Temporary Structures FormName of Event Date Date of delivery/erection Date of removal Time of event 010203040506070809101112HH000510152025303540455055MMAMPMAM/PMName of Organization/Chapter/Department Name of Responsible Person for Event Responsible Person's Phone Number Responsible Person's Email Address Name of Production Company (If Applicable) Production Company Phone Number Production Company Email Purpose of structure Type of structure StageTentCanopyOtherTent Number For tents that have already been assigned a numberProjected Number of Attendees Is tent greater than 400 sq ft? YesNoWhat is the anchoring method? If anchored in ground have line locates been completed? YesNoIs structure certified as flame resistant? (Documentation required by tag, stamp or flame test) YesNoUpload flame resistant documentation. Is 20-foot separation provided between the structure and other tents, canopies, parked vehicles, or internal combustion engines? (For the purpose of determining required distances, support ropes & guy wires shall be considered as part of the tent/canopy) YesNoDoes the tent/canopy have flaps/sides? YesNoIf yes, please describe: Are exits from tent/canopy evident, evenly spaced, maintained free of obstructions and are aisle clearances of at least 48 inches provided in the tent/canopy where required? YesNoAre “EXIT” signs posted? YesNoWill there be any open flames, heat, or any gases, such as charcoal grill within 20 feet of the tent/canopy? YesNoWill you have a generator? YesNoWill there be fire extinguishers present? (These will need to be in addition, not pulled from already assigned locations) YesNoWill event staff be on duty prior to and during events to monitor conditions in and adjacent to tent/canopy and assist with evacuation in the event of an emergency? YesNoWhere applicable, are stairs and handrails in place? YesNoAll decorations and/or special effects have been submitted? YesNoIf yes, please describe: Provide a layout of the interior space when the structure will be enclosed with soft or rigid walls, and when the occupancy load exceeds 50 persons. Certification that the structure safely resists the wind design speed listed above. Certification shall be signed by a licensed professional engineer. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
