Unit Name*

Unit ID*

Acreage*

Land Owner*

Burn Boss*

Planned Burn Date

Burn Window Start

Burn Window End

Objective Details

Min Temperature (°F)*

Max Temperature (°F)*

Min Relative Humidity (%)*

Max Relative Humidity (%)*

Min Wind Speed (mph)*

Max Wind Speed (mph)*

Wind Direction*

Mixing Height (ft)

Minimum acceptable mixing height above ground level

Transport Wind Speed (mph)

Average wind speed through the mixing layer

Dispersion Index

Minimum acceptable dispersion index (typically 1–100)

Smoke Sensitive Areas*

Distance to Nearest Sensitive Area (mi)

AQMD / Air Quality District Notification RequiredAQMD / Air Quality District Notification Required

AQMD Permit / Authorization Number

Expected Smoke Duration (hrs)

Ventilation Index

Product of mixing height and transport wind speed

Ignition Method*

Ignition Pattern*

Expected Rate of Spread (chains/hr)

Predicted rate of spread under prescription conditions

Expected Flame Length (ft)

Required Personnel Count*

Contingency Plan*

Escape Routes*

Safety Zones*

Test Fire ConductedTest Fire Conducted

Smoke Cleared as PredictedSmoke Cleared as Predicted

All Personnel BriefedAll Personnel Briefed

Communications Checked (Radio Test)Communications Checked (Radio Test)

Go / No-Go Decision*

Go/No-Go Notes

Free Fillable Prescribed Burn Plan

Like this form?