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FIRS REPORT - 1800 628 844.
Primary Call Report
A - REPORT HEADER
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Brigade Advised Date & Time (as per Pager)
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Pager Details (copy and paste from BART)
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Location
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OIC Name:
- Capt. Matt Ahern
- Lt. Corey Schmutter
- Lt. Ben Draffin
- Lt. Geoff Oliver
- Lt. Dave Evered
- Lt. Ash Turnham
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OIC Name If not Officer:
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Primary Brigade:
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What type of incident did you attend?
- Structure Fire (House, Shop, Barn, Shed, Garage etc.
- Non Structure (Car, Bin, Pole, BBQ, Mail box, etc)
- Grass & Scrub Fire (Crop, Orchard, Forest, Roadside, Pine etc.
- Incident (MVA, RAR, Animal Rescue, Public Service, Lock in/out etc.)
- False Alarm (Hoax, Good Intent, Legal Burn, Protected Premise
- Support Other Fire Service
- Support CFA Brigade
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Territory
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Occupant Type
- Private
- Local Govt
- State Govt
- Commonwealth Govt
- Unoccupied
- Unsure
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What is Property Used For
- Public Assembly (Recreation, Amusement, Restaurant, Church, etc)
- Educational (School, Kindergarten, Trade school, University, etc)
- Institutional (Medical, Prison, Nursing, Child Care, Foster Home, etc)
- Residential (Flats, Houses, Motels, Inns, Tents - seasonal or all year)
- Shop/Store/Office (Service Station, Banks etc)
- Basic Industry/Utility/Defence (Farming, Police, Phone Exchange, etc)
- Manufacturing (Winery, Brewery, Food industry, Sawmill, Refinery, etc)
- Storage (Warehouse, Silo, Barn, Stable, Timber yard, Garage, Wharf, etc)
- Special (Vacant Building, Forest, Road, Park, Bridge, Cemetry, etc)
- Undetermined (Unknown, Not Applicable)
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Brigade Action Taken
- Extinguish, Salvage, Overhaul, Ventilate
- Rescue or Assistance
- Investigation Only
- Remove Hazard, Evacuation
- Service, Assist Elderly, Gain Entry
- Other Service (Crowd, Traffic Control)
- Called Off En Route
- Standby, Cover Assignment, Step Up
- Other
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Other
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First on Scene:
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OTHER AGENCIES ON SCENE
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Electricity
- Notified
- Reqd to Attend
- Attended
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Water
- Notified
- Reqd to Attend
- Attended
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Gas
- Notified
- Reqd to Attend
- Attended
-
Police
- Notified
- Reqd to Attend
- Attended
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Ambulance
- Notified
- Reqd to Attend
- Attended
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SES
- Notified
- Reqd to Attend
- Attended
-
MFB
- Notified
- Reqd to Attend
- Attended
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DELWP
- Notified
- Reqd to Attend
- Attended
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EPA
- Notified
- Reqd to Attend
- Attended
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Govt welfare Agencies
- Notified
- Reqd to Attend
- Attended
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Charitable Support Agencies
- Notified
- Reqd to Attend
- Attended
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Council
- Notified
- Reqd to Attend
- Attended
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Other
- Notified
- Reqd to Attend
- Attended
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Enter other details:
INCIDENT SPECIFICS
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SELECT TYPE OF FIRE/INCIDENT
STRUCTURE FIRE
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CONSTRUCTION TYPE
- Brick Veneer
- Double Brick / Block
- Mud Brick / Abode
- Pre Fab / Semi Perm / Mobile Home
- Steel Frame/Lining (Shed, Factory)
- Tilt Slab
- Timber Fibre Cement, cladding
- Timber Weatherboard
- Undetermined
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STRUCTURE TYPE
- Air Supported
- Building - one fixed use
- Building - two or more fixed uses
- Open Platform
- Open Structure
- Undetermined
- Underground Structure
- Not Classified
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LOW VOLTAGE FUSE REMOVED
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Removed by:
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DOMESTIC SMOKE ALARM FITTED
Owner/Occupier Details
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Title
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Name
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Home Phone No.
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Mob Ph.
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Owner / Occupier
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Insurance Details (if known)
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Were there any exposures?
EXPOSURE
EXPOSURE
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Owners Name:
-
Address:
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Property use:
- Public Assembly (Recreation, Amusement, Restaurant, Church, etc)
- Educational (School, Kindergarten, Trade school, University, etc)
- Institutional (Medical, Prison, Nursing, Child Care, Foster Home, etc)
- Residential (Flats, Houses, Motels, Inns, Tents - seasonal or all year)
- Shop/Store/Office (Service Station, Banks etc)
- Basic Industry/Utility/Defence (Farming, Police, Phone Exchange, etc)
- Manufacturing (Winery, Brewery, Food industry, Sawmill, Refinery, etc)
- Storage (Warehouse, Silo, Barn, Stable, Timber yard, Garage, Wharf, etc)
- Special (Vacant Building, Forest, Road, Park, Bridge, Cemetry, etc)
- Undetermined (Unknown, Not Applicable)
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Estimated Property Loss $
-
Estimated Contents Loss: $
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Estimated Total Loss: $
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Type of Non Structure Fire
CAR FIRE
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Rego:
-
State:
- Vic
- NSW
- SA
- WA
- QLD
- NT
- ACT
-
Year (if known)
-
Make:
-
Model:
Owner Details (if known)
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Title
-
Name
-
Address:
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Home Phone No.
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Mob Ph.
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Insurance Details (if known)
EXPOSURE
EXPOSURE
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Owners Name:
-
Address:
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Property use:
- Public Assembly (Recreation, Amusement, Restaurant, Church, etc)
- Educational (School, Kindergarten, Trade school, University, etc)
- Institutional (Medical, Prison, Nursing, Child Care, Foster Home, etc)
- Residential (Flats, Houses, Motels, Inns, Tents - seasonal or all year)
- Shop/Store/Office (Service Station, Banks etc)
- Basic Industry/Utility/Defence (Farming, Police, Phone Exchange, etc)
- Manufacturing (Winery, Brewery, Food industry, Sawmill, Refinery, etc)
- Storage (Warehouse, Silo, Barn, Stable, Timber yard, Garage, Wharf, etc)
- Special (Vacant Building, Forest, Road, Park, Bridge, Cemetry, etc)
- Undetermined (Unknown, Not Applicable)
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Estimated Property Loss $
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Estimated Contents Loss: $
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Estimated Total Loss: $
End of section, go to POLICE DETAILS (if applicable)
BIN FIRE
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Details:
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Add Photo
Owner Details (if known)
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Title
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Name
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Address:
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Home Phone No.
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Mob Ph.
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Insurance Details (if known)
EXPOSURE
EXPOSURE
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Owners Name:
-
Address:
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Property use:
- Public Assembly (Recreation, Amusement, Restaurant, Church, etc)
- Educational (School, Kindergarten, Trade school, University, etc)
- Institutional (Medical, Prison, Nursing, Child Care, Foster Home, etc)
- Residential (Flats, Houses, Motels, Inns, Tents - seasonal or all year)
- Shop/Store/Office (Service Station, Banks etc)
- Basic Industry/Utility/Defence (Farming, Police, Phone Exchange, etc)
- Manufacturing (Winery, Brewery, Food industry, Sawmill, Refinery, etc)
- Storage (Warehouse, Silo, Barn, Stable, Timber yard, Garage, Wharf, etc)
- Special (Vacant Building, Forest, Road, Park, Bridge, Cemetry, etc)
- Undetermined (Unknown, Not Applicable)
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Estimated Property Loss $
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Estimated Contents Loss: $
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Estimated Total Loss: $
End of section, go to POLICE DETAILS (if applicable)
POLE FIRE
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Pole Number:
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Power Co. Notified?
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Did they attend?
End of section, go to POLICE DETAILS (if applicable)
BBQ FIRE
Owner/Occupier Details
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Title
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Name
-
Home Phone No.
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Mob Ph.
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Owner / Occupier
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Insurance Details (if known)
Appliance Details
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BBQ Make:
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BBQ Model:
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Fuel type:
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Were there any exposures damaged?
EXPOSURE
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Owners Name:
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Property use:
- Public Assembly (Recreation, Amusement, Restaurant, Church, etc)
- Educational (School, Kindergarten, Trade school, University, etc)
- Institutional (Medical, Prison, Nursing, Child Care, Foster Home, etc)
- Residential (Flats, Houses, Motels, Inns, Tents - seasonal or all year)
- Shop/Store/Office (Service Station, Banks etc)
- Basic Industry/Utility/Defence (Farming, Police, Phone Exchange, etc)
- Manufacturing (Winery, Brewery, Food industry, Sawmill, Refinery, etc)
- Storage (Warehouse, Silo, Barn, Stable, Timber yard, Garage, Wharf, etc)
- Special (Vacant Building, Forest, Road, Park, Bridge, Cemetry, etc)
- Undetermined (Unknown, Not Applicable)
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Estimated Property Loss $
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Estimated Contents Loss: $
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Estimated Total Loss: $
End of section, go to POLICE DETAILS (if applicable)
OTHER
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Enter Details:
Owner/Occupier Details
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Title
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Name
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Home Phone No.
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Mob Ph.
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Owner / Occupier
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Insurance Details (if known)
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Add Photo (optional)
Owner/Occupier Details
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Title
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Name
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Home Phone No.
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Mob Ph.
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Owner / Occupier
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Insurance Details (if known)
GRASS & SCRUB FIRE
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Vegetation Type
- Forest, Trees
- Grassland, Scattered Trees
- Hardwood Plantation
- Softwood Plantation
- Native Forest, Rainforest
- Mallee
- Orchard, Vineyard
- Crops
- Not Applicable
Area Burnt (ha)
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Private:
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Local Govt:
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State Park:
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National Park:
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Forest/Timber reserve:
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Flora/Fauna/Nature
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Defence Dept:
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Other Public Land:
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Undetermined:
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WERE THERE ANY RURAL LOSSES?
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Sheep:
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Cattle:
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Other Livestock:
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Fencing (km):
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Hay/Fodder (tonne):
Owner/Occupier Details (If any)
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Title
-
Name
-
Home Phone No.
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Mob Ph.
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Owner / Occupier
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Insurance Details (if known)
End of section, go to POLICE DETAILS (if applicable)
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INCIDENT TYPE:
MVA
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Vehicle Details
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Rego:
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State:
- Vic
- NSW
- SA
- WA
- QLD
- NT
- ACT
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Year (if known)
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Make:
-
Model:
-
Owner Details (if known)
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Details of MVA:
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Add photo (optional)
C - HAZARDOUS MATERIALS
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Chemical
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Primary Hazard
- Explosives
- Gas
- Flammable Liquids
- Flammable Solids
- Oxidising Substance
- Poison
- Radioactive
- Corrosive
- Undetermined
- Other
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Type of Hazmat Incident
- Chemical Reaction
- Explosion (BLEVE)
- Explosion - Expanding Vapour
- Fire causing Hazmat incident
- Fire resulting in Hazmat incident
- Fire with Hazmat release/reaction
- Leak
- Potential Hazmat Incident
- Spill
- Vapour Cloud Release
- Not Applicable
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Action Taken:
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Personal Protection Used:
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Decontamination:
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Chemical Name/s:
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UN No.
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QTY Present:
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QTY Released:
Owner/Occupier Details (If any)
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Title
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Name
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Home Phone No.
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Mob Ph.
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Owner / Occupier
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Insurance Details (if known)
ANIMAL RESCUE
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Enter details of incident:
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Did Animal Rescue Agency Attend:
End of section, go to POLICE DETAILS (if applicable)
LOCK IN/LOCK OUT
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Enter details of incident:
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Did RACV Agency Attend:
Owner/Occupier Details (If any)
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Title
-
Name
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Home Phone No.
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Mob Ph.
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Owner / Occupier
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Insurance Details (if known)
End of section, go to POLICE DETAILS (if applicable)
OTHER:
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Enter details of incident:
End of section, go to POLICE DETAILS (if applicable)
B - PROTECTED PREMISES
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Alarm No.
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Circuit No.
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Premises Name
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Type of Alarm Call:
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Other:
F - FIRE FIGHTING
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FIRE FIGHT INFO
Hose Lines
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High Pressure Line (Pumper)
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25mm Hose line
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38mm Hose Line
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64mm Hose Line
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Other:
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Major Extinguishing Medium
- Water
- Foam
- Solids (sand, soil)
- Chemicals
- Carbon Dioxide
- Vaporising Liquid
- Steam
- Undetermined
- Other
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Breathing Apparatus Used
BA WEARER
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Name:
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No. Of Cylinders
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Foam Used
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Percentage Used %
- 0.1%
- 0.2%
- 0.3%
- 0.4%
- 0.5%
- 0.6%
- 0.7%
- 0.8%
- 0.9%
- 1.0%
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Approx Qty used (Ltrs):
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Percentage Used
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Approx Qty used (Ltrs):
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Possible Cause of Fire
Ignition Details
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Where did the fire start
- Means of Exit
- Assembly, Sales area
- Functional Area
- Kitchen
- Lounge
- Storage Area
- Service Facility
- Structural area
- Transportation, Vehicle area
- Other
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Other:
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What Started the Fire
- Incendiary
- Suspicious
- Misuse of Heat of Ignition
- Misuse of Material Ignited
- Mechanical failure, malfunction
- Design, Construction, Installation deficiency
- Operational Deficiency
- Natural Condition/event
- Undetermined/Not Classified
- Other
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Other:
POLICE DETAILS
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Number:
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Name:
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Station:
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CIVILIAN CASUALTIES/RESCUES EVACUATIONS
D - CIVILIAN CASUALTIES/ RESCUES EVACUATIONS
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No. Civilians Injured:
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No. Civilians Rescued:
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No. Civilian Fatalities:
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No. Civilians Evacuated:
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ADDITIONAL NOTES:
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Supporting Photo's