National Fire Incident Reporting System forms
[Pages:32]A
FDID
State
MM
DD
Incident Date
YYYY
Station
Incident Number
Exposure
Delete Change No Activity
NFIRS?1 Basic
OMB 1660-0069 Expires 04/30/2019
*Paperwork Burden Notice on Back
B Location Type
Street address
Check this box to indicate that the address for this incident is provided on the Wildland Fire Module in Section B, "Alternative Location Specification." Use only for wildland fires.
Intersection
In front of
Number/Milepost Prefix
Street or Highway
Rear of
Adjacent to
Apt./Suite/Room
City
Directions
U.S. National Grid Cross Street, Directions or National Grid, as applicable
Census Tract
-
State
Street Type
-
ZIP Code
Suffix
C Incident Type
E1 Dates and Times Month Day
Midnight is 0000
Year
Hour Min
Incident Type
D Aid Given or Received
None
Check boxes if dates are the same as Alarm Date.
Alarm
ALARM always required
ARRIVAL required, unless canceled or did not arrive
1 Mutual aid received
2 Auto. aid received
3 Mutual aid given 4 Auto. aid given
Their FDID
Their State
Arrival
CONTROLLED optional, except for wildland fires
Controlled
5 Other aid given
Their Incident Number
Last Unit Cleared
LAST UNIT CLEARED, required except for wildland fires
E2 Shifts and Alarms Local Option
Shift or Alarms District Platoon
E3 Special Studies Local Option
Special Study ID#
Special Study Value
F Actions Taken
Primary Action Taken (1) Additional Action Taken (2) Additional Action Taken (3)
G1
Resources
Check this box and skip this block if an Apparatus or Personnel Module is used.
Suppression
Apparatus Personnel
EMS
Other
Check box if resource counts include aid received resources.
G2 Estimated Dollar Losses and Values
LOSSES:
Required for all fires if known. Optional for non-fires.
None
Property $
,
,
Contents $
,
,
PRE-INCIDENT VALUE: Optional
Property $
,
,
Contents $
,
,
Completed Modules
Fire?2 Structure Fire?3 Civilian Fire Cas.?4 Fire Service Cas.?5 EMS?6 HazMat?7 Wildland Fire?8 Apparatus?9 Personnel?10 Arson?11
H1 Casualties
H None 3 Hazardous Materials Release
None I
Deaths Injuries
Fire
1
Service
2
3
Civilian
4
H2 Detector Required for confined fires.
5 6
7
1 Detector alerted occupants 8
2 Detector did not alert them 0 U Unknown
Natural gas: slow leak, no evacuation or HazMat actions Propane gas: ................
................
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