Fire Incident Report Form PDF Details

Recent fires in the area have prompted city officials to remind residents about the importance of submitting a fire incident report form. The form can be used to report any type of fire, from kitchen accidents to large-scale blazes. Officials say that reporting fires is essential for ensuring that firefighters are dispatched quickly and that property owners receive the assistance they need. Submitting a fire incident report form is easy, and can be done online or by mail.

QuestionAnswer
Form NameFire Incident Report Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesfire incident template printable, fire incident report sample doc, fire incident template, basic fire incident report form

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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

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Filling out this PDF will require attention to detail. Make sure that all necessary blank fields are filled in properly.

1. The fire incident report format sample word usually requires certain details to be entered. Be sure the following blank fields are finalized:

Filling in section 1 of fire incident template form

2. The next part is usually to submit these blanks: Insura nce C ontact, P olice C ontact, O wners N am e, O wn ers Ad dress, O ccupants N am e, P hone, P hone, P hone, and P hone.

The right way to prepare fire incident template form stage 2

It is easy to make a mistake when filling out your P hone, and so make sure to reread it prior to deciding to finalize the form.

3. The next step is usually simple - fill in every one of the fields in Property U se, Educational, M ercantile Business, Storage, Health Care Detention, Industry U tility, O utside or special property, Residential, M anufacturing, Other, p ro v id e p ro p e rty u s e d e, N u m b e r o f b u ild in g s in, A cre s b u rn e d B u ild in g he, F lo o r s iz e, and T o ta l o f sto rie s to complete the current step.

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

4. This next section requires some additional information. Ensure you complete all the necessary fields - F ire S p re a d, C onfined to room of origin, Confined to building of origin, C onfined to floor of origin, Beyond building of origin, M o b ile P ro p e rty In v olv e d, M o b ile P ro p e rty T yp e, None, Passenger or road transport, Aircraft, Not involved with ignition but, Freight road vehicle, Industrial agriculture, Involved with ignition but did, and Transport vehicle - to proceed further in your process!

Step # 4 of filling out fire incident template form

5. When you approach the end of your document, you'll notice just a few more requirements that should be fulfilled. Specifically, p ro v id e d e ta ile d d e s c, Operating equipment s p a rk e, Other open flame smokers, Other heat sources m u ltip le h, Hot smouldering object h e a t o, Chemical Natural heat sources s, Undetermined h e a t s o u rc e, Explosives fireworks b la s tin, Heat spread from another fire, Ite m F irs t Ig n ite d, p ro v id e d e ta ile d d e s c, Structural component w a ll c o, Adornment recreational items, Organic materials a g ric u ltu, and Furniture utensils u p h o ls te must be done.

Filling out part 5 of fire incident template form

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