The Form S-bd 8568 is a document that is used to help prove to the IRS that you have met the required tests for being a qualifying child or qualifying relative. This form can be beneficial for taxpayers who are claiming certain tax credits, such as the Earned Income Tax Credit (EITC) or the Child and Dependent Care Credit. If you are unsure whether or not you meet the qualifications for one of these tax credits, be sure to speak with an accountant or tax specialist. Filling out this form incorrectly could lead to an audit by the IRS, so it is important to be thorough and accurate when completing it.
| Question | Answer |
|---|---|
| Form Name | Form Sbd 8568 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | RV, Hemodialysis, Overpressure, False |
FDID #:
FIRE DEPARTMENT NAME:
DATE |
ALARM TIME |
ARRIVAL TIME |
CONTROL TIME LAST UNIT CLEARED |
INCIDENT # |
EXPOSURE # |
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LOCATION |
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Exact Location |
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Intersection |
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Street or Highway |
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Front of |
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Rear of |
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Apt/Room |
City |
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State |
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Zip Code |
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Adjacent to |
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Cross Streets or Directions |
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INCIDENT TYPE
(Situation Found)
See Back for Code
AID GIVEN OR RECEIVED
Mutual Aid Received
Automatic Aid Received
Mutual Aid Given
Automatic Aid Given
Other Aid Given
None
ACTIONS TAKEN
Primary Action Taken
Additional Action Taken (1)
Additional Action Taken (2)
RESOURCES
ApparatusPersonnel
Suppression
EMS
Other
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ESTIMATED DOLLAR LOSS |
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CASUALTIES |
DETECTORS |
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PROPERTY USE |
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LOSSES |
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Death |
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Injury |
(Required for Confined Fires Only) |
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Property $ |
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Detector Alerted Occupants |
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Contents $ |
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Fire Service |
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see back for code |
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Civilian Fire |
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Detector Did Not Alert Occupants |
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Personal information you provide may |
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Property $ |
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be used for secondary purposes. |
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Contents $ |
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Civilian EMS |
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Unknown |
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[Privacy Law, s. 15.04 (1) (m)] |
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HAZARDOUS MATERIALS RELEASE |
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MIXED USE PROPERTY |
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NONE |
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DIESEL FUEL/FUEL OIL: vehicle tank or portable storage |
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Not Mixed |
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Industrial Use |
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Assembly Use |
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Military Use |
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NATURAL GAS: slow leak, no evacuation or HazMat actions |
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HOUSEHOLD SOLVENTS: home/office spill, cleanup only |
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Educational Use |
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Farm Use |
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Medical Use |
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Other Mixed |
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PROPANE GAS: <21 LB. (as in home BBQ grill) |
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MOTOR OIL: from engine or portable container |
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Residential Use |
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Use |
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Row of Stores |
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GASOLINE: vehicle fuel tank or portable container |
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PAINT: from paints cans totaling <55 gallons |
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Enclosed Mall |
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Business & Residential |
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KEROSENE: fuel burning equipment or portable storage |
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OTHER: Special HazMat actions required or spill > 55 gallons |
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Office Use |
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OCCUPANT/PARTY INVOLVED NAME (LAST, FIRST, MIDDLE) |
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ADDRESS/CITY/ZIP CODE |
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TELEPHONE |
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OWNER NAME (LAST, FIRST, MIDDLE) |
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ADDRESS/CITY/ZIP CODE |
ROOM / APT # |
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TELEPHONE |
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NOTES:
AUTHORIZATION
Officer in Charge |
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Position or Rank |
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Assignment |
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Day |
Year |
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Member Making Report |
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Position or Rank |
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Assignment |
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Month |
Day |
Year |
COMPLETE THIS SIDE FOR ALL INCIDENTS - COMPLETE BOTH SIDES FOR ALL FIRES |
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Property Details |
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None |
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Ignition |
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Cause of Ignition |
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Not Residential |
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Bulk storage or warehousing |
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Intentional |
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Processing or manufacturing |
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Unintentional |
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Estimated # of residential |
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Packaged goods for sale |
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Area of Fire Origin |
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Failure of Equipment or Heat |
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living units in the building of |
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Repairs or service |
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Source |
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origin whether or not all units |
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Act of Nature |
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became involved |
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Bulk storage or warehousing |
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Cause Under Investigation |
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Processing or manufacturing |
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Heat Source |
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Cause Undetermined after |
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Buildings not involved |
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Packaged goods for sale |
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Investigation |
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Repairs or service |
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Factors Contributing to Ignition |
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Number of buildings involved |
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None |
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Bulk storage or warehousing |
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Item First Ignited |
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None |
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Processing or manufacturing |
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Packaged goods for sale |
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Fire spread confined to |
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Acres burned (outside fires) |
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Less than 1 acre |
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Repairs or service |
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object of origin |
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Factor #1 |
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Type of Material First Ignited |
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Factor #2 |
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Human Factors |
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None |
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Equipment Involved in Ignition |
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None |
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Contributing to Ignition |
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Asleep |
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Possibly impaired by alcohol/drugs |
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Equipment Involved |
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Brand |
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Model |
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Serial Number |
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Unattended person |
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Possibly mentally disabled |
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Portable |
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Stationary |
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Physically disabled |
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Year |
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Equipment Power Source |
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Multiple persons involved |
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Mobile Property Involved |
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Age was a factor |
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None |
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Mobile Property Type |
Mobile Property Make |
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Fire Suppression Factors |
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Not involved in ignition, but burned |
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Fire Suppression Factor (1) |
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Year |
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Mobile Property Model |
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Involved in ignition, but didn't burn |
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Fire Suppression Factor (2) |
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VIN Number |
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Involved in ignition and burned |
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Fire Suppression Factor (3) |
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License Plate Number |
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State |
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Structure Type |
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Building Status |
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Building Height |
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Fire Origin |
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Enclosed building |
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Under construction |
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(Count ROOF as part of Highest Story) |
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Fixed portable/mobile structure |
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Occupied & operating |
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Below Grade |
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Open structure |
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Idle, not routinely used |
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Total # of stories at or above grade |
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Story of origin |
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Air supported structure |
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Under major renovation |
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Fire Spread |
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Tent |
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Vacant & secured |
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Total # of stories below grade |
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Confined to object of origin |
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Open platform (e.g. piers) |
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Vacant & unsecured |
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Main Floor Size (Complete One) |
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Confined to room of origin |
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Underground structure (work areas) |
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Being demolished |
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Confined to floor of origin |
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Connective structure (e.g. fences) |
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Undetermined |
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Total square feet |
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Confined to building of origin |
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Other type of structure |
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Other |
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BY |
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Beyond building of origin |
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Length in Feet |
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Width in Feet |
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Number of Stories Damaged by Flame |
Material Contributing Most to Flame Spread |
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Insurance Company Information |
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Number of stories w/ minor damage |
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(1 to 24% Flame Damage) |
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Insurance Company Name |
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Number of stories w/ significant damage |
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Item contributing most to flame spread |
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(25 to 49% Flame Damage) |
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Policy Number |
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Number of stories w/ heavy damage |
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(50 to 74% Flame Damage) |
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Agent's Name |
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Number of stories w/ extreme damage |
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Type of material contributing most to flame spread |
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(75 to 100% Flame Damage) |
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Phone Number |
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Presence of Detectors |
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Detector Effectiveness |
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Presence of Automatic |
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System Operation |
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None Present |
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Alerted |
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Extinguishing System |
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Operated & effective |
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Present |
Detector Power Supply |
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Occupants failed to respond |
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None Present |
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Operated & not effective |
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There were no occupants |
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Present |
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Fire too small to activate |
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Detector Type |
Detector Operation |
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Failed to alert occupants |
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Failed to operate |
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Other |
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Smoke |
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Fire too small to activate |
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Heat |
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Operated |
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Type of System |
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Failed to Operate |
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Sprinkler,water flow detection |
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Undetermined |
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Detector Failure Reason |
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More than 1 type present |
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# of Heads Operating |
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System Failure Reason |
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Assembly
111Bowling alley
112Billiard center, pool hall
113Electronic amusement center
114Ice rink: indoor, outdoor
115Roller rink: indoor or outdoor
116Swimming facility: indoor or
outdoor
110Fixed use recreation places, other
121Ballroom, gymnasium
122Convention center, exhibition hall
123Stadium, arena
124Playground
129Amusement center: indoor/outdoor
120Variable use amusement, recreation places
131Church, mosque, synagogue, temple, chapel
134Funeral parlor
130Places of worship, funeral parlors
141Athletic/health club
142Clubhouse
143Yacht Club
144Casino, gambling clubs
140Clubs, other
151Library
152Museum
154Memorial structure, including monuments & statues
155Courthouse
150Public or government, other
161Restaurant or cafeteria
162Bar or nightclub
160Eating, drinking places
171Airport passenger terminal
173Bus station
174Rapid transit station
170Passenger terminal, other
181Live performance theater
182Auditorium or concert hall
183Movie theater
185Radio, television studio
186Film/movie production studio
180Studio/theater, other
100Assembly, Other
Educational
211Preschool
213Elementary school, including
kindergarten
215High school/junior high
school/middle school
210Schools,
241Adult education center, college
classroom
254Day care, in commercial property
255Day care, in residence, licensed
256Day care in residence, unlicensed.
200Educational, other
Health Care, Detention &
Correction
311
more persons
321Mental retardation/development disability facility
322Alcohol or substance abuse recovery center
323Asylum, mental institution
331Hospital – medical or psychiatric
332Hospices
341Clinic,
342Doctor, dentist or oral surgeon's office
343Hemodialysis unit
340Clinics, Doctors offices,
hemodialysis centers,other
361Jail, prison (not juvenile)
Property Use Codes
363Reformatory, juvenile
detention center
365Police station
300Health care, detention, & correction, other
Residential
4191 or 2 family dwelling
429Multifamily dwellings
439Boarding/rooming house, residential hotels
449Hotel/motel, commercial
459Residential board and care
462Sorority house, fraternity house
464Barracks, dormitory
460Dormitory type residence, other
400Residential, other
Mercantile, Business
511Convenience store
519Food and beverage sales, grocery store
529Textile, wearing apparel sales
539Household goods, sales, repairs
549Specialty shop
557Personal service, including barber & beauty shops
559Recreational, hobby, home repair sales, pet store
564Laundry, dry cleaning
569Professional supplies, services
571Service station, gas station
579Motor vehicle or boat sales, services, repair
580General retail, other
581Department or discount store
592Bank
593Office: veterinary or research
596Post office or mailing firms
599Business office
500Mercantile, business, other
Industrial, Utility, Defense, Agriculture, Mining
610Energy production plant,
other
614Steam or heat generating plant
615Electric generating plant
629Laboratory or science lababoratory
631Defense, military installation
635Computer center
639Communications center
640Utility or Distribution system, other
642Electrical distribution
644Gas distribution, pipeline, gas distribution
645Flammable liquid distribution, pipeline, flammable
647Water utility
648Sanitation utility
655Crops or orchard
659Livestock production
669Forest, timberland, woodland
679Mine or quarry
600Utility, defense, agriculture, mining, other
Manufacturing, processing
700Manufacturing, processing
Storage
807Outside material storage area
808Outbuilding or shed
816Grain elevator, silo
819Livestock, poultry storage
839Refrigerated storage
849Outside storage tank
880Vehicle storage, other
881Parking garage, (detached residential garage)
882Parking garage, general vehicle
888Fire station
891Warehouse
899Residential or self storage units
898Dock, marina, pier, wharf
800Storage, other
Outside or Special Property
919Dump, sanitary landfill
921Bridge, trestle
922Tunnel
926Outbuilding, protective shelter
931Open land or field
935Campsite with utilities
936Vacant lot
937Beach
938Graded and
941Open ocean, sea or tidal waters
946Lake, river, stream
940Water area, other
951Railroad right of way
952Railroad yard
961Highway or divided highway
962Residential street, road or residential driveway
963Street or road in commercial area
965Vehicle parking area
960Street, other
972Aircraft runway
973Aircraft
974Aircraft loading area
981Construction site
982Oil or gas field
983Pipeline, power line or other utility right of way
984Industrial plant yard – area
900Outside or special property, other
000Property Use, other
NNN No Property Use
UUU Property Use Undetermined
Incident Reporting Quick Reference Guide [Revision 07/25/02]
Fires
Structure Fire
111Building fire
112Fires in structures other than in a building
113Cooking fire, confined to container
114Chimney or flue fire, confined to chimney or flue
115Incinerator overload or malfunction, fire confined
116Fuel burner/boiler malfunction, fire confined
117Commercial Compactor fire, confined to rubbish
118Trash or rubbish fire, contained
121Fire in mobile home used as fixed residence
122Fire in motor home, camper, recreational vehicle
123Fire in portable building, fixed location
120Fire in mobile property used as a fixed structure, other
Mobile property (vehicle) fire
131Passenger vehicle fire
132Road freight or transport vehicle fire
133Rail vehicle fire
134Water vehicle fire
135Aircraft fire
136
137Camper or recreational vehicle (RV) fire
138
130Mobile property (vehicle) fire, other
Natural vegetation fire
141Forest, woods or wildland fire
142Brush, or brush and grass mixture fire
143Grass fire
140Natural vegetation fire, other
Outside rubbish fire
151Outside rubbish, trash or waste fire
152Garbage dump or sanitary landfill fire
153Construction or demolition landfill fire
154Dumpster or other outside trash receptacle fire
155Outside stationary compactor/compacted trash fire
150Outside rubbish fire, other
Special outside fire
161Outside storage fire
162Outside equipment fire
163Outside gas or vapor combustion explosion
164Outside mailbox fire
160Special outside fire, other
Cultivated vegetation, crop fire
171Cultivated grain or crop fire
172Cultivated orchard or vineyard fire
173Cultivated trees or nursery stock fire
170Cultivated vegetation, crop fire, other
Overpressure rupture
211Overpressure rupture of steam pipe or pipeline
212Overpressure rupture of steam boiler
213Steam rupture of pressure or process vessel
210Overpressure rupture from steam, other
221Overpressure rupture of air or gas pipe/pipeline
222Overpressure rupture of boiler from air or gas
Rescue & Emergency Medical Service Incidents
Medical assist
311Medical assist, assist EMS crew
Emergency medical service (EMS)
321EMS call, excluding vehicle accident with injury
322Vehicle accident with injuries
Incident Type Codes
323Motor vehicle/pedestrian
accident (MV Ped)
331
Search
341Search for person on land
342Search for person in water
343Search for person underground
340Search, other
Extrication, rescue
351Extrication of victim(s) from building/structure
352Extrication of victim(s) from vehicle
353 Removal of victim(s) from stalled elevator
354Trench/below grade rescue
355Confined space rescue
356High angle rescue
357Extrication of victim(s) from machinery
350Extrication, rescue, other
Water & ice related rescue
361Swimming/recreational water areas rescue
362Ice rescue
363Swift water rescue
364Surf rescue
365Watercraft rescue
360Water & ice related rescue, other
Rescue or EMS standby
381Rescue or EMS standby
Hazardous Conditions (No fire) Flammable gas or liquid
condition
411Gasoline or other flammable liquid spill
412Gas leak (natural gas or LPG)
413Oil or other combustible liquid spill
410Flammable gas or liquid condition, other
Toxic condition
421Chemical hazard (no spill or leak)
422Chemical spill or leak
423Refrigeration leak
424Carbon monoxide incident
420Toxic condition, other
431Radiation leak, radioactive material
430Radioactive condition, other
Electrical wiring/equipment problem
441Heat from short circuit (wiring), defective/worn
442Overheated motor
443Light ballast breakdown
444Power line down
445Arcing, shorted electrical equipment
440Electrical wiring/equipment problem, other
Service Call Person in distress
511
512Ring or jewelry removal
510Person in distress, other
Water problem
521Water evacuation
522Water or steam leak
520Water problem, other
Smoke or odor removal
531Smoke or odor removal
Unauthorized burning
561Unauthorized burning
Good Intent Call
Dispatched & canceled en route
611Dispatched & canceled en route
Wrong location
621Wrong location
Controlled burning
631Authorized controlled burning
632Prescribed fire
Steam, other gas mistaken for smoke
651Smoke scare, odor of smoke
652Steam, vapor, fog or dust thought to be smoke
653Barbecue, tar kettle
650Steam, other gas mistaken for smoke, other
Good intent call, other
600Good intent call, other
False Alarm & False Call Malicious, mischievous false call
711Municipal alarm system, malicious false alarm
712Direct tie to FD, malicious /false alarm
713Telephone, malicious false alarm
714Central station, malicious false alarm
715Local alarm system, malicious false alarm
710Malicious, mischievous false call, other
Bomb scare - no bomb
721Bomb scare - no bomb
System malfunction
731Sprinkler activation due to malfunction
732Extinguishing system activation due to malfunction
733Smoke detector activation due to malfunction
734Heat detector activation due to malfunction
735Alarm system sounded due to malfunction
736CO detector activation due to malfunction
730System malfunction, other
Unintentional transmission of alarm
741Sprinkler activation, no fire – unintentional
742Extinguishing system activation
743Smoke detector activation, no fire – unintentional
744Detector activation, no fire – unintentional
745Alarm system sounded, no fire – unintentional
746Carbon monoxide detector activation, no CO
740Unintentional transmission of alarm, other
Biohazard scare
751Biological hazard, malicious false report
False alarm or false call, other
700False alarm or false call, other
Severe Weather & Natural Disaster
811Earthquake assessment
812Flood assessment
813Wind storm, tornado/hurricane assessment
814Lightning strike (no fire)
815Severe weather or natural disaster standby
800Severe weather or natural disaster, other
Special incident type
911Citizen complaint
900Special type of incident, other
This is only a partial list of Incident Type Codes. The complete listing can be found in the NFIRS
5.0Quick Reference guide that can be downloaded at https://nfirs.fema.gov/documentation/reference/.
Incident Reporting Quick Reference Guide [Revision 07/25/02]