Title Page
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Site conducted
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Alexander FD Incident Number:
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Conducted on:
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Prepared by:
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Incident location:
Property Owner/ Tenant Information
Property Owner
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Please enter all property owners:
Property Owner
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Property owner name:
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Phone number:
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E-mail address:
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Mailing address:
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Photo of the ID of owner:
Tenant Information
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Please enter all tenants/ businesses on site if not the property owner name:
Tenant(s)/ Business(s)
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Tenant/ business owner name:
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Phone number:
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E-mail address:
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Mailing address:
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Photo of the ID of tenant:
Information Collected from Owners/ Witnesses
Property Information
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Do they have insurance?
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Insurance company name/ phone number:
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Is there a loan on the property?
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Finance company name/ phone number:
Tenant Needs
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Do they need a board up company?
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Do they need Red Cross assistance?
Victim/ Witness Statement(s)
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Please have each witness give a statement as needed:
Witness
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Category:
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Name:
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Photo of witness ID, or photo of witness:
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Date and time of witness statement:
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What happened in their words?
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Photo of witness statement:
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Witness signature:
Processing the Scene
Processing the Scene
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Current weather conditions:
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Is this a structure?
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Exterior photos: Pictures of the address numbers on mailbox and/ or house, then starting on the Alpha side of the structure, Bravo, Charlie, and then Delta:
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Are there any exposures?
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Enter each exposure separately:
Exposure
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Location and description of exposure:
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Photos of exposure:
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Pictures of the initial entry point:
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Photos of each room:
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Area of origin and point of origin if known:
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Is this a mobile property?
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Mobile Property: Make, Model, Year:
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Exterior photos: Picture of the license plate and Vehicle Identification Number (VIN), then starting at the front of the mobile property moving clockwise to each side of the mobile property:
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Are there any exposures?
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Enter each exposure separately:
Exposure
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Location and description of exposure:
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Photos of exposure:
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Area of origin and point of origin if known:
Fire Scene Analysis, Hypothesis, and Determination
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Are you an Arson Investigator?
Fire Scene Analysis
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It should be noted that the examination of the scene was conducted in accordance with all applicable suggested methods described in the National Fire Protection Agency (NFPA) 921, The Guide for Fire and Explosion Investigations.
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Draw a layout of the scene:
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Photo of scene sketch
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Forced entry?
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Who forced entry?
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What department(s) where at the scene?
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What was described to you by the initial arriving companies?
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Describe what you see; exterior to the interior, and the un-burned to the burned:
Evidence
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Is there evidence being collected?
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Entry for each piece of evidence:
Evidence
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Date and time evidence was collected
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Evidence number:
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Location of evidence:
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Photo of location of evidence:
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Photo of empty evidence container next to evidence:
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Photo of evidence in container with gloves next to container:
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Photo of evidence container sealed:
Hypothesis
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In order to reach my final conclusion in this matter, several different hypotheses were examined, studied, and considered as discussed in sections 17.5 through 17.7 of NFPA 921 in regards to how this fire may have originated. They are listed below:
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H1 Natural
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H2 Accidental
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H3 Incendiary
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H4 Undetermined
Determination of Origin and Cause
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Describe your hypothesis and what your opinion is about the origin and cause.
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I base this on the following evidence.
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Supporting pictures/ documents:
Additional Comments by the Investigator
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Additional notes:
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Additional photographs:
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Fire Department incident reports:
Signature
- Signature (required each time report is modified):
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Name and signature of AFD personnel that completed report:
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Date and time report is completed
