Form F 1004 – Fill Out and Use This PDF

APPENDIX D

FIRE INVESTIGATION FORMS

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PRELIMINARY FIRE INVESTIGATION

Montana Department of Natural Resources and Conservation Fire and Aviation Bureau

F-1004 (Rev.7/2005)

Page

of

Q

S

T

R

Area

Unit

Incident #

Estimated Start

Reported

Address

Fire Name

Date

Date

Time

Time

City

Location

Other Fire Numbers

What Burned?

Acres Burned

Reporting Party

Codes:

‘V’ Victim

‘W’ Witness

‘S’ Suspect

‘T’ Tenant/Owner

Code:

Name:

Drivers Lic. ID #

Sex

Hair

Eyes

Hgt.

Wt.

DOB/Age

Address:

City

State

Telephone

Code:

Name:

Drivers Lic. ID #

Sex

Hair

Eyes

Hgt.

Wt.

DOB/Age

Address:

City

State

Telephone

Code:

Name:

Drivers Lic. ID #

Sex

Hair

Eyes

Hgt.

Wt.

DOB/Age

F

Address:

City

State

Telephone

Code:

Name:

Drivers Lic. ID #

Sex

Hair

Eyes

Hgt.

Wt.

DOB/Age

Address:

City

State

Telephone

Statutes or Administrative Rules Violated:

Wind

Humitidy

Photos?

Taken by whom?

Name

speed/Direction

Temp At

Yes

Gusts To

No

Date

Time

Insured?

Yes

No

Company/Agent

F-1004 Rev 7/2005

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Page ____ of ____

F-1004 (second page) Rev 07/05

General Remarks (such as statements, observations, license numbers, equipment ID, evidence etc.):

What Caused the Fire? (State opinions and conclusions)

Debris Burning:

Did the fire escape control

Yes

No

Burn permit? Yes #

No

Required?

Yes

No

Piled Debris

Machine

Hand

Length/Diameter:

Width:

Height:

Incinerator

Clearance:

Screen:

Yes

No

Screen mesh size:

Railroad: Fire Guard?

Yes

No

Maintained

Yes

No

Ownership

Train Number

Time Passed:

Direction of travel:

Milepost number:

Power line:

Pole ID#

+750 volts

-750 volts

Tree Involved: Yes

No

Distance of limbs to conductor:

Utility Representative:

Conductor Clearance:

Yes

No

Remarks:

Did the fire burn the property of others?

Yes

No

Action Taken

None

Investigation Continued

See Supplement:

Yes

No

Signature

Printed Name

Criminal

Civil Litigation

Title:

Date:

Judicial

Administrative

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PRELIMINARY FIRE INVESTIGATION

Montana Department of Natural Resources and Conservation Fire and Aviation Bureau

F-1004a (Rev.7/2005)

Page ____ of ____

Supplemental Form

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F-1004

Appendix D

FIRE INVESTIGATION REPORT

WHEN SUBMITTED: Following it’s use by a fire investigator.

NUMBER OF COPIES: One copy (original retained by the fire investigator). Additional copies may be made upon request for Unit, Land Office or Forestry Division.

GENERAL DESCRIPTION OF THE FORM: This is a field form used by fire investigators during the course of a preliminary fire investigation. It provides the necessary information for documentation of the fire and serves as a source document should a fire require further investigation.

DETAILED INSTRUCTIONS TO COMPLETE THE FORM:

Q: ¼ ¼ of section where fire started.

S: Section where fire started.

T: Township where fire started.

R: Range where fire started.

AREA: Area (Land Office) with protection.

UNIT: Unit with protection.

INCIDENT #: Unit fire number.

ESTIMATED START & REPORTED: Date (month, day, year) and time (24 hour). Double check to see that the date and time correspond with those on the F-1000 and F-900.

ADDRESS, CITY & LOCATION: Give the address (if available) city and general location of the fire. Can be continued in the general comments section.

FIRE NAME & OTHER FIRE NUMBERS: Self-explanatory, must be the same name as appears on F-1000 and F-900.

WHAT BURNED: Brief description of what was burned. This information should correspond with the F-1000,

i.e.: grass, timber, one barn, vehicle 1995 Chevy pickup, etc.

REPORTING PARTY: This is very important for follow up information. Get the full name of the reporting party, mailing address, and all available phone numbers.

CODES: These are used to identify the names in the following boxes.

CODE: Use the appropriate code to identify the person.

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NAME, DRIVERS LIC. ID #, SEX, HAIR, EYES, HGT. WT. DOB/AGE: Try to detail as much information as possible to aid in follow up information. Multiple copies of this page may be used if there are multiple witness, suspects or victims, the general comments box may also be used.

STATUTES OR ADMINISTRATIVE RULES VIOLATED: List statutes or administrative rules that were violated in the ignition or escape of this fire.

WIND SPEED/DIRECTION: Self-explanatory, be sure to note the time and date the weather observations were taken. Include all observations taken by the initial attack responders in the general comments section or in their statement(s).

PHOTOS: If photos were taken by a private citizen be sure to get their name, address and phone number. Assure the person that the DNRC will replace the film, pay for the processing and only keep the fire portion of the film.

INSURED: If the party was insured list the company and agent.

GENERAL REMARKS: Any information that does not fit into other blocks on this form, or continuations from other blocks should be listed in this section.

BEFORE FIREFIGHTERS ARRIVED, WHAT SUPPRESSION EFFORTS, IF ANY WERE TAKEN: This can be very important. When possible substantiate with statements from witnesses.

WHAT CAUSED THE FIRE: State your opinion. Utilize the information in other blocks, and from statements to create a negative corpus, eliminate all other causes.

DEBRIS BURNING: If the fire is determined to be a debris burning fire, fill the blanks in this section. These blocks will aid in determining follow up action or billing.

RAILROAD: If the fire is determined to be a railroad fire, fill the blanks in this section. These blocks will aid in determining follow up action or billing.

POWERLINE: If the fire is determined to be a powerline fire, fill the blanks in this section. These blocks will aid in determining follow up action or billing.

REMARKS: Use this section to provide comments that may be used to support your conclusion or to support possible billing actions.

DID THE FIRE BURN THE PROPERTY OF OTHERS: If yes the owner(s) should be listed as victims on page one.

ACTION TAKEN: Check the appropriate box.

SEE SUPPLEMENT: Check if supplemental form F-1004a or other documents are used.

SIGNATURE: Sign, print name, date and include your title.

WHEN FORM IS COMPLETED: Keep original, copies may be routed to, unit, land office, and bureau.

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DATE & TIME: Write the date and time when the items are being delivered and signed over.

RELEASED BY:

NAME: Write the name of the person releasing the items.

ORGANIZATION: Write the name of the organization releasing the items.

SIGNATURE: The signature of the person releasing the items is recorded here.

RECEIVED BY:

NAME: Write the name of the person receiving the items.

ORGANIZATION: Write the name of the organization receiving the items.

SIGNATURE: The signature of the person receiving the items is recorded here.

PURPOSE: Record the purpose for releasing/receiving the item, i.e. analysis, lockup, safe keeping etc.

WHEN THE FORM IS COMPLETED: Each time the items appearing on the form are released and received, the chain of custody (bottom) portion of this form must be filled in so that a detailed record is kept of each person who has released and received the items. This is to keep track of anyone who has been in possession of the evidentiary item from the time it is collected until the time it appears in court. If the chain of custody is broken, the evidence may not be admissible. If spaces run out on one form, fill out a second form and label it page 2 of 2 etc. Keep the form with the case documents.

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					OWNER’S CONSENT TO SEARCH
F 1016					Appendix D
DATE			, 20
INCIDENT #

I,, being the lawful owner and/or occupant of the following

described premises, do hereby give permission to the undersigned representative(s) of the Montana Department of Natural Resources and Conservation, to conduct such search or searched of the entire premises as deemed necessary. It is understood that a receipt will be given for any items so removed and it is further understood that said items will all be returned to me when deemed by the Montana Department of Natural Resources and Conservation to be of no further value. I further state that I have been informed of my constitutional right not to have a search made of the premises hereinafter mentioned without a search warrant and of my right to refuse consent to such a search.

This written permission is being given by me to the investigator named below and is given voluntarily and without threats or promises of any kind.

Signed

Address

Premises description

Address or legal description

City

County

, Montana

Investigator

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Montana Department of Natural Resources and Conservation

RECEIPT

		INCIDENT NO.
On		, I,			,
received from,						, the following items:

Dated this

day of

, 20

.

Received by:

Received from:

Witness:

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