Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Incident Number
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Date
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Location of call
Incident Information
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Type of Call
- Structure Fire
- Vehicle Fire
- Brush/Forest Fire
- Grass/Leaf Fire
- Refuse
- Assist Police/EMS
- Smoke Investigation
- Bomb Scare
- Electrical Distribution
- Alarm Malfuntion
- Fuel Spill/Leak
- Chemical Spill/Leak
- Carbon Monoxide Dectector
- Rescue/Extrication
- False Call
- Service Call
- Natural Gas Leak
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Remarks
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Ignition Factor
- N/A
- Operating Equipment
- Electrical Arcing
- Hot or Smoldering Object
- Explosives, Fireworks, Other
- Munitions
- Incendiary Device
- Cigarette, Pipe, or Cigar
- Match, Lighter, Candle
- Other Open Flame
- Chemical, Natural Heat Source, Other
- Lightning Discharge
- Heat from another fire
- Other, Undetermined
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Method of Extinguishment
Owner Information
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Name
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Address
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Telephone Number
Occupant Information
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Property Occupied By Owner
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Telephone Number:
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Property occupied by:
Insurance Information
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Agency
- Miller Insurance
- Lockard Insurance
- Waugh Insurance Agency
- State Farm
- The General
- Progressive
- Uninsured
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Agent
Structure Value
Vehicle Value
Content Value
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Vehicle Information
Vehicle Information
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Year
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Make & Model
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License #
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Serial #
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House Trailer Information
House Trailer
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Year
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Make & Model
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Serial #
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Appliance Information
Appliances
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Year
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Make
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Serial #
Response Information
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Responding Apparatus
Apparatus
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Apparatus Number
- 1901
- 1905
- 1906
- 1907
- 1908
- 1909
- 1910
- 1911
- 1912
- 1913
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Staffing
- 1921 Ryan Pelletier
- 1922 Ben Matthews
- 1923
- 1924 Dennis Dupree
- 1925 Randy Dupree
- 1926 Bill Denny
- 1927 Roman Brandau
- 1928 Aaron Dupree
- 1929 Darrel Wright
- 1930 Brian Dunn
- 1931 Cory Ireland
- 1932 Chris Wages
- 1933
- 1934 Dustin Coffman
- 1935 Joe Mahle
- 1936 Logan Lindamood
- 1937
- 1938 David Gilliand
- 1939 Scott Sabo
- 1940 Jason Phillips
- 1941 Ashley Pelletier
- 1942 Ryan Souders
- 1943 John Stabler
- 1944 Devry McGlaughlin
- 1945 Brent Cochran
- 1946 Chris Waugh
- 1947 David Lehew
- 1948
- 1949 Doug Wright
- 1950 Gilbert Hartley
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Mutual Aid Departments
Mutual Aid
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Department:
- Bloomfield
- Coalton
- Hamilton
- Jackson
- Liberty
- Scioto
- Madison-Jefferson
- Jackson County Hazmat Team
- Hamden
- McArthur
- Wilksville
- Zaleski
- Harrison
- Liberty (Ross County)
- Jefferson (Ross County)
- Rio Grande (Gallia County)
- Centerville (Gallia County)
- Greenfield (Gallia County)
- Gallipolis (Gallia County)
- State Wide Mutual Aid, Other
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Officer in Charge:
- 1921 Ryan Pelletier
- 1922 Ben Matthews
- 1923
- 1924 Dennis Dupree
- 1925 Randy Dupree
- 1926 Bill Denny
- 1927 Roman Brandau
- 1928 Aaron Dupree
- 1929 Darrel Wright
- 1930 Brian Dunn
- 1931 Cory Ireland
- 1932 Chris Wages
- 1933
- 1934 Dustin Coffman
- 1935 Joe Mahle
- 1936 Logan Lindamood
- 1937
- 1938 David Gilliand
- 1939 Scott Sabo
- 1940 Jason Phillips
- 1941 Ashley Pelletier
- 1942 Ryan Souders
- 1943 John Stabler
- 1944 Devry McGlaughlin
- 1945 Brent Cochran
- 1946 Chris Waugh
- 1947 David Lehew
- 1948
- 1949 Doug Wright
- 1950 Gilbert Hartley
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Member Making Report:
- 1921 Ryan Pelletier
- 1922 Ben Matthews
- 1923
- 1924 Dennis Dupree
- 1925 Randy Dupree
- 1926 Bill Denny
- 1927 Roman Brandau
- 1928 Aaron Dupree
- 1929 Darrel Wright
- 1930 Brian Dunn
- 1931 Cory Ireland
- 1932 Chris Wages
- 1933
- 1934 Dustin Coffman
- 1935 Joe Mahle
- 1936 Logan Lindamood
- 1937
- 1938 David Gilliand
- 1939 Scott Sabo
- 1940 Jason Phillips
- 1941 Ashley Pelletier
- 1942 Ryan Souders
- 1943 John Stabler
- 1944 Devry McGlaughlin
- 1945 Brent Cochran
- 1946 Chris Waugh
- 1947 David Lehew
- 1948
- 1949 Doug Wright
- 1950 Gilbert Hartley
