Incident Response Sheet File Agency Number TRIBAL COUNCIL FIRE DEPARTMENT Date of Incident Time Returned to Hall 1. 3. Time Activated 2. Location of Incident 4. Type of Incident Structural fire Outdoor fire Vehicle fire False Alarm 5. (Select one) MVC Medical Other (please specify) Owner(s) Occupant(s) 6. If there was a fire, what was on fire? 7. What caused the incident? 8. Where did the incident start? (floor level/area of origin) 9. If fire, extent of flames (flames confined to item/room/floor/building, or extended beyond structure) 10. Extent of damage (damage confined to item/room/floor/building, or extended beyond structure) 11. What equipment(s) was used? (i.e.: to extinguish the flames) 12. What rolling equipment was dispatched? 13. Sprinkler protection Detector in place Building floor level 14. 15. 16. Building floor area 17. Sq. Ft. or L x W Yes No Smoke Heat CO None (Number of stories) Insurance Available Est. Property Value($) Est. Value Loss ($) Insurance Company 21. 18. 19. 20. Yes No Bldg Building Bldg Contents Contents Contents Misc. Misc. Misc. Number of Occupants Number of Persons Evacuated 22. 23. Injuries/Fatalities (name, date of birth, gender, type and cause of casualty) 24. Vehicles involved (Make/Model, Year, License Plate, Serial #) 25.
Incident Response Sheet File Agency Number TRIBAL COUNCIL FIRE DEPARTMENT 1. Date of Incident 2. Time Activated 3. Time Returned to Hall 4. Location of Incident 5. Type of Incident Structural fire Outdoor fire Vehicle fire False Alarm (Select one) MVC Medical Other (please specify) 6. Owner(s) Occupant(s) 7. If there was a fire, what was on fire? 8. What caused the incident? 9. Where did the incident start? (floor level/area of origin) 10. If fire, extent of flames (flames confined to item/room/floor/building, or extended beyond structure) 11. Extent of damage (damage confined to item/room/floor/building, or extended beyond structure) 12. What equipment(s) was used? (i.e.: to extinguish the flames) 13. What rolling equipment was dispatched? 14. Sprinkler protection Yes No 15. Detector in place Smoke Heat CO None 16. Building floor level (Number of stories) 17. Building floor area Sq. Ft. or L x W 18. Insurance Available 19. Est. Property Value($) 20. Est. Value Loss ($) 21. Insurance Company Yes No Building Bldg Bldg Contents Contents Contents Misc. Misc. Misc. 22. Number of Occupants 23. Number of Persons Evacuated 24. Injuries/Fatalities (name, date of birth, gender, type and cause of casualty) 25. Vehicles involved (Make/Model, Year, License Plate, Serial #)
stats_fn_response_2016.docx