Incident Report 1.2

• Conducted on

  Date
• Location
  Address

Incident

• Situation Found

• Type of Action Taken

Owner / Occupant

• Owner Name

• Owner Address

• Owner Phone Number

• Occupant Name

• Occupant Address

• Occupant Phone Number

Other Agencies Involved

• Fire Dept.

  Select Smithton Fire New Athens Fire St. Libory Fire Fayetteville Fire Mascoutah Fire Red Bud Fire Belleville Fire

  • Smithton Fire
  • New Athens Fire
  • St. Libory Fire
  • Fayetteville Fire
  • Mascoutah Fire
  • Red Bud Fire
  • Belleville Fire

• Law Enforcement

  Select Freeburg PD Smithton PD New Athens PD Belleville PD State County

  • Freeburg PD
  • Smithton PD
  • New Athens PD
  • Belleville PD
  • State
  • County

• EMS

  Select MedStar New Athens Abbott Other

  • MedStar
  • New Athens
  • Abbott
  • Other

• Other

Estimated Total Loss

• Estimated Loss

• Photo

  Media

• Estimated By

Remarks

• Remarks

• Form Filled Out By