* 1. Physical Building Details

* 2. Emergency contact information

* 3. Alternate Emergency contact information

* 4. Emergency contact preferred method of communication

* 5. If there is a building engineer; please provide contact information

* 6. Please select box that corresponds to your facility type. If you select other, please describe why the property is designated as critical, including description of potential impacts from water or sewer disruption.

* 7. Describe operational impacts if water is available for flushing toilets and cleaning but not for consumption purposes.
for less than 24 hours

* 8. Describe operational impacts if water is available for flushing toilets and cleaning but not for consumption purposes.
for greater than 24 hours

* 9. Describe operational impact if water is not available due to a construction or distribution system failure for less than 24 hours

* 10. Describe operational impact if water is not available due to a construction or distribution system failure for greater than 24 hours

* 11. If you have a written emergency or contingency plan that establishes how long the property can operate with limited or reduced water/sewer services, how long is your contingency period?

* 12. If there is an individual at your organization who is responsible for emergency planning, please provide contact details:

* 13. What is the total occupancy served by your property’s water system
(e.g. number of employees, number of residents, number of visitors, and number of buildings)?

* 14. If your property serves a vulnerable population (e.g. ill, elderly, children), please describe the population type and quantity of people.

* 15. If your property provides a vital public health or public safety purpose, please describe.

* 16. If you have potable water storage tanks onsite, please indicate the volume of onsite potable water storage.

* 17. If you have bottled water stored onsite, please indicate how much bottled water is stored onsite.

* 19. If you have a supply of portable toilets, what is the quantity?

* 20. If you have an emergency power source, such as a generator or quick connect for a generator, please describe.

* 21. What is your DC Water Account Number (located on bill)

* 22. If your organization has more than one DC Water account, please provide account numbers

* 23. Is there any other information that you want to share with DC Water regarding emergency water/sewer impacts on your property or facilities?

T