Fire response

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Time on scene

  Date

FD actions

• Initial response

  Select Primary search Secondary search Defensive attack Interior attack Combined attack

  • Primary search
  • Secondary search
  • Defensive attack
  • Interior attack
  • Combined attack

• Rescues made?

  Yes

  No

  N/A

• Status on arrival

  Select Nothing showing Fire extinguished prior to arrival Fire with no evidence from street Fire with smoke showing only Flames showing from small area Flames showing from large area Fully involved Exposures involved

  • Nothing showing
  • Fire extinguished prior to arrival
  • Fire with no evidence from street
  • Fire with smoke showing only
  • Flames showing from small area
  • Flames showing from large area
  • Fully involved
  • Exposures involved

• Water source

  Select Hydrant Tanker shuttle Other

  • Hydrant
  • Tanker shuttle
  • Other

• Fire control

  Select Extinguished by fire department Extinguished by automatic system Extinguished by occupant Fire self extinguished Other

  • Extinguished by fire department
  • Extinguished by automatic system
  • Extinguished by occupant
  • Fire self extinguished
  • Other

• Area of origin?

  Yes

  No

  N/A

• Source of ignition?

  Yes

  No

  N/A

• First ignited?

  Yes

  No

  N/A

• Possible cause?

  Yes

  No

  N/A

Impact

• Initial detect?

  Select Smoke alarm device sounded Fire alarm system sounded Automatic sprinkler system activated Automatic system other than sprinkler Co detector sounded Person detected Other initial detection No initial detection Undetermined

  • Smoke alarm device sounded
  • Fire alarm system sounded
  • Automatic sprinkler system activated
  • Automatic system other than sprinkler
  • Co detector sounded
  • Person detected
  • Other initial detection
  • No initial detection
  • Undetermined

• Extent of fire?

  Select Object of origin Room of origin Floor of origin Multiple floors Entire structure Roof/exterior of structure only

  • Object of origin
  • Room of origin
  • Floor of origin
  • Multiple floors
  • Entire structure
  • Roof/exterior of structure only

Building information

• Building height?

  Select 1 2 3 4 Basement

  • 1
  • 2
  • 3
  • 4
  • Basement

• Level of origin?

  Select 1 2 3 4 Basement

  • 1
  • 2
  • 3
  • 4
  • Basement

• Age of structure?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Occupancy type? Ex ... church, farm, residential? Seasonal, permanent ?

  Yes

  No

  N/A

• Illegal use?

  Yes

  No

  N/A

Smoke alarms / evacuation

• Smoke alarm presence?

  Select Area of origin no smoke alarm Area of origin smoke alarm present and activated Area of origin smoke alarm present did not operate Area of origin smoke alarm present operation undetermined Area of origin smoke alarm presence undetermined

  • Area of origin no smoke alarm
  • Area of origin smoke alarm present and activated
  • Area of origin smoke alarm present did not operate
  • Area of origin smoke alarm present operation undetermined
  • Area of origin smoke alarm presence undetermined

• Reason for smoke alarm failure?

  Yes

  No

  N/A

• Smoke alarm type?

  Select Battery operated Hardwired Wireless Interconnected Presence undetermined

  • Battery operated
  • Hardwired
  • Wireless
  • Interconnected
  • Presence undetermined

• Smoke alarm present on other floors?

  Yes

  No

  N/A

• Smoke alarm impact?

  Select All persons at risk evacuated as a result of hearing smoke alarms Some persons self evacuated as a result of hearing smoke alarms No one evacuated as a result of hearing smoke alarms Alarm operated but failed to alert persons at risk Occupants first alerted by other means No alarm , no persons present Undetermined

  • All persons at risk evacuated as a result of hearing smoke alarms
  • Some persons self evacuated as a result of hearing smoke alarms
  • No one evacuated as a result of hearing smoke alarms
  • Alarm operated but failed to alert persons at risk
  • Occupants first alerted by other means
  • No alarm , no persons present
  • Undetermined

Fire alarm/sprinkler

• Fire alarm presence?

  Select Fire alarm system present No fire alarm system Not applicable Undetermined

  • Fire alarm system present
  • No fire alarm system
  • Not applicable
  • Undetermined

• Fire alarm operation?

  Select System operated System did not operate Not applicable Fire alarm system operation undetermined

  • System operated
  • System did not operate
  • Not applicable
  • Fire alarm system operation undetermined

• Fire alarm impact?

  Select All persons at risk evacuated as a result of hearing smoke alarms Some persons self evacuated as a result of hearing smoke alarms No one evacuated as a result of hearing smoke alarms Alarm operated but failed to alert persons at risk Occupants first alerted by other means No alarm , no persons present Undetermined

  • All persons at risk evacuated as a result of hearing smoke alarms
  • Some persons self evacuated as a result of hearing smoke alarms
  • No one evacuated as a result of hearing smoke alarms
  • Alarm operated but failed to alert persons at risk
  • Occupants first alerted by other means
  • No alarm , no persons present
  • Undetermined

• Sprinkler presence?

  Select Full sprinkler system present Partial sprinkler system present No system present Undetermined

  • Full sprinkler system present
  • Partial sprinkler system present
  • No system present
  • Undetermined

• Sprinkler activation

  Select System activated Did not operate: remote or separate from fire Did not operate: fire to small to trigger Did not operate: other reasons Did not operate: reasons unknown Not applicable no system present Activation/ operation undetermined

  • System activated
  • Did not operate: remote or separate from fire
  • Did not operate: fire to small to trigger
  • Did not operate: other reasons
  • Did not operate: reasons unknown
  • Not applicable no system present
  • Activation/ operation undetermined

Insurance

• Insured?

  Yes

  No

  N/A

• Insurance information provided?

  Yes

  No

  N/A

Occupant information

• Any occupant/owner information available?

  Yes

  No

  N/A

• Any scene photos enter here

  Media