Kaufman Fire Marshal Office

• Audit Title

• F1- Grass/Hay F2- Structure (Residential) F3- Structure (Non-residential) F4- Vehicle F5- Wildland F6- Misc.

• Report #:

• Investigation Conducted on:

  Date
• Location
  Address

• Investigator

  Select Kyle McAfee Chad Woosley KCFM John Garvin KCFM Randy Richards KCFM Kaufman Police

  • Kyle McAfee
  • Chad Woosley KCFM
  • John Garvin KCFM
  • Randy Richards KCFM
  • Kaufman Police

Owner's Information

• Name:

• Race:

  Select Caucasian African-American Hispanic Native American Asian Middle Eastern

  • Caucasian
  • African-American
  • Hispanic
  • Native American
  • Asian
  • Middle Eastern

• Sex:

  Male

  Female

• Date of Birth:

  Date

• DL#:

• SS#:

• Cell Phone #:

• Home Address:
  Address

• Home Phone #:

• Work Address:
  Address

• Work Phone:

Occupant's Information:

• Same as Owner?

  Yes

  No

• Name:

• Race:

  Select Caucasian African-American Hispanic Native American Asian Middle Eastern

  • Caucasian
  • African-American
  • Hispanic
  • Native American
  • Asian
  • Middle Eastern

• Sex:

  Male

  Female

• Date of Birth:

  Date

• DL#:

• SS#:

• Cell Phone #:

• Home Address:
  Address

• Home Phone #:

• Work Address:
  Address

• Work Phone:

Reporting Party

• Public Safety Agency or 911 Caller?

  Public Safety Agency

  911 Caller

• Public Safety Agency:

  Select Able Springs FD Careflight College Mound FD Combine FD Crandall FD Crandall PD Elmo FD ETMC EMS (AIR) ETMC EMS (Ground) Forney FD Forney PD Kaufman County Constable Pct. 1 Kaufman County Constable Pct. 2 Kaufman County Constable Pct. 3 Kaufman County Constable Pct. 4 Kaufman County Office of Emergency Management Kaufman County Sheriff's Office Kaufman FD Kaufman PD Kemp FD Kemp PD Life Air EVAC Mabank FD Mabank PD Rosser FD Scurry FD Terrell VFD Terrell FD (City) Terrell PD TXDPS (Ground) TXDPS (Air)

  • Able Springs FD
  • Careflight
  • College Mound FD
  • Combine FD
  • Crandall FD
  • Crandall PD
  • Elmo FD
  • ETMC EMS (AIR)
  • ETMC EMS (Ground)
  • Forney FD
  • Forney PD
  • Kaufman County Constable Pct. 1
  • Kaufman County Constable Pct. 2
  • Kaufman County Constable Pct. 3
  • Kaufman County Constable Pct. 4
  • Kaufman County Office of Emergency Management
  • Kaufman County Sheriff's Office
  • Kaufman FD
  • Kaufman PD
  • Kemp FD
  • Kemp PD
  • Life Air EVAC
  • Mabank FD
  • Mabank PD
  • Rosser FD
  • Scurry FD
  • Terrell VFD
  • Terrell FD (City)
  • Terrell PD
  • TXDPS (Ground)
  • TXDPS (Air)

• Same as Owner or Occupant?

  Same as Owner

  Same as Occupant

  Third Party Reporter

• Name:

• Race:

  Select Caucasian African-American Hispanic Native American Asian Middle Eastern

  • Caucasian
  • African-American
  • Hispanic
  • Native American
  • Asian
  • Middle Eastern

• Sex:

  Male

  Female

• Date of Birth:

  Date

• DL#:

• SS#:

• Cell Phone #:

• Home Address:
  Address

• Home Phone #:

• Work Address:
  Address

• Work Phone:

Incident Times

• Fire Department Response?

  Yes

  No

• Responding Agency:

  Select Able Springs FD College Mound FD Combine FD Crandall FD Elmo FD Forney FD Kaufman FD Kemp FD Mabank FD Rosser FD Scurry FD Terrell VFD Terrell FD (City) Other Department Kaufman County FMO State Agency

  • Able Springs FD
  • College Mound FD
  • Combine FD
  • Crandall FD
  • Elmo FD
  • Forney FD
  • Kaufman FD
  • Kemp FD
  • Mabank FD
  • Rosser FD
  • Scurry FD
  • Terrell VFD
  • Terrell FD (City)
  • Other Department
  • Kaufman County FMO
  • State Agency

• Other Department:

• Dispatched:

  Date

• Enroute:

  Date

• At Scene:

  Date

• Tap-Out:

  Date

• Clear:

  Date

• Kaufman Fire Department Office Incident Times

• Dispatched:

  Date

• Enroute:

  Date

• At Scene:

  Date

• Clear:

  Date

Resources

• Total Manpower:

• # of Engines:

• # of Aerial Trucks:

• # of Rescues/Squads:

• # of Tankers (Water Tenders)

• # of Brush Trucks:

• # of Dozers/Graders:

• # of Air Tankers

• Mutual Aid Departments:

  Select Able Springs FD College Mound FD Combine FD Crandall FD Elmo FD Forney FD Kaufman FD Kemp FD Mabank FD Rosser FD Scurry FD Terrell VFD Terrell FD (City) Other Department Kaufman County FMO State Agency

  • Able Springs FD
  • College Mound FD
  • Combine FD
  • Crandall FD
  • Elmo FD
  • Forney FD
  • Kaufman FD
  • Kemp FD
  • Mabank FD
  • Rosser FD
  • Scurry FD
  • Terrell VFD
  • Terrell FD (City)
  • Other Department
  • Kaufman County FMO
  • State Agency

• Other Mutual Aid Departments:

• Other Agencies:

  Select Careflight Crandall PD ETMC EMS (Air) ETMC EMS (Ground) Forney PD Kaufman County OEM Kaufman County Pct. 1 Constable Kaufman County Pct. 2 Constable Kaufman County Pct. 3 Constable Kaufman County Pct. 4 Constable Kaufman County Sheriff's Office Kaufman PD Kemp PD Life Air EVAC Mabank PD Terrell PD Texas Forest Service TVEC TXDPS (Air) TXDPS (Ground) Oncor Other Agency Red Cross Kaufman County FMO

  • Careflight
  • Crandall PD
  • ETMC EMS (Air)
  • ETMC EMS (Ground)
  • Forney PD
  • Kaufman County OEM
  • Kaufman County Pct. 1 Constable
  • Kaufman County Pct. 2 Constable
  • Kaufman County Pct. 3 Constable
  • Kaufman County Pct. 4 Constable
  • Kaufman County Sheriff's Office
  • Kaufman PD
  • Kemp PD
  • Life Air EVAC
  • Mabank PD
  • Terrell PD
  • Texas Forest Service
  • TVEC
  • TXDPS (Air)
  • TXDPS (Ground)
  • Oncor
  • Other Agency
  • Red Cross
  • Kaufman County FMO

• Other Agencies:

Weather Conditions

• Historical Weather Data - www.wunderground.com/history
  http://www.wunderground.com/history/

• Weather Description:

• Temperature ( ̊F):

• Wind Direction:

  Select N NNE NE ENE E ESE SE SSE S SSW SW WSW W WNW NW NNW

  • N
  • NNE
  • NE
  • ENE
  • E
  • ESE
  • SE
  • SSE
  • S
  • SSW
  • SW
  • WSW
  • W
  • WNW
  • NW
  • NNW

• Wind Speed (mph):

• Relative Humidity (%):

Incident Information

• Incident Commander Name:

• Incident Commander ID#:

• Initial Size-up:

• Type of Fire:

  Select Residential Commercial Agricultural Grass/Wildland Vehicle Church School Utility Storage Other

  • Residential
  • Commercial
  • Agricultural
  • Grass/Wildland
  • Vehicle
  • Church
  • School
  • Utility
  • Storage
  • Other

• Type of Fire:

• Large Scale Incident Command System

• Command Staff:

• Safety Officer:

• Liaison Officer:

• Public Information Officer:

• General Staff:

• Operations Section Chief:

• Planning Section Chief:

• Logistics Section Chief:

• Finance/Admin Section Chief:

Burned Property Information

• Structure Fire

• Occupancy Classification:

  Select Assembly Business Educational Factory High Hazard Institutional Mercantile Residential Storage Utility/Misc. Mixed Use

  • Assembly
  • Business
  • Educational
  • Factory
  • High Hazard
  • Institutional
  • Mercantile
  • Residential
  • Storage
  • Utility/Misc.
  • Mixed Use

• Assembly Type:

  A-1: Assembly with Fixed Seating

  A-2: Assembly for Food/Drink Consumption

  A-3: Assembly for Worship/Recreation/Amusement

  A-4: Assembly for Indoor Sporting Events

  A-5: Assembly for Outdoor Activities

• Factory Type:

  F-1: Moderate Hazard Industrial

  F-2: Low Hazard Industrial

• High Hazard Type:

  H-1: Detonation Hazard

  H-2: Deflagration Hazard

  H-3: Readily Supports Combustion

  H-4: Health Hazard

  H-5: Semiconductor Production

• Institutional Type:

  I-1: >16 people for 24 hours/Custodial or Supervisory Care

  I-2: >5 people for 24 hours/Full Medical Care

  I-3: >5 people/Restrained or Detained

  I-4: >5 people for less than 24 hours/Custodial or Supervisory Care

• Residential Type:

  R-1: Residential >10 Temporary Residents

  R-2: Residential >16 Permanent Residents

  R-3: Residential <16 Permanent, <10 Temporary Residents

  R-4: Residential 5-16 Permanent Residents Receiving Custodial or Supervisory Care

• Storage Type:

  S-1: Moderate Hazard Storage

  S-2: Low Hazard Storage

• Select All Applicable Occupancy Classifications:

  Select Assembly Business Educational Factory High Hazard Institutional Mercantile Residential Storage Utility/Misc. Mixed Use

  • Assembly
  • Business
  • Educational
  • Factory
  • High Hazard
  • Institutional
  • Mercantile
  • Residential
  • Storage
  • Utility/Misc.
  • Mixed Use

• Occupancy:

  Occupied

  Unoccupied

  Abandoned

• Type of Construction:

  Select Type I (Fire Resistive) Type II (Non-combustible) Type III (Ordinary) Type IV (Heavy Timber) Type V (Wood Frame)

  • Type I (Fire Resistive)
  • Type II (Non-combustible)
  • Type III (Ordinary)
  • Type IV (Heavy Timber)
  • Type V (Wood Frame)

• Foundation:

  Select Concrete Slab Peir and Beam Manufactured Home Raised/Blocks Dirt Floor

  • Concrete Slab
  • Peir and Beam
  • Manufactured Home
  • Raised/Blocks
  • Dirt Floor

• Siding:

  Select Wood Brick Veneer Metal Vinyl Other

  • Wood
  • Brick Veneer
  • Metal
  • Vinyl
  • Other

• Other Siding Materials:

• Roof:

  Select Composition Shingle Wood Shingle Metal Other

  • Composition Shingle
  • Wood Shingle
  • Metal
  • Other

• Other Roofing Material:

• Code Violations

  Yes

  No

• Violations Found:

Property Utilities

• Water

• Company Name

• Activity

  Turned on

  Turned Off

• Date Turned Off

  Date

• Electric

• Company Name

• Activity

  Turned on

  Turned Off

• Date Turned Off

  Date

• Gas

• Company Name

• Activity

  Turned on

  Turned Off

• Date Turned Off

  Date

• Vehicle Fire

• License Plate #:

• State:

• Plate Year/Registration:

• Vehicle Identification Number (VIN):

• Year Model:

• Make:

• Model:

• Color:

• Direction of Travel:

  Select N NNE NE ENE E ESE SE SSE S SSW SW WSW W WNW NW NNW

  • N
  • NNE
  • NE
  • ENE
  • E
  • ESE
  • SE
  • SSE
  • S
  • SSW
  • SW
  • WSW
  • W
  • WNW
  • NW
  • NNW

• Exact Location:

• Lien Holder Name:

• Lien Holder Address:
  Address

• Lien Holder Phone #:

• Impounded By:

• Towing Service Phone #:

Insurance Information

• Insurance?

  Yes

  No

  Unknown

• Insurance Company:

• Policy #:

• Policy Date:

  Date

• Policy Amount:

• Deductable:

• Insurance Company Address:
  Address

• Insurance Company Phone #:

• Insurance Agent Name:

• Insurance Agent Phone #:

Mortgage Information

• Mortgage on Structure?

  Yes

  No

  Unknown

• Mortgage Company:

• Account #:

• Mortgage Company Address:
  Address

• Mortgage Company Phone #:

• Mortgage Amount:

• Monthly Payment:

• Remaining Balance:

• Arrears:

Person (s) in question

• Name of Person

• Date of Birth

  Date

• Identification Number

• Social Security Number

• Address

• Work Name

• Work Address

• Work phone

• Type of Person

  Witness

  Suspect

Person (s) in question

• Name of Person

• Date of Birth

  Date

• Identification Number

• Social Security Number

• Address

• Work Name

• Work Address

• Work phone

• Type of Person

  Witness

  Suspect

Person (s) in question

• Name of Person

• Date of Birth

  Date

• Identification Number

• Social Security Number

• Address

• Work Name

• Work Address

• Work phone

• Type of Person

  Witness

  Suspect

Cause of Incident

• Incident Status:

  Select Under Investigation Undetermined Natural Occurance Accidental Incendiary with Unintentional Effects Incendiary with Intentional Effects

  • Under Investigation
  • Undetermined
  • Natural Occurance
  • Accidental
  • Incendiary with Unintentional Effects
  • Incendiary with Intentional Effects

Incident Documentation

• Narrative:

• Incident Photographs:

  Media

• Incident Diagram:

  Drawing

Fire Marshal's Office Use Only

• Report Completed By:

  Kyle McAfee

  Chad Woosley KCFM

  John Garvin KCFM

  Randy Richards KCFM

  Kaufman Police

• Signed:

  Sign

• Agency: Kaufman Fire Department

• Report Complete:

  Date