Automatic fire alarm / indident report

• Incident Name

• Select date

  Date

• Prepared by

Building details

• Site

• Building and Level

Type of incident

• False Alarm

  Yes

  No

  N/A

• Fire

  Yes

  No

  N/A

• Other

Alarm activated by?

• Smoke detector?

  Yes

  No

  N/A

• Thermal detector?

  Yes

  No

  N/A

• Sprinkler?

  Yes

  No

  N/A

• Vesda?

  Yes

  No

  N/A

• Phone call

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Method of extinguishing

• Sprinkler

  Yes

  No

  N/A

• Fire blanket

  Yes

  No

  N/A

• Portable extinguisher

  Yes

  No

  N/A

• Hose reel

  Yes

  No

  N/A

• Other give details

  Yes

  No

  N/A

Casualties / injuries / near miss

• Patients

  Yes

  No

  N/A

• Staff

  Yes

  No

  N/A

• Visitors

  Yes

  No

  N/A

• Other? Give Details

  Yes

  No

  N/A

incident information

• Add media

  Media

Hospital fire officer recommendation

• Recommendations

  Yes

  No

  N/A

Sign of

• Add signature

  Sign

• Select date

  Date