NFIRS INCIDENT FIELD NOTES-Page 1

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 etector Alerted OccupantsHOUSEHOLD SOLVENTS: home/office spill, cleanup onlyAssembly UseDIESEL FUEL/FUEL OIL: vehicle tank or portable storageNot MixedGASOLINE: vehicle fuel tank or portable containerPROPANE GAS: <21 LB.

2 (as in home BBQ grill)Member Making ReportOfficer in ChargePAINT: from paints cans totaling <55 gallonsOTHER: Special HazMat actions required or spill > 55 gallonsPosition or RankAssignmentDayFarm UsePosition or RankADDRESS/CITY/ZIP CODEO ther Mixed YearTELEPHONETELEPHONE(Required for Confined Fires Only)OtherEMSS uppressionAdditional Action Taken (2)DETECTORSC ause of IgnitionBulk storage or warehousingIntentionalProcessing or manufacturingUnintentionalPackaged goods for saleFailure of Equipment or Heat Repairs or serviceSourceAct of NatureBulk storage or warehousingCause Under InvestigationProcessing or manufacturingCause Undetermined afterPackaged goods for saleInvestigationRepairs or serviceBulk storage or warehousingProcessing or manufacturingPackaged goods for saleRepairs or serviceHuman Factors Equipment Involved in IgnitionContributing to IgnitionPossibly impaired by alcohol/drugsEquipment InvolvedBrandModelSerial NumberUnattended personPossibly mentally disabledStationaryPhysically disabledYearEquipment Power SourceMultiple persons involvedMobile Property Involved Not involved in ignition.

3 But burnedStateEnclosed buildingFixed portable/mobile structureOpen structureTotal # of stories at or above gradeAir supported structureTentTotal # of stories below gradeOpen platform ( piers)Underground structure (work areas) Confined to floor of originConnective structure ( fences)Total square feet Confined to building of originOther type of structure Beyond building of origin Number of stories w/ minor damage(1 to 24% Flame Damage) Number of stories w/ significant damage(25 to 49% Flame Damage) Number of stories w/ heavy damage(50 to 74% Flame Damage) Number of stories w/ extreme damage(75 to 100% Flame Damage) None Present Operated & effectivePresentOccupants failed to respond None Present Operated & not effectiveThere were no occupants Present Fire too small to activateFailed to alert occupants Failed to operateSmoke Fire too small to activate OtherHeat OperatedCombination-smoke & heat Failed to OperateSprinkler.

4 Water flow detection UndeterminedMore than 1 type presentCreated 11/2002 None None Portable Story of originType of material contributing most to flame spreadItem contributing most to flame spreadAlerted occupants-they respondedDetector Failure ReasonType of SystemSystem Operation# of Heads OperatingSystem Failure ReasonPolicy Number Confined to object of originLength in FeetWidth in FeetMaterial Contributing Most to Flame Spread Confined to room of origin Being demolishedbecame involvedOn-Site MaterialsOn-Site Material (2)On-Site Material (1)origin whether or not all unitsliving units in the building ofEstimated # of residentialAsleepNoneBuildings not involvedOn-Site Material (3)Detector TypePresence of DetectorsNumber of Stories Damaged by FlameInsurance Company InformationPhone NumberAgent's NameInsurance Company Name Detector OperationPresence of Automatic Extinguishing SystemDetector Power SupplyDetector EffectivenessFire OriginFactor #2 Below GradeBuilding HeightYearBuilding StatusFire SpreadMain Floor Size (Complete One)BY Other Undetermined Vacant & unsecured Under major renovationIgnitionFactors Contributing to Ignition NoneFactor #1 Area of Fire Origin Fire spread confined to object of originItem First IgnitedHeat SourceMobile Property ModelVIN NumberLicense Plate NumberStructure TypeProperty Details Not ResidentialAcres burned (outside fires)Number of buildings involvedFire Suppression FactorsNoneLess than 1 acreFire Suppression Factor (1)

5 Fire Suppression Factor (2)Age was a factorFire Suppression Factor (3) Under construction Occupied & operating(Count ROOF as part of Highest Story) Vacant & secured Idle, not routinely used Involved in ignition and burnedMobile Property Make Involved in ignition, but didn't burn NoneMobile Property TypeType of Material First Ignit