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FIRS REPORT - 1800 628 844.
Primary Call Report
A - REPORT HEADER
Brigade Advised Date & Time (as per Pager)

Pager Details (copy and paste from BART)

Location (if different to Above)
OIC Name:

OIC Name If not Officer:

Primary Brigade:

What type of incident did you attend?

Territory

Occupant Type
What is Property Used For
Brigade Action Taken

Other

First on Scene

First on Scene (if other)

OTHER AGENCIES ON SCENE

Electricity
Water
Gas
Police
Ambulance
SES
MFB
DELWP
EPA
Govt welfare Agencies
Charitable Support Agencies
Council
Other

Enter other details:

INCIDENT SPECIFICS

SELECT TYPE OF FIRE/INCIDENT

STRUCTURE FIRE
CONSTRUCTION TYPE
STRUCTURE TYPE
PERCENTAGE INVOLVED ON ARRIVAL %

LOW VOLTAGE FUSE REMOVED

Removed by:

DOMESTIC SMOKE ALARM FITTED

Owner/Occupier Details

Title

Name

Home Phone No.

Mob Ph.

Owner / Occupier

Insurance Details (if known)

Were there any exposures?

EXPOSURE
EXPOSURE

Owners Name:

Address:

Property use:

Estimated Property Loss $

Estimated Contents Loss: $

Estimated Total Loss: $

Type of Non Structure Fire

CAR FIRE

Rego:

State:

Year (if known)

Make:

Model:

Owner Details (if known)

Title

Name

Address:

Home Phone No.

Mob Ph.

Insurance Details (if known)

EXPOSURE
EXPOSURE

Owners Name:

Address:

Property use:

Estimated Property Loss $

Estimated Contents Loss: $

Estimated Total Loss: $

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

Details:

Add Photo
Owner Details (if known)

Title

Name

Address:

Home Phone No.

Mob Ph.

Insurance Details (if known)

EXPOSURE
EXPOSURE

Owners Name:

Address:

Property use:

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?

Did they attend?

End of section, go to POLICE DETAILS (if applicable)
BBQ FIRE
Owner/Occupier Details

Title

Name

Home Phone No.

Mob Ph.

Owner / Occupier

Insurance Details (if known)

Appliance Details

BBQ Make:

BBQ Model:

Fuel type:

Were there any exposures damaged?

EXPOSURE

Owners Name:

Property use:

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

Name

Home Phone No.

Mob Ph.

Owner / Occupier

Insurance Details (if known)

Add Photo (optional)
Owner/Occupier Details

Title

Name

Home Phone No.

Mob Ph.

Owner / Occupier

Insurance Details (if known)

GRASS & SCRUB FIRE
Vegetation Type
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?

Sheep:

Cattle:

Other Livestock:

Fencing (km):

Hay/Fodder (tonne):

Owner/Occupier Details (If any)

Title

Name

Home Phone No.

Mob Ph.

Owner / Occupier

Insurance Details (if known)

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

INCIDENT TYPE:

MVA
Vehicle Details

Rego:

State:

Year (if known)

Make:

Model:

Owner Details (if known)

Details of MVA:

Add photo (optional)
C - HAZARDOUS MATERIALS
Chemical
Primary Hazard
Type of Hazmat Incident

Action Taken:

Personal Protection Used:

Decontamination:

Chemical Name/s:

UN No.

QTY Present:

QTY Released:

Owner/Occupier Details (If any)

Title

Name

Home Phone No.

Mob Ph.

Owner / Occupier

Insurance Details (if known)

ANIMAL RESCUE

Enter details of incident:

Did Animal Rescue Agency Attend:

End of section, go to POLICE DETAILS (if applicable)
LOCK IN/LOCK OUT

Enter details of incident:

Did RACV Agency Attend:

Owner/Occupier Details (If any)

Title

Name

Home Phone No.

Mob Ph.

Owner / Occupier

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:

Other:

F - FIRE FIGHTING

FIRE FIGHT INFO

Hose Lines

High Pressure Line (Pumper)

25mm Hose line

38mm Hose Line

64mm Hose Line

Other:

Major Extinguishing Medium

Breathing Apparatus Used

BA WEARER

Name:

No. Of Cylinders

Foam Used

Percentage Used %

Approx Qty used (Ltrs):

Percentage Used

Approx Qty used (Ltrs):

Possible Cause of Fire

Ignition Details
Where did the fire start

Other:

What Started the Fire

Other:

POLICE DETAILS

Number:

Name:

Station:

CIVILIAN CASUALTIES/RESCUES EVACUATIONS

D - CIVILIAN CASUALTIES/ RESCUES EVACUATIONS

No. Civilians Injured:

No. Civilians Rescued:

No. Civilian Fatalities:

No. Civilians Evacuated:

ADDITIONAL NOTES:

Supporting Photo's