FIRS - 1800 628 844. Fire & Incident Report (new)

FIRS REPORT - 1800 628 844.

Primary Call Report

A - REPORT HEADER

• Brigade Advised Date & Time (as per Pager)

  Date

• Pager Details (copy and paste from BART)

• Location (if different to Above)
  Address

• OIC Name:

  Select Capt. Matt Ahern Lt. Corey Schmutter Lt. Ben Draffin Lt. Geoff Oliver Lt. Dave Evered Lt. Ash Turnham

  • Capt. Matt Ahern
  • Lt. Corey Schmutter
  • Lt. Ben Draffin
  • Lt. Geoff Oliver
  • Lt. Dave Evered
  • Lt. Ash Turnham

• OIC Name If not Officer:

• Primary Brigade:

• What type of incident did you attend?

  Select 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

  • 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

• Territory

  CFA

  MFB

  DELWP

  NSW

  SA

• Occupant Type

  Select Private Local Govt State Govt Commonwealth Govt Unoccupied Unsure

  • Private
  • Local Govt
  • State Govt
  • Commonwealth Govt
  • Unoccupied
  • Unsure

• What is Property Used For

  Select 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)

  • 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)

• Brigade Action Taken

  Select 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

  • 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

• Other

• First on Scene

  Select THEB PUMPER BORO PUMPER THEB TK1 THEB TK2 THEB FCV MONT PUMPER PMPR 26 (MFB) OTHER

  • THEB PUMPER
  • BORO PUMPER
  • THEB TK1
  • THEB TK2
  • THEB FCV
  • MONT PUMPER
  • PMPR 26 (MFB)
  • OTHER

• First on Scene (if other)

• OTHER AGENCIES ON SCENE

  Yes

  No

  N/A

• Electricity

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Water

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Gas

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Police

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Ambulance

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• SES

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• MFB

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• DELWP

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• EPA

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Govt welfare Agencies

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Charitable Support Agencies

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Council

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Other

  Select Notified Reqd to Attend Attended

  • Notified
  • Reqd to Attend
  • Attended

• Enter other details:

INCIDENT SPECIFICS

• SELECT TYPE OF FIRE/INCIDENT

  Structure Fire

  Non Structure Fire

  Grass & Scrub Fire

  Incident (MVA etc.)

  Direct Alarm

STRUCTURE FIRE

• CONSTRUCTION TYPE

  Select 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

  • 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

• STRUCTURE TYPE

  Select Air Supported Building - one fixed use Building - two or more fixed uses Open Platform Open Structure Undetermined Underground Structure Not Classified

  • Air Supported
  • Building - one fixed use
  • Building - two or more fixed uses
  • Open Platform
  • Open Structure
  • Undetermined
  • Underground Structure
  • Not Classified

• PERCENTAGE INVOLVED ON ARRIVAL %

• LOW VOLTAGE FUSE REMOVED

  Yes

  No

  N/A

• Removed by:

• DOMESTIC SMOKE ALARM FITTED

  Yes - not operating

  Yes - operating

  Yes - fitted incorrectly

  No

Owner/Occupier Details

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Home Phone No.

• Mob Ph.

• Owner / Occupier

  Owner

  Occupier

  Both

• Insurance Details (if known)

• Were there any exposures?

  Yes

  No

  N/A
EXPOSURE

EXPOSURE

• Owners Name:

• Address:

• Property use:

  Select 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)

  • 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)

• Estimated Property Loss $

• Estimated Contents Loss: $

• Estimated Total Loss: $

• Type of Non Structure Fire

  Car Fire

  Bin Fire

  Pole Fire

  BBQ Fire

  Other

CAR FIRE

• Rego:

• State:

  Select Vic NSW SA WA QLD NT ACT

  • Vic
  • NSW
  • SA
  • WA
  • QLD
  • NT
  • ACT

• Year (if known)

• Make:

• Model:

Owner Details (if known)

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Address:

• Home Phone No.

• Mob Ph.

• Insurance Details (if known)

EXPOSURE

EXPOSURE

• Owners Name:

• Address:

• Property use:

  Select 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)

  • 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)

• Estimated Property Loss $

• Estimated Contents Loss: $

• Estimated Total Loss: $

End of section, go to POLICE DETAILS (if applicable)

BIN FIRE

• Details:

• Add Photo

  Media

Owner Details (if known)

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Address:

• Home Phone No.

• Mob Ph.

• Insurance Details (if known)

EXPOSURE

EXPOSURE

• Owners Name:

• Address:

• Property use:

  Select 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)

  • 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)

• Estimated Property Loss $

• Estimated Contents Loss: $

• Estimated Total Loss: $

End of section, go to POLICE DETAILS (if applicable)

POLE FIRE

• Pole Number:

• Power Co. Notified?

  Yes

  No

  N/A

• Did they attend?

  Yes

  No

  N/A

End of section, go to POLICE DETAILS (if applicable)

BBQ FIRE

Owner/Occupier Details

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Home Phone No.

• Mob Ph.

• Owner / Occupier

  Owner

  Occupier

  Both

• Insurance Details (if known)

Appliance Details

• BBQ Make:

• BBQ Model:

• Fuel type:

  Gas

  Electric

  Solid Fuel

• Were there any exposures damaged?

  Yes

  No

  N/A

EXPOSURE

• Owners Name:

• Property use:

  Select 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)

  • 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)

• Estimated Property Loss $

• Estimated Contents Loss: $

• Estimated Total Loss: $

End of section, go to POLICE DETAILS (if applicable)

OTHER

• Enter Details:

Owner/Occupier Details

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Home Phone No.

• Mob Ph.

• Owner / Occupier

  Owner

  Occupier

  Both

• Insurance Details (if known)

• Add Photo (optional)

  Media

Owner/Occupier Details

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Home Phone No.

• Mob Ph.

• Owner / Occupier

  Owner

  Occupier

  Both

• Insurance Details (if known)

GRASS & SCRUB FIRE

• Vegetation Type

  Select Forest, Trees Grassland, Scattered Trees Hardwood Plantation Softwood Plantation Native Forest, Rainforest Mallee Orchard, Vineyard Crops Not Applicable

  • Forest, Trees
  • Grassland, Scattered Trees
  • Hardwood Plantation
  • Softwood Plantation
  • Native Forest, Rainforest
  • Mallee
  • Orchard, Vineyard
  • Crops
  • Not Applicable
Area Burnt (ha)

• Private:

• Local Govt:

• State Park:

• National Park:

• Forest/Timber reserve:

• Flora/Fauna/Nature

• Defence Dept:

• Other Public Land:

• Undetermined:

• WERE THERE ANY RURAL LOSSES?

  Yes

  No

  N/A

• Sheep:

• Cattle:

• Other Livestock:

• Fencing (km):

• Hay/Fodder (tonne):

Owner/Occupier Details (If any)

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Home Phone No.

• Mob Ph.

• Owner / Occupier

  Owner

  Occupier

  Both

• Insurance Details (if known)

End of section, go to POLICE DETAILS (if applicable)

• INCIDENT TYPE:

  MVA

  Hazardous Materials

  Animal Rescue

  Lock in/Lock out

  Other

MVA

Vehicle Details

• Rego:

• State:

  Select Vic NSW SA WA QLD NT ACT

  • Vic
  • NSW
  • SA
  • WA
  • QLD
  • NT
  • ACT

• Year (if known)

• Make:

• Model:

• Owner Details (if known)

• Details of MVA:

• Add photo (optional)

  Media

C - HAZARDOUS MATERIALS

Chemical

• Primary Hazard

  Select Explosives Gas Flammable Liquids Flammable Solids Oxidising Substance Poison Radioactive Corrosive Undetermined Other

  • Explosives
  • Gas
  • Flammable Liquids
  • Flammable Solids
  • Oxidising Substance
  • Poison
  • Radioactive
  • Corrosive
  • Undetermined
  • Other

• Type of Hazmat Incident

  Select 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

  • 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

• Action Taken:

• Personal Protection Used:

• Decontamination:

• Chemical Name/s:

• UN No.

• QTY Present:

• QTY Released:

Owner/Occupier Details (If any)

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Home Phone No.

• Mob Ph.

• Owner / Occupier

  Owner

  Occupier

  Both

• Insurance Details (if known)

ANIMAL RESCUE

• Enter details of incident:

• Did Animal Rescue Agency Attend:

  Yes

  No

  N/A

End of section, go to POLICE DETAILS (if applicable)

LOCK IN/LOCK OUT

• Enter details of incident:

• Did RACV Agency Attend:

  Yes

  No

  N/A

Owner/Occupier Details (If any)

• Title

  Mr

  Mrs

  Miss

  Ms

• Name

• Home Phone No.

• Mob Ph.

• Owner / Occupier

  Owner

  Occupier

  Both

• Insurance Details (if known)

End of section, go to POLICE DETAILS (if applicable)

OTHER:

• Enter details of incident:

End of section, go to POLICE DETAILS (if applicable)

B - PROTECTED PREMISES

• Alarm No.

• Circuit No.

• Premises Name

• Type of Alarm Call:

  False Call - No Fire, no testing, maintenance, no work practices

  False Call - On site work practices

  False Call - testing/maintenance by Maint Co.

  Fire/Incident

  Other

• Other:

F - FIRE FIGHTING

• FIRE FIGHT INFO

Hose Lines

• High Pressure Line (Pumper)

  Yes

  No

  N/A

• 25mm Hose line

  1Line

  2 Lines

  3 Lines

  4 Lines

• 38mm Hose Line

  1Line

  2 Lines

  3 Lines

  4 Lines

• 64mm Hose Line

  1Line

  2 Lines

  3 Lines

  4 Lines

• Other:

• Major Extinguishing Medium

  Select Water Foam Solids (sand, soil) Chemicals Carbon Dioxide Vaporising Liquid Steam Undetermined Other

  • Water
  • Foam
  • Solids (sand, soil)
  • Chemicals
  • Carbon Dioxide
  • Vaporising Liquid
  • Steam
  • Undetermined
  • Other

• Breathing Apparatus Used

  Yes

  No

  N/A
BA WEARER

• Name:

• No. Of Cylinders

  1 Cylinder

  2 Cylinders

  3 Cylinders

  4 Cylinders

• Foam Used

  A CLASS

  B CLASS

  NONE

• Percentage Used %

  Select 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9% 1.0%

  • 0.1%
  • 0.2%
  • 0.3%
  • 0.4%
  • 0.5%
  • 0.6%
  • 0.7%
  • 0.8%
  • 0.9%
  • 1.0%

• Approx Qty used (Ltrs):

• Percentage Used

  3%

  6%

• Approx Qty used (Ltrs):

• Possible Cause of Fire

Ignition Details

• Where did the fire start

  Select Means of Exit Assembly, Sales area Functional Area Kitchen Lounge Storage Area Service Facility Structural area Transportation, Vehicle area Other

  • Means of Exit
  • Assembly, Sales area
  • Functional Area
  • Kitchen
  • Lounge
  • Storage Area
  • Service Facility
  • Structural area
  • Transportation, Vehicle area
  • Other

• Other:

• What Started the Fire

  Select 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

  • 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

• Other:

POLICE DETAILS

• Number:

• Name:

• Station:

• CIVILIAN CASUALTIES/RESCUES EVACUATIONS

  Yes

  No

  N/A

D - CIVILIAN CASUALTIES/ RESCUES EVACUATIONS

• No. Civilians Injured:

• No. Civilians Rescued:

• No. Civilian Fatalities:

• No. Civilians Evacuated:

• ADDITIONAL NOTES:

• Supporting Photo's

  Media