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Checklist for an Emergency Response Assistance Plan
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| Adress: | ||||||
| City | Province: | Postal Code | ||||
| Contact's Name | Title: | ||
| Phone: | ( ) | Fax: | ( ) |
| Email Adress: | Date received application | ||
| Region: | |||
| Comments | ||
| a) | the name and address of the place of business including the postal code, of the applicant; (i.e. the person who offers for for transport or imports); | |
| b) | the telephone number and, if applicable, the electronic mailing address and facsimile number of the applicant; | |
| c) | the classification of the dangerous goods which includes the following as applicable; | |
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i) the shipping name, |
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ii) the primary class, |
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iii) the compatibility group letter, |
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iv) the subsidiary class, |
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v) the UN number, |
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vi) the packing group, |
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vii) the risk group. |
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| d) | the type and size of the means of containment used to transport the dangerous goods to which the ERAP relates; | |
| e) | the geographical area covered by the ERAP; | |
| f) | a telephone number to call to immediately activate the ERAP; | |
| Mechanism for activation of the ERAP | ||
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Telephone number |
( ) | |
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Telephone number |
( ) | |
| g) | a description of the emergency response capabilities of the consignor or a third party who has agreed to provide those capabilities, including | |
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(i) the number of persons qualified to give, by telephone, technical advice about the dangerous goods, |
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(ii) the number of persons qualified and available to provide advice and assistance at the site of an emergency, |
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(iii) a list of the specialized equipment that can be transported to and used at the site of an emergency site, |
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(iv) a general description of the response actions capable of being taken at the site of an emergency, |
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(v) a description of the transportation arrangements to bring specialized emergency response personnel and equipment to the site of an emergency, and, |
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(vi) a description of the communications systems that can be made available at the site of an emergency. |
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| h) | a potential accident assessment including | |
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(i) a general analysis of how an accidental release of dangerous goods could occur |
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(ii) a general description of the potential consequences of an accidental release of dangerous goods; and |
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(iii) a description of the action the applicant is expected to take in the event of an accidental release or an imminent accidental release of dangerous goods. |
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| i) | copies of any formal agreement with a third party for the provisions of assistance | |
| j) | the signature of the person submitting the application. |
| Recommended Issuance of ERAP Reference Number | ||
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YES |
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NO |
| Signature | RMS Name | Date: |
Approved:
| Signature | Chief, Response Operations | Date: |
