Information

  • Type of report

  • F1- Grass/Hay F2- Structure (Residential) F3- Structure (Non-residential) F4- Vehicle F5- Wildland F6- Misc.

  • Report #:

  • Investigation Conducted on:

  • Location
  • Investigator

Owner's Information

  • Name:

  • Race:

  • Sex:

  • Date of Birth:

  • DL#:

  • SS#:

  • Cell Phone #:

  • Home Address:
  • Home Phone #:

  • Work Address:
  • Work Phone:

Occupant's Information:

  • Same as Owner?

  • Name:

  • Race:

  • Sex:

  • Date of Birth:

  • DL#:

  • SS#:

  • Cell Phone #:

  • Home Address:
  • Home Phone #:

  • Work Address:
  • Work Phone:

Reporting Party

  • Public Safety Agency or 911 Caller?

  • Public Safety Agency:

  • Same as Owner or Occupant?

  • Name:

  • Race:

  • Sex:

  • Date of Birth:

  • DL#:

  • SS#:

  • Cell Phone #:

  • Home Address:
  • Home Phone #:

  • Work Address:
  • Work Phone:

Incident Times

  • Fire Department Response?

  • Responding Agency:

  • Other Department:

  • Dispatched:

  • Enroute:

  • At Scene:

  • Tap-Out:

  • Clear:

  • Kaufman Fire Department Office Incident Times

  • Dispatched:

  • Enroute:

  • At Scene:

  • Clear:

Resources

  • Total Manpower:

  • # of Engines:

  • # of Aerial Trucks:

  • # of Rescues/Squads:

  • # of Tankers (Water Tenders)

  • # of Brush Trucks:

  • # of Dozers/Graders:

  • # of Air Tankers

  • Mutual Aid Departments:

  • Other Mutual Aid Departments:

  • Other Agencies:

  • Other Agencies:

Weather Conditions

  • Historical Weather Data - www.wunderground.com/history
    http://www.wunderground.com/history/

  • Weather Description:

  • Temperature ( ̊F):

  • Wind Direction:

  • Wind Speed (mph):

  • Relative Humidity (%):

Incident Information

  • Incident Commander Name:

  • Incident Commander ID#:

  • Initial Size-up:

  • Type of Fire:

  • Type of Fire:

  • Large Scale Incident Command System

  • Command Staff:

  • Safety Officer:

  • Liaison Officer:

  • Public Information Officer:

  • General Staff:

  • Operations Section Chief:

  • Planning Section Chief:

  • Logistics Section Chief:

  • Finance/Admin Section Chief:

Burned Property Information

  • Structure Fire

  • Assembly Type:

  • Occupancy Classification:

  • Factory Type:

  • High Hazard Type:

  • Institutional Type:

  • Residential Type:

  • Storage Type:

  • Select All Applicable Occupancy Classifications:

  • Occupancy:

  • Type of Construction:

  • Foundation:

  • Siding:

  • Other Siding Materials:

  • Roof:

  • Other Roofing Material:

  • Code Violations

  • Violations Found:

Property Utilities

  • Water

  • Company Name

  • Activity

  • Date Turned Off

  • Electric

  • Company Name

  • Activity

  • Date Turned Off

  • Gas

  • Company Name

  • Activity

  • Date Turned Off

  • Vehicle Fire

  • License Plate #:

  • State:

  • Plate Year/Registration:

  • Vehicle Identification Number (VIN):

  • Year Model:

  • Make:

  • Model:

  • Color:

  • Direction of Travel:

  • Exact Location:

  • Lien Holder Name:

  • Lien Holder Address:
  • Lien Holder Phone #:

  • Impounded By:

  • Towing Service Phone #:

Insurance Information

  • Insurance?

  • Insurance Company:

  • Policy #:

  • Policy Date:

  • Policy Amount:

  • Deductable:

  • Insurance Company Address:
  • Insurance Company Phone #:

  • Insurance Agent Name:

  • Insurance Agent Phone #:

Mortgage Information

  • Mortgage on Structure?

  • Mortgage Company:

  • Account #:

  • Mortgage Company Address:
  • Mortgage Company Phone #:

  • Mortgage Amount:

  • Monthly Payment:

  • Remaining Balance:

  • Arrears:

Person (s) in question

  • Name of Person

  • Date of Birth

  • Identification Number

  • Social Security Number

  • Address

  • Work Name

  • Work Address

  • Work phone

  • Type of Person

Person (s) in question

  • Name of Person

  • Date of Birth

  • Identification Number

  • Social Security Number

  • Address

  • Work Name

  • Work Address

  • Work phone

  • Type of Person

Person (s) in question

  • Name of Person

  • Date of Birth

  • Identification Number

  • Social Security Number

  • Address

  • Work Name

  • Work Address

  • Work phone

  • Type of Person

Cause of Incident

  • Incident Status:

Incident Documentation

  • Narrative:

  • Incident Photographs:

  • Incident Diagram:

Fire Marshal's Office Use Only

  • Report Completed By:

  • Signed:

  • Agency: Kaufman Fire Department

  • Report Complete:

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