Emergency Farm Plan Electronic Template

Emergency Farm Plan Electronic TemplateNote: See MSU Extension bulletin E-2575 Emergency Planning on the Farm(http://shop.msu.edu/product p/bulletin-e2575.htm) for detailed information on emergency planning.IntroductionThis electronic template will assist you inwriting an emergency farm plan. By saving acopy of the completed plan on your computeror storage device, you will be able to easilyupdate the plan when changes occur on thefarmstead or with the inventory of pesticidesand other agricultural chemicals.will meet the reporting requirement for farmsthat store extremely hazardous substances(anhydrous ammonia and certain otherpesticides listed in bulletin E-2575). The planalso meets the requirement for those farms thatstore liquid fertilizers in quantities that exceed2,500 gallons in a single container or 7,500 inmultiple containers.Agricultural safety experts recommendupdating the emergency farm plan at leastannually and sharing the content and locationof the plan with family members, employeesand local emergency providers (such as the firedepartment or the Local Emergency PlanningCommittee). Out-of-date plan copies must bedestroyed to avoid confusion.Directions for completing the planWhen submitted to the Local EmergencyPlanning Committee and the State SARA Title IIIProgram, the completed emergency farm planManually insert the farmstead andneighborhood maps into the printed copiesof the emergency plan. (Note: You mayBefore completing the template, use the SAVEbutton at the end of this page to rename andsave this file to your computer. Save the file to alocation you can easily find for future updates.Complete the electronic template by typing inyour farm information in the blank spaces. Thensave the renamed file again.electronically insert maps of the farmsteadand the neighborhood only if they are savedas PDFs.) Printed copies of the plan should bestored at the farm office, in tractor cabs, in theMichigan Emergency Tube (optional) and withyour Local Emergency Planning Committee orlocal fire department.If your farm stores extremely hazardoussubstances, you can email the completedelectronic template (without the maps) to theMichigan SARA Title III Program at deq-sara@michigan.gov.Contact your Michigan AgricultureEnvironmental Assurance Program (MAEAP)technician for additional information oncompleting an emergency farm plan.Technicians are located in county ConservationDistrict offices.SAVEPRINT

Your Emergency Farm PlanFarm NameSection Ia. Farm Emergency Contact InformationDatePlace copies of this completed form near each farm phone.Smart911 services may be available in your county. For information, go to Smart911.com or contact your county 911 dispatcher.Owner Emergency ContactsFarm InformationNeighbors ContactsPrimaryContactNameof f FarmDirectionsto llAddressNamePhoneCellAddressStorage Site(s) address/location (if different)NamePhoneCellCellAddressAddress4

Your Emergency Farm PlanFarm NameSection Ib. Agency Emergency Telephone NumbersDatePlace copies of this completed form near each farm phone.Smart911 services may be available in your county. For information, go to Smart911.com or contact your county 911 dispatcher.Fire/Police/Medical Central DispatchEmergency phone . . . . . . . . . . . . . . . . . . . . . . . . . . . 911General phoneHospitalNamePhoneFire DepartmentNamePhoneElectrical CompanyEmergencyGeneralGas CompanyEmergencyGeneralAgrichemical DealerNamePhoneState and Federal AgencyTelephone Numbers:County Drain CommissionerAgriculture Pollution Emergency Hotline,Michigan Department of Agriculture andRural Development (MDARD) . . . . . . 800-405-0101PhonePollution Emergency Alerting System (PEAS),Michigan Department of EnvironmentalQuality (MDEQ) . . . . . . . . . . . . . . . . . . 800-292-4706NameNational Response Center (NRC) . . . 800-424-8802Michigan Poison Control. . . . . . . . . . . . 800-222-1222Michigan Meth Hotline. . . . . . . . . . . . . 866-638-4847NameEquipment Dealer/MechanicPhoneEmergency Management Coordinator/LEPCNamePhoneFBI Field Office (Detroit)313-965-2323VeterinarianNameEnvironmental Cleanup CompanyPhoneNamePhoneFamily DoctorNamePhoneCounty Road CommissionNamePhone5

Your Emergency Farm PlanSection II. Map InformationComplete two maps for each site (farmstead and neighborhood maps).Map the farmstead site (or other part of the farm where agrichemicals are stored) and label the following:Buildings/structures location Septic tanks, wastewater systems, cisterns Drainage ditches, culverts, surface drains Slope of land (drainage direction) North directionBarns, houses, shops, outbuildings, silos, grain bins,manure storage/pits, livestock barns (note if manurestorage below), refrigeration compressors, uprightor bunker silosChemical/Fertilizer/Fuel storageLand featuresIdentify where chemicals, fertilizers, and fuelare stored. Roads and crossroads, driveways and lanes, fencesand gates Wells and/or municipal water supply, hydrants,ponds, streams, rivers, lakes and wetlandsNorthSampleFarmstead MapLPWellEEPASTGrainBinsAST – Aboveground storage tankCG – Compressed gasses (oxy/acetylene)E – Main electrical shutoffEP – Emergency plan contained in Michiganemergency tube or key-box (see Glossaryon page 27)G – Main gas shutoffLP – Liquid propane (note if buried)RU – Refrigeration units/compressors and coolanttypeUST – Underground storage tankWell – Farm water wellNorthMyNeighbor’sFarmsteadWellHouseUse these symbols to show ResidenceSampleNeighborhoodMap

Your Emergency Farm PlanFarm NameSection IIa. Farmstead Map – CONFIDENTIALDatePlace a map of your farmstead below. Clearly label buildings and special concerns at the farmstead facility. Manually insert the farmstead map when printing copies ofthe plan; or, you may insert a digital map of the farmstead if you save the file as a PDF. Click on the space below.KeyAST – Aboveground storage tankCG – Compressed gasses (oxy/acetylene)E – Main electrical shutoffEP – Emergency plan contained in Michigan emergencytube or key-box (see Glossary on page 27)G – Main gas shutoff7LP – Liquid propane (note if buried)RU – Refrigeration units/compressors andcoolant typeUST – Underground storage tankWell – Farm water well

Your Emergency Farm PlanFarm NameSection IIb. Neighborhood Map – CONFIDENTIALDateManually insert the neighborhood map when printing copies of the plan; or, you may insert a digital map of the neighborhood if you save the file as a PDF.Click on the space below.Make your own key.8

Your Emergency Farm PlanFarm NameDateSection IIIa. Agrichemical InformationList agrichemicals used or stored. If agrichemicals are listed in Table 1 on pages 24-25, they may need to be reported to authorities. Use page 26 to report.Product Nameand Formulation(Trade/Brand name)MaxLbs/Galson siteActive Ingredient(AI) and PercentAIThis chemicalis listed onpages 24 or 25 North American/DOT GuidebookNumber*National Fire ProtectionAssociation (NFPA)704M Rating*Health-FlammabilityReactivitySeasons on HandSP Spring,S Summer, F Fall,W Winter,YR Year RoundBuilding orArea storedLabel shouldmatch map label.Example: Anhydrous1,000 galAmmonia100% UN 10053—1—0SPIn Field OnlyAmmonia(Not staged atfarmstead)*N ote: The North American/Department of Transportation (DOT) Guidebook Number and National Fire Protection Association (NFPA) 704M Rating can be found on Safety Data Sheets (SDSs)for the chemical of concern. SDSs can be obtained from dealers, manufacturers and various Internet sites. Product name, formulation, active ingredient and percent active ingredient are on theagrichemical label.9

Your Emergency Farm PlanFarm NameSection IIIb. Farm Flammables and RefrigerantsDateFuel TypeTotal Capacity andSeasons on HandContainer TypeSP Spring, S Summer, F Fall,W Winter, YR Year RoundStorage LocationDescription(e.g., In front of pole barn)Diesel FuelGasolineFuel OilNew Oil(motor and hydraulic)Used Oil(oil burner storage)Propane (home heat, forklift)Oxygen/Acetylene(cart tanks vs handheld tanks)KeroseneAnhydrous Ammonia forRefrigeration(See page 21 if you have this product.)(Other)10

Your Emergency Farm PlanFarm NameSection IV. Farm Response ResourcesDateTo be used and reviewed with farm employeesResourceFarm LocationWater SourcesShovelsFire Extinguishers (Employees trained in use)Excavation EquipmentSpill KitsMedical KitsFlashlights/GeneratorAbsorbent MaterialsPersonal Protective Equipment:(chemical-resistant) suits, goggles, gloves, bootsManure Pumping Equipment/ContractorEmpty Tanks or Containers(to hold manure, liquids, absorbent material or contaminated material/soil)Safety Data Sheets (SDSs):All employers are required to have a Safety Data Sheet (SDS) for each hazardous chemicalstored or used in the workplace and to make SDSs available to employees.Other (Please Specify)11

Your Emergency Farm PlanSection V. Emergency Action Plans for Manure,Fertilizer and Pesticide SpillsFarm NameDateBreach of manure or commercial fertilizerstorageManure/Fertilizer/Pesticide spillin the fieldManure storage volume enters thefreeboard areaGeneral Action Steps: Stop any flow into storage area,build containment dams, add soil to berms and applymanure/fertilizer from discharge to fields at agronomic rates. Utilize prearranged additional storagewith neighbor. Prepare a Spill or Release Report.General Action Steps: Stop applications, buildcontainment dams and collect material. Applycollected material at agronomic rates. Prepare aSpill or Release Report.Your Plan/Resources:Your Plan/Resources:General Action Steps: Transfer manure to additionalon-farm storage structure with adequate capacity ifavailable. Utilize prearranged additional storage withneighbor. Land apply manure at agronomic ratesto fields that are least likely to pose a dischargerisk. Pump manure to an isolated area of a fieldwith poor drainage to avoid berm overtopping andstructure failure. Contact MDEQ, MDARD or both asappropriate. Prepare a Spill or Release Report.Your Plan/Resources:Spill on roadwayRunoff of manure/fertilizerfrom the fieldGeneral Action Steps: Stop applications, plow adiversion trench and remove manure/fertilizer,if necessary. Prepare a Spill or Release Report.General Action Steps: Human injuries, if present,take precedence. Stop any additional spills, buildcontainment dams, remove material and land applyat agronomic rates. Contact the road commissionand drain commission. Do not wash material intoroadside ditches or surface water. Prepare a Spillor Release Report.Report any pesticide, fertilizer or manure spills to:Michigan Department of Agriculture andRural Development (MDARD)Your Plan/Resources:Your Plan/Resources:General agriculture information questions shouldbe directed to MDARD’s general information number1-800-292-393912AGRICULTURE POLLUTIONEMERGENCY HOT LINE1-800-405-0101(continued on next page.)