NFIRS INCIDENT FIELD NOTES-Page 1

NFIRS INCIDENT FIELD NotesExact LocationIntersectionFront ofRear ofAdjacent to Mutual Aid ReceivedAutomatic Aid ReceivedMutual Aid GivenAutomatic Aid GivenOther Aid GivenNoneInjuryFire ServiceCivilian EMSI ndustrial UseUseADDRESS/CITY/ZIP CODEOWNER NAME (LAST, FIRST, MIDDLE) notes : MonthMonthCreated 11/2002 COMPLETE THIS SIDE FOR ALL INCIDENTS - COMPLETE BOTH SIDES FOR ALL FIRESC ivilian FireDetector Did Not Alert OccupantsUnknownEducational UseMedical UseYearAUTHORIZATIONO ffice UseNumberApparatusKEROSENE: fuel burning equipment or portable storageAssignmentDayResidential UseBusiness & ResidentialEnclosed MallRow of StoresROOM / APT #OCCUPANT/PARTY INVOLVED NAME (LAST, FIRST, MIDDLE)PRE- INCIDENT VALUEMOTOR OIL: from engine or portable containerProperty $Property $NONEHAZARDOUS MATERIALS RELEASEC ontents $NATURAL GAS: slow leak, no evacuation or HazMat actionsContents $Additional Action Taken (1)DeathCASUALTIESESTIMATED DOLLAR LOSSLOSSESS tateINCIDENT TYPE(Situation Found)AID GIVEN OR RECEIVEDRESOURCESP ersonnelPrimary Action TakenEXPOSURE #Zip CodeARRIVAL TIME:CONTROL TIME:ACTIONS TAKENINCIDENT #LAST UNIT CLEARED:ALARM TIME:LOCATIONCityCross Streets or DirectionsStreet or HighwayApt/Room / / DATEM ilitary UsePROPERTY USEMIXED USE PROPERTYD et

NFIRS Incident Field Notes Exact Location Intersection Front of Rear of Adjacent to Mutual Aid Received Automatic Aid Received Mutual Aid Given Automatic Aid Given

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