Your Emergency Farm Plan
Farm Name: Click here to enter text. Date: Click here to enter a date.
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Section 1A. Farm Emergency Contact Information
Place copies of this form near each phone!
Owner Emergency Contacts Neighbor Contacts
Primary Contact: Click here to enter text. Name:Click here to enter text.
Phone: Click here to enter text. Phone:Click here to enter text.
Cell:Click here to enter text. Cell:Click here to enter text.
Address:Click here to enter text. Address:Click here to enter text.
Alternative Contact:Click here to enter text. Name:Click here to enter text.
Phone: Click here to enter text. Phone:Click here to enter text.
Cell:Click here to enter text. Cell:Click here to enter text.
Address:Click here to enter text. Address:Click here to enter text.
Farm Information
Name of Farm: Click here to enter text.
Address of Farm:Click here to enter text.
Directions to farm:Click here to enter text.
Storage site(s) address/location (if different): Click here to enter text.
Section 1B. Emergency Phone Numbers
Place copies of this form near each phone!
Fire | Police | Medical Dispatch
Emergency phone ……………911 Equipment Dealer
Name: Click here to enter text.
Hospital Phone: Click here to enter text.
Name: Click here to enter text.
Phone: Click here to enter text. Name: Click here to enter text.
Phone: Click here to enter text.
Fire Department
Name: Click here to enter text. Environmental Cleanup Company
Phone: Click here to enter text. Name: Click here to enter text.
Phone: Click here to enter text.
Electrical Company
Name: Click here to enter text. Veterinarian
Phone: Click here to enter text. Name: Click here to enter text.
Phone: Click here to enter text.
Gas Company
Name: Click here to enter text. Family Doctors
Phone: Click here to enter text. Name: Click here to enter text.
Phone: Click here to enter text.
Agrichemical Dealer
Name: Click here to enter text. Insurance Agency
Phone: Click here to enter text. Name: Click here to enter text.
Phone: Click here to enter text.
State & Federal Telephone Numbers
SD Poison Control………800-222-1222
SD Rural Development….605-352-1100
SD Department of Environmental
& Natural Resources…….605-773-5559
Section II. Map Information
Map your farmstead on the next page and label the following:
Buildings and structure locations – barns, houses, outbuildings, silos, grain bins, manure storage pits, shops, refrigeration compressors, upright or bunker silos.
Land features – roads and crossroads, driveways, fences, gates, wells or water supply, hydrants, ponds, streams, rivers, septic tanks, drainage ditches, culverts, slope of land (drainage direction), North/South/West/East.
Chemical, fertilizer and fuel storage – Identify where chemicals, fertilizers and fuel is stored.
Sample Map
Section IIB. Map Information
Map your farmstead in the space below.
NORTH
Use these symbols to show locations:
AST – Above ground storage tank E- Main electrical shutoff LP – Liquid propane (note if buried)
CG – Compressed gasses G – Main gas shutoff RU – Refrigeration units/compressors
UST – Underground storage tank Well – Farm water well
Section III. Farm Flammables and Refrigerants
Fuel Type Total Capacity and Container Type Storage Location
Diesel Fuel
Fuel Oil
New Oil
Used Oil
Propane
Oxygen
Kerosene
Other
Section IV. Farm Response Resources
To be used and reviewed with farm employees.
Resource Farm Location
Water Sources
Shovels
Fire Extinguisher
Excavation Equipment
Spill Kits
Medical Kits
Flashlight/Generator
Absorbent Materials
Chemical Resistant Suits, Goggles, Gloves, Boots, etc.