observations should be measured and recorded on a (specify    |
| time frame) basis on the Weather / Fuels / Fire Behavior / Smoke      |
| Observations form found in Appendix G.                                |
+-----------------------------------------------------------------------+
| C.  **Fire Behavior Monitoring Required and Procedures**              |
+-----------------------------------------------------------------------+
| Fire behavior observations should be measured and recorded on a       |
| (specify time frame) basis on the Weather / Fuels / Fire Behavior /   |
| Smoke Observations form found in Appendix G.                          |
+-----------------------------------------------------------------------+
| D.  **Monitoring Required to Ensure Prescribed Fire Plan Objectives   |
|     are Met**                                                         |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| E.  **Smoke Dispersal Monitoring Required and Procedures**            |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+

**ELEMENT 21 - POST-BURN ACTIVITIES**

+-----------------------------------------------------------------------+
| **Post-Burn Activities that Must be Completed**                       |
+-----------------------------------------------------------------------+
| Describe the post-burn activities that must be completed. This may    |
| include post-burn reports, safety mitigation measures, and            |
| rehabilitation needs including those as a result of pre-burn          |
| activities undertaken.                                                |
|                                                                       |
| The Prescribed Fire Burn Boss will insure the Prescribed Fire Post    |
| Burn Evaluation is completed (Appendix H). Utah Division of Air       |
| Quality, [**Form 5**](http://www.utahsmp.net/FORMS/2form_5.htm) --    |
| Daily Emission Report must be submitted by 08:00 on the day following |
| the burn. The Weather/Fuels/Fire Behavior/Smoke Observations          |
| (Appendix G) will be collected and placed into the project folder.    |
| Any additional Fire Effects Reports will be completed and placed in   |
| the project folder.                                                   |
+-----------------------------------------------------------------------+

**APPENDICES**

A.  **Maps - Vicinity and Project**

B.  **Technical Review Checklist**

C.  **Complexity Analysis**

D.  **Risk Assessment - Job Hazard Analysis**

E.  **Fire Behavior Modeling Documentation or Empirical Documentation**
    (unless it is included in the fire behavior narrative in Element 7 -
    Prescription)

F.  **Air Operations Plan** (if applicable)

G.  **Prescribed Fire Post Burn Evaluation**

H.  **Weather / Fuels / Fire Behavior / Smoke Observations**

**APPENDIX A - MAPS**

**1. Vicinity Map**

**2. Project Map**

**APPENDIX B - TECHNICAL REVIEWER CHECKLIST**

+--------------------------------+-----+------------------------------+
| **PRESCRIBED FIRE PLAN         | *   | **COMMENTS**                 |
| ELEMENTS**                     | *S, |                              |
|                                | U   |                              |
|                                | ,** |                              |
|                                |     |                              |
|                                | *   |                              |
|                                | *or |                              |
|                                | N/  |                              |
|                                | A** |                              |
+--------------------------------+-----+------------------------------+
| 1.  **Signature Page**         |     |                              |
+--------------------------------+-----+------------------------------+
| 2.  **GO-NO-GO Checklists**    |     |                              |
+--------------------------------+-----+------------------------------+
| 3.  **Complexity Analysis      |     |                              |
|     Summary**                  |     |                              |
+--------------------------------+-----+------------------------------+
| 4.  **Description of the       |     |                              |
|     Prescribed Fire Area**     |     |                              |
+--------------------------------+-----+------------------------------+
| 5.  **Goals and Objectives**   |     |                              |
+--------------------------------+-----+------------------------------+
| 6.  **Funding**                |     |                              |
+--------------------------------+-----+------------------------------+
| 7.  **Prescription**           |     |                              |
+--------------------------------+-----+------------------------------+
| 8.  **Scheduling**             |     |                              |
+--------------------------------+-----+------------------------------+
| 9.  **Pre-Burn                 |     |                              |
|     Considerations**           |     |                              |
+--------------------------------+-----+------------------------------+
| 10. **Briefing**               |     |                              |
+--------------------------------+-----+------------------------------+
| 11. **Organization and         |     |                              |
|     Equipment**                |     |                              |
+--------------------------------+-----+------------------------------+
| 12. **Communication**          |     |                              |
+--------------------------------+-----+------------------------------+
| 13. **Public and Personnel     |     |                              |
|     Safety and Medical**       |     |                              |
+--------------------------------+-----+------------------------------+
| 14. **Test Fire**              |     |                              |
+--------------------------------+-----+------------------------------+
| 15. **Ignition Plan**          |     |                              |
+--------------------------------+-----+------------------------------+
| 16. **Holding Plan**           |     |                              |
+--------------------------------+-----+------------------------------+
| 17. **Contingency Plan**       |     |                              |
+--------------------------------+-----+------------------------------+
| 18. **Wildfire Conversion**    |     |                              |
+--------------------------------+-----+------------------------------+
| 19. **Smoke Management and Air |     |                              |
|     Quality**                  |     |                              |
+--------------------------------+-----+------------------------------+
| 20. **Monitoring**             |     |                              |
+--------------------------------+-----+------------------------------+
| 21. **Post-Burn Activities**   |     |                              |
+--------------------------------+-----+------------------------------+
| > **Appendix A: Maps**         |     |                              |
+--------------------------------+-----+------------------------------+
| > **Appendix B: Complexity     |     |                              |
| > Analysis**                   |     |                              |
+--------------------------------+-----+------------------------------+
| > **Appendix C: Risk           |     |                              |
| > Assessment/JHA**             |     |                              |
+--------------------------------+-----+------------------------------+
| > **Appendix D: Fire           |     |                              |
| > Prediction Modeling Runs**   |     |                              |
+--------------------------------+-----+------------------------------+
| > **Other**                    |     |                              |
+--------------------------------+-----+------------------------------+

**S = Satisfactory U = Unsatisfactory N/A = Non Applicable**

  ------- --------------- ------- -------------- ------- ---------------------------------
  ****   **Recommended   ****   **Not          ****   **Approval is recommended subject
          for Approval**          Recommended            to the completion of all
                                  for Approval**         requirements listed in the
                                                         comments or on the Prescribed
                                                         Fire Plan.**

  ------- --------------- ------- -------------- ------- ---------------------------------

  --------------------------- -- ------------------------- -- -------------
                                                              

  Technical Reviewer             Qualification and            Date
                                 Currency (Y/N)               
  --------------------------- -- ------------------------- -- -------------

**APPENDIX C - COMPLEXITY ANALYSIS**

This analysis is designed to be used with the NWCG Prescribed Fire
Complexity Rating System Guide (PMS 424 - January 2004) and Prescribed
Fire Complexity Rating Descriptors starting on Page 6 of the guide
<http://www.nwcg.gov/pms/RxFire/complexity_analysis.pdf>.

An initial complexity rating should be completed during the project
development stage to identify items needing mitigation. These items can
then be addressed during the development of the Prescribed Fire Plan.
When doing the complexity rating, be sure to consider areas outside of
the project boundaries that could be impacted by smoke or an escaped.
Once the Prescribed Fire Plan is near completion, the final complexity
rating is made providing justifications for changes and any mitigating
actions resulting in change. Select rating level and delete remaining
ratings for both the preliminary and final ratings (do not highlight as
when printed in black and white, rating level is unknown). Entire
complexity element should be on one page (not split between multiple
pages),

The final rating should be entered on the Complexity Elements Summary
and cover page of the Prescribed Fire Plan. The mitigating measures
identified in the plan should be noted in the rationale for the
Complexity Analysis Summary. All complexity elements with a rating of
high should be highlighted in the management summary.

  ------------------- ------------------------------ ---------- --------------
  **PREPARED BY**                                    **DATE**   

                                                                

  **APPROVED BY**                                    **DATE**   

                      Agency Administrator                      

  **APPROVED BY**                                    **DATE**   

                      Agency Administrator                      
  ------------------- ------------------------------ ---------- --------------

**Complexity Elements**

+--------------------+-------------------------------------------------+
| > **1. Potential   |                                                 |
| > for Escape**     |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| > **2. The Number  |                                                 |
| > and Dependency   |                                                 |
| > of Activities**  |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| > **3. Off-Site    |                                                 |
| > Values**         |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **4. On-Site       |                                                 |
| Values**           |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **5. Fire          |                                                 |
| Behavior**         |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **6. Management    |                                                 |
| Organization**     |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **7. Public and    |                                                 |
| Political          |                                                 |
| Interest**         |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **8. Fire          |                                                 |
| Treatment          |                                                 |
| Objectives**       |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **9. Constraints** |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **10. Safety**     |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **11. Ignition     |                                                 |
| Pr                 |                                                 |
| ocedures/Methods** |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **12. Interagency  |                                                 |
| Coordination**     |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **13. Project      |                                                 |
| Logistics**        |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

+--------------------+-------------------------------------------------+
| **14. Smoke        |                                                 |
| Management**       |                                                 |
+--------------------+-------------------------------------------------+
| **Risk**           | **Rationale**                                   |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Potential        | **Rationale**                                   |
| Consequences**     |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| **Technical        | **Rationale**                                   |
| Difficulty**       |                                                 |
+--------------------+-------------------------------------------------+
| Preliminary Rating |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+
| Final Rating       |                                                 |
|                    |                                                 |
| ***Low Moderate    |                                                 |
| High***            |                                                 |
+--------------------+-------------------------------------------------+

> **APPENDIX D - RISK ASSESSMENT / JOB HAZARD ANALYSIS**

**APPENDIX E - FIRE BEHAVIOR MODELING DOCUMENTATION OR EMPIRICAL
DOCUMENTATION**

**APPENDIX F - AIR OPERATIONS PLAN**

  ----------------------- ------- ----- ----- ----- ----- ----- ---------- ----- ----- -----
  **APPENDIX G -- WEATHER                                                              
  / FUELS / FIRE BEHAVIOR                                                              
  / SMOKE OBSERVATIONS**                                                               

  **Weather and Fuels**                                                                

  **OBSERVATION TIME**                                                                 
  (24 HR)                                                                              

  **SLOPE** (%)                                                                        

  **ASPECT**                                                                           

  **ELEVATION** (FEET)                                                                 

  **FUEL MODEL** (1-13)                                                                

  **SHADING** (\<50% or                                                                
  \>50%)                                                                               

  **DRY BULB                                                                           
  TEMPERATURE** (°F)                                                                   

  **WET BULB                                                                           
  TEMPERATURE** (°F)                                                                   

  **RELATIVE HUMIDITY**                                                                
  (%)                                                                                  

  **EYE LEVEL WIND                                                                     
  SPEED** (MPH)                                                                        

  **WIND DIRECTION**                                                                   

  **CLOUD COVER** (%)                                                                  

  **1-HR FUEL MOISTURE**                                                               
  (%)                                                                                  

                                                                                       

  **Fire Behavior**                                                                    

  **FIRE** (HEAD, FLANK,                                                               
  BACKING)                                                                             

  **AVERAGE FLAME                                                                      
  LENGTH** (FT)                                                                        

  **MAX. FLAME LENGTH**                                                                
  (FT)                                                                                 

  **RATE OF SPREAD**                                                                   
  (CH/HR)                                                                              

  **TORCHING/CROWNING**                                                                
  (Y or N)                                                                             

  **FIRE WHIRLS** (Y or                                                                
  N)                                                                                   

  **SPOTTING** (Y or N)                                                                

  **SMOKE DIRECTION**                                                                  

  **SMOKE RISE**                                                                       

                                                                                       

  **Notes**                                                                            

                                                                                       

  **OBSERVER NAME:**                                            **DATE**               
  ----------------------- ------- ----- ----- ----- ----- ----- ---------- ----- ----- -----

  ------------------ --------------- ------------- ---- --------- ------------- ---- ------------ --------- ---------- ----------------- ---------------
  **APPENDIX H -                                                                                                                         
  PRESCRIBED FIRE                                                                                                                        
  POST BURN                                                                                                                              
  EVALUATION**                                                                                                                           

  **Burn Unit**                      **Date(s)                                       **Acres                           **Ignition Start  
                                     Burned**                                        Burned**                          Time**            

                                                                                                                                         

  **Weather and Fuel                                                                                                                     
  Conditions**                                                                                                                           

                                     **Time of                                       **Low**                           **High**          
                                     Ignition**                                                                                          

  **Temperature**                                                                                                                        

  **Relative                                                                                                                             
  Humidity**                                                                                                                             

  **1-hr Fuel                                                                                                                            
  Moisture**                                                                                                                             

  **10-hr Fuel                       **100-hr Fuel                                   **1000-hr                         **Days Since      
  Moisture**                         Moisture**                                      Fuel                              Significant       
                                                                                     Moisture**                        Precipitation**   

                                                                                                                                         

  **Wind Direction                   **Wind Speed                                    **Percent of                      **Ignition        
  (Average)**                        (Average)**                                     Fuel                              Duration (min.)** 
                                                                                     Consumed**                                          

                                                                                                                                         

  **Accomplishment                                                                                                                       
  of Fuels Treatment                                                                                                                     
  Objectives**                                                                                                                           

  **Overall                                             **Yes**                      **No**                                              
  Objectives                                                                                                                             
  Achieved:**                                                                                                                            

  **Short Term                                                                                                                           
  Results (include                                                                                                                       
  changes in fuel                                                                                                                        
  profile and fire                                                                                                                       
  regime condition                                                                                                                       
  class)**                                                                                                                               

                                                                                                                                         

  **Cost                                                                                                                                 
  Evaluation**                                                                                                                           

  **Burn Plan        **Site                                       **Burn                          **Total                                **Cost/Acre**
  Preparation**      Preparation**                                Operation**                     Burn                                   
                                                                                                  Costs**                                

  \$                 \$                                           \$                              \$                                     \$

  **Narrative --                                                                                                                         
  Prescribed Fire                                                                                                                        
  Burn Boss                                                                                                                              
  Comments**                                                                                                                             

  **i.e. operations,                                                                                                                     
  safety, fire                                                                                                                           
  behavior,                                                                                                                              
  personnel &                                                                                                                            
  equipment                                                                                                                              
  performance,                                                                                                                           
  logistics, smoke                                                                                                                       
  management**                                                                                                                           

                                                                                                                                         

  **Prescribed Fire                                                                                         **Date**                     
  Burn Boss**                                                                                                                            
  ------------------ --------------- ------------- ---- --------- ------------- ---- ------------ --------- ---------- ----------------- ---------------