Fire Incident Report Form PDF Details

This fire incident report template (F-15.11 REG 1, Appendix B, Form A) completely records all the specifics of fire-related accidents:

- Basic information. The fire department involved, time, date, and address. It also specifies the incident type (structure, vehicle, and vegetation fire).

- Resources and values. The number of apparatus and personnel involved, estimated dollar value of the property, and estimated dollar value of damages.

- Contacts and insurance. Information for the insurance company, police, property owner, and occupant.

- Property details. Describes the use of the property, the number of buildings involved, and the building status (e.g., under construction, occupied, vacant).

- Incident description. Lists details regarding fire spread, mobile property involved, and ignition factors.

- Contributing factors. Details on factors that contributed to the ignition, such as misuse of materials, mechanical failures, and human factors.

The fire department incident report form is essential for gathering statistical data and developing safety regulations. Moreover, these reports are commonly used in legal and insurance situations, offering details for determining liability and filing compensation requests. Fire department incident report templates also enable assessing the reaction to the case and improve efficiency in upcoming responses.

QuestionAnswer
Form Name Fire Incident Report Form
Form Length 4 pages
Fillable? Yes
Fillable fields 63
Avg. time to fill out 10 min
Other names fire incident template printable, fire incident report sample doc, fire incident template, basic fire incident report form

Form Preview Example

FIRE SAFETY

F-15.11 REG 1

Appendix B

Form A - Fire Incident Report (Insurance)

[SECTION 6]

 

 

E m e rg e n c y M a n a g e m e n t

 

 

 

 

 

 

 

B a s ic Fire Incident Report

 

 

a n d F ire S a fe ty

 

 

 

 

 

 

 

 

 

 

 

P a g e 1 of 3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F ire D epartm ent:

 

 

 

Incident Tim e:

 

 

 

Incident D ate:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

u s e 2 4 -h o u r c lo c k

 

 

d a y / m o n th / y e a r

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Incident A ddre ss:

 

 

 

 

/

 

 

 

 

 

/

 

 

 

 

 

 

 

s tre e t a d d re s s /lo t, b lo c k a n d p la n # /la n d lo c a tio n d e s c rip tio n

R M /T o w n /C ity /V illa g e /H a m le t

 

 

p o s ta l c o d e

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In c id e n t T yp e :

Structure Fire

Vehicle F ire

Vegetation Fire

 

 

G arbage F ire

 

 

 

 

 

 

Other:

 

 

 

 

p ro v id e d e ta il o f fire in c id e n t if n o t c la s s ifie d a b o v e

 

 

 

 

 

N ote:

Complete and attach to this report a “Fire Detector and Extinguishing Equipment Report” and/or a “Casualty Report” as applicable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M utual Aid

M utual Aid Received

M utual Aid G iven

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R e s ou rc e s

 

 

 

 

 

 

 

 

 

 

N um ber o f A ppara tus

 

 

N um ber o f P ers onnel

 

 

 

 

 

 

 

lis t to ta l n u m b e r o f a p p a ra tu s re s p o n d e d

lis t to ta l n u m b e r o f p e rs o n n e l re s p o n d e d

 

 

 

 

 

 

 

 

 

 

 

V a lu e s

E stim a te d D o lla r V a lu e of P ro p e rty: $ Insura nce F ile #

E stim a te d D o lla r V a lu e of D a m a g e s: $ Insura nce C om pany:

 

P e rs o ns In v olv e d

 

 

 

 

 

 

 

Insura nce C ontact:

 

P hone:

 

 

 

 

P olice C ontact:

 

P hone:

 

 

 

 

O w ner’s N am e:

 

P hone:

 

 

O wn er’s Ad dress:

 

 

 

 

 

 

 

O ccupant's N am e

 

P hone:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F-15.11 REG 1

FIRE SAFETY

P r o p e rty U se

Educational

H ealth Care / D etention

R esidential

M ercantile / Business

Storage

Industry / U tility

O utside or special property

M anufacturing

 

Other

p ro v id e p ro p e rty u s e d e ta il o f th e s tr u c tu re if n o t c la s s ifie d a b o v e

N u m b e r o f b u ild in g s in v olv e d

 

 

A cre s b u rn e d

 

B u ild in g he ig h t

 

F lo o r s iz e

 

 

 

 

 

 

 

 

 

 

 

 

T o t a l # o f s t o r ie s

 

In d ic a t e f t 2 o r m 2

B u ild in g S ta tu s

 

 

 

 

 

 

 

 

 

 

 

U nder C onstruction

 

U nder m ajor renovation

Being dem olished

 

 

 

 

 

O ccupied

 

Vacant and secured

U ndeterm ined

 

 

 

 

 

Idle / N ot routinely used

Vacant and unsecured

 

 

 

 

 

 

O ther

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

p ro v id e d e ta ils o f b u ild in g s ta tu s if n o t c la s s ifie d a b o v e

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C o n tin u e d o n P a ge 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E M F S 0 3 /1 5 A - 1

FIRE SAFETY

F-15.11 REG 1

E m e rg e n c y M a n a g e m e n t

B a s ic Fire Incident Report

a n d F ire S a fe ty

P a g e 2 of 3

 

 

 

 

 

Fire Spread Confined to room of origin Confined to floor of origin

Confined to building of origin

Beyond building of origin

M obile Property Involved

M obile Property Type

 

 

 

None

Passenger or road transport

Aircraft

Not involved with ignition, but burned

Freight road vehicle

Industrial, agriculture, construction

Involved with ignition, but did not burn

Transport vehicle

M iscellaneous

Involved with ignition and burned

W ater vessel

Unknown

M obile P ro perty D etails

 

 

 

 

 

M ake

 

 

 

 

 

 

M odel

 

 

 

 

 

 

Licence num b er

 

P rovince

 

V IN

 

Ignition F actors

A re a of O rigin

p ro v id e d e ta ile d d e s c rip tio n o f t h e p rim a ry u s e o f t h e a re a w h e re th e fir e s ta rt e d - a ls o c h e c k b e lo w a s a p p lic a b le

Means of egress

Storage areas

Transportation vehicle areas

> h a llw a y s , e n tra n c e a re a s , fire e x its

> s to re ro o m s , c lo s e ts , g a ra g e s

> p a s s e n g e r a re a , tru n k , e n g in e

Assembly areas

Service areas

Outside areas

> th e a te rs , c o m m u n ity h a lls , liv in g ro o m s

> c o n d u it, p ip e s , e le v a to r s h a ft

> s tre e ts , p a rk in g lo ts , ra ilw a y tra c k s

Function area

Service or equipment areas

Other areas

> b e d ro o m , k itc h e n , o ffic e , d in in g ro o m

> m e c h a n ic a l ro o m s , c e lls

> a r e a s n o t o th e rw is e lis te d

Technical processing area

Structural areas

Undetermined

> la b o ra to rie s , o p e ra tin g ro o m s , s ta g e s

> a ttic s , c ra w l s p a c e s , e x te rio r o f w a lls

> a r e a o r o rig in c a n n o t b e d e te rm in e d

H eat So urce

p ro v id e d e ta ile d d e s c rip tio n o f t h e h e a t s o u rc e w h ic h ig n ite d th e fir s t o b je c t t o b u rn - a ls o c h e c k b e lo w a s a p p lic a b le

Operating equipment

Other open flame, smoker's materials

Other heat sources

> s p a rk , e m b e r, e le c tric a l a rc , ra d ia n t h e a t

> c ig a re tte s , c a n d le s , m a tc h , lig h te r

> m u ltip le h e a t s o u rc e s

Hot smouldering object

Chemical, Natural heat sources

Undetermined

> h e a t o f fric tio n , m o lte n m a te ria l, w e ld in g

> s u n lig h t, s p o n ta n e o u s c o m b u s tio n

> h e a t s o u rc e c a n n o t b e d e te rm in e d

Explosives, fireworks

Heat spread from another fire

 

> b la s t in g a g e n t , m u n it io n s , fir e w o r k s

> f la m e c o n t a c t , r a d ia n t h e a t , e m b e r s

 

Item First Ignited

p ro v id e d e ta ile d d e s c rip tio n o f t h e ite m fir s t ig n ite d - a ls o c h e c k b e lo w a s a p p lic a b le

Structural component

Adornment, recreational items, signs

Organic materials

> w a ll c o v e rin g s , f ra m in g , f lo o r c o v e rin g s

> C h ris tm a s tr e e s , a w n in g s , t e n ts , t o y s

> a g ric u ltu ra l c ro p s , h u m a n s , a n im a ls

Furniture, utensils

Storage supplies

General materials

> u p h o ls te ry , c a b in e ts , a p p lia n c e s

> b o x e s , p a c k in g m a te ria ls , p a lle ts

> b o o k s , tra s h , d u s t, lin t, tire s , fe rtilize r

Soft goods, wearing apparel

Liquids, piping, filters

Undetermined

> m a ttre s s e s , lin e n , c lo th in g , d ra p e s

> fla m m a b le g a s e s / liq u id s , p ip e s , d u c ts

> ite m firs t ig n ite d c a n n o t b e d e te rm in e d

C ause of Ignition

p ro v id e d e ta ile d d e s c rip tio n o f t h e c a u s e o f ig n itio n - a ls o c h e c k b e lo w a s a p p lic a b le

Intentional

Failure of equipment

Cause under investigation

> m is u s e o f h e a t s o u rc e , in c e n d ia ry fire

> e q u ip m e n t n o t fu n c tio n in g p ro p e rly

> o r ig in a n d c a u s e n o t y e t d e te rm in e d

Unintentional

Act of nature

Cause undetermined

> c a re le s s , re c k le s s , a c c id e n ta l a c ts

> w e a th e r, flo o d s , a n im a l b e h a v io u r

> c a u s e u n d e te rm in e d a fte r in v e s tig a tio n

E M F S 0 3 /1 5 A - 2

F-15.11 REG 1FIRE SAFETY

E m e rg e n c y M a n a g e m e n t

B a s ic Fire Incident Report

a n d F ire S a fe ty

P a g e 3 of 3

 

 

 

 

Factors Contributing to Ignition

p ro v id e d e ta ile d d e s c rip tio n o f th e fa c to rs th a t a llo w e d h e a t s o u rc e a n d c o m b u s tib le m a te ria ls to c o m e in to c o n ta c t/c o m b in e

Misuse of materials

Design, Installation Deficiency

Fire spread or control

> u n s a fe u s e o r p la c e m e n t o f h e a t s o u rc e

> d e s ig n , c o n s tru c tio n , in s ta lla tio n fa u lts

> e x p o s u re , re k in d le , c o n tro lle d b u rn s

Mechanical failure, malfunction

Operational Deficiency

Undetermined

> w o rn c o m p o n e n ts , c o n tro l fa ilu re , le a k

> c o llis io n s , u n a tte n d e d e q u ip m e n t

> ig n itio n fa c to rs c a n n o t b e d e te rm in e d

Electrical failure, malfunction

Natural condition

 

> s h o rt c irc u it, a rc in g , e q u ip m e n t fa ilu re

> w in d , flo o d , a n im a l b e h a v io u r

 

H um an F actors

p ro v id e d e ta ile d d e s c rip tio n o f th e h u m a n fa c to rs re la te d to th e fir e - a ls o c h e c k b e lo w a s a p p lic a b le

Asleep

Possible mentally disabled

None

> o c c u p a n t(s ) a s le e p a t tim e o f fire

> p e rs o n s w ith p e rm a n e n t d is a b ilitie s

> n o p e rs o n s in v o lv e d

Impaired by alcohol or drugs

Physically disabled

 

> im p a ire d o c c u p a n t(s ) a s le e p o r a w a k e

> p e rm a n e n t o r te m p o ra ry d is a b ilitie s

 

Unattended

Multiple persons

 

> p e rs o n s re q u irin g c a re le ft u n a tte n d e d

> n o te n u m b e r o f p e rs o n s a b o v e

 

Equipm ent Involved in Ignition

p ro v id e d e ta ile d d e s c rip tio n o f e q u ip m e n t in v o lv e d in ig n itio n - a ls o c h e c k b e lo w a s a p p lic a b le

Heating, ventilation, air conditioning

Commercial and medical equipment

Electronic, other electrical equipment

> fu rn a c e , fire p la c e , s to v e , w a te r h e a te r

> v e n d in g m a c h in e s , O 2 e q u ip m e n t

> c o m p u te rs , T V s , s te re o s , c a s h re g is te r

Electrical distribution, lighting, power

Garden tools, agricultural equipment

Personal and household equipment

> d is trib u tio n p a n e ls , o u tle t, lig h ts

> c o m b in e , c h a in s a w , m ilk in g m a c h in e

> c lo th e s d ry e r, c u rlin g iro n , p o w e re d to y s

Shop tools and industrial equipment

Kitchen and Cooking Equipment

Other equipment involved in ignition

> p o w e r s a w , w e ld in g to rc h , c o m p re s s o r

> C o ffe e m a k e r, m ic ro w a v e , d is h w a s h e r

> o th e r e q u ip m e n t n o t lis te d , n o n e

Brand or M ake

 

 

Serial N um ber or other identification

 

 

M odel

 

 

Ye ar of m anufacture

 

 

 

R em arks

 

P erso n C om pleting This R eport

 

 

 

 

 

 

 

 

 

 

 

 

N am e

 

 

 

 

R ank/Title

 

 

 

 

Phone

 

 

 

 

 

 

 

 

 

 

 

 

W ork

 

H om e

 

 

 

C ell

 

 

 

 

R epresenting

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g o v e rn m e n t a g e n c y , firm

o r c o rp o ra tio n - p ro v id e a d d re s s

 

 

O ther F orm s filed with this R eport:

C asualty R eport

F ire D etector an d E xtinguishing E quipm ent R eport

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E M F S 0 3 /1 5 A - 3

How to Edit Fire Incident Report Form Online for Free

Accurately completing this printable fire incident report form is important for documenting details for insurance claims, investigations, and statistical reporting.

1. Fill in the Basic Information

Begin by writing the fire department's name involved in the incident management. Specify the incident date and time using the 24-hour clock format. Record the complete incident address, including street, block, lot, and plan number, and the broader location description, such as the town or city.

 

Filling in section 1 of fire incident template form

2. Describe the Incident

Select the type of fire from the options provided — structure, vehicle, vegetation, garbage, or other. If you mark "Other" on this fire report template, provide a detailed description.

The right way to prepare fire incident template form stage 2

3. Record Mutual Aid Information

Indicate whether mutual aid was given or received. Mutual aid refers to resources shared between agencies during emergency responses.

4. List Resources and Assess Damages

Document the number of fire apparatus and personnel responding to the incident. Enter the estimated dollar value of the property and the damages incurred.

5. Input Contact Information

Provide the contact details for the insurance company, the police department involved, and the owner and occupant of the property affected by the fire. Ensure all phone numbers are current and correct.

 

Property U se, Industry  U tility, and M anufacturing in fire incident template form

6. Specify Property Use and Status

Select the property use that best describes the location of the fire, such as residential, educational, or business. Then, detail the status of the building at the time of the fire, such as under construction, occupied, or vacant.

7. Detail the Fire Spread and Mobile Property Involved

Note how the fire spread (e.g., confined to the room of origin, beyond the building of origin) and list any mobile property involved, such as passenger vehicles or aircraft.

 

Step # 4 of filling out fire incident template form

8. Identify the Area and Cause of Ignition

Describe the area where the fire started and identify the heat source that ignited the first object. It might include operational equipment, open flames, or electrical arcs. Then, determine the cause of the ignition, whether intentional, accidental, or due to equipment failure.

9. Analyze Contributing Factors

Write any additional factors that contributed to the ignition or spread of the fire, such as misuse of materials, mechanical failures, or design deficiencies.

 

Filling out part 5 of fire incident template form

10. Complete Additional Details and Reports

If other equipment was involved in the ignition, list them here. Also, write if an additional report accompanies this form.

11. Sign and Date the Form

The person completing the report should provide their name, rank or title, contact information, and the agency or organization they represent. Sign and date the fire department accident report form to authenticate the provided information.