Vehicle Fire - Michigan



Vehicle Fire |Incident Number | |

| |Date |

| |Investigator |

|Information | |

| |

| |

| |

| |

| |

| |

|Day/date/time of fire |

| |

| |

| |

| |

| |

|Location (Street, City, Zip, Township and County) |

| |

| |

| |

| |

|Day/date/time of investigation |

| |

| |

| |

|Location of investigation |

| |

| |

| |

|Police Department |

| |

| |

| |

| |

|Fire discovered/reported by |

| |

| |

| |

| |

|Interview person who discovered fire |

|Scene Description |

| |

|Where was smoke/fire first observed |Doors Left |Windows |

| |Open Closed |Up Down |

|Smoke/fire blowing which way |

|Hood |

|Open Closed |

|Who notified the fire department |

|Fire Department response time |

|Police Present |

|What do you think cause the fire |

| |

|Other information |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Fire Department |

| |

| |

| |

| |

| |

|Suppression Information |

|Interviewed |Dispatched |Arrival |Cleared |

|Officer in Charge (OIC) |Wind direction and speed |Temperature |Conditions |

|Time of Alarm |

|Weather |

|First fire fighters on the scene/Observations |

| |

| |

| |

| |

|Location of smoke/flames |

|Vehicle security upon arrival |

| |Last area extinguished |

|Locations/types of ventilation |

|First area extinguished |

|Problems with extinguishment |Overhaul |

| |Yes No |

|Rekindle |

|Yes No |

|Consent to Search |Served - Date/Time: |

| |Tabulation returned to court |

|Verbal Written From whom: |yes no |

| Criminal search warrant |Served By: |

|Administrative search warrant | |

|Court / Judge |

|Affiant: |

|Suggested Interviews |

| OIC Fire department personnel Police personnel Witnesses Owner Neighbors |

|Driver Passengers Others (list) |

|Victim Rights Form (UD-30) |

| yes no By: |

| |

| |

| |

| |

|Interview |

| Owner |When Purchased |From Whom |

|Driver | | |

|Passenger (s) |Financed |Financial Institution |

| |Yes No | |

|Engine Size |Amount owed |Monthly payment (current?) |

|Amount Paid |Current Mileage |

|Extended Warranties: |Who regularly drives the vehicle |

|Mileage at time of purchase |Amount of Fuel |

|Problems/Complaints |

|Fluid Levels |Where |Reason |

|Last person to enter engine compartment |Any problems with animals |

|Date of last service |

|How often is oil changed |

|Recalls |Telephone |Accidents |

|Any add-on to vehicle |

|Alarm System |

|Parts replaced on vehicle |

|Driven/Parked (how long) |

|Where were you coming from/going to |Pulling a trailer |Any leaks prior to fire |

|What accessories were being operated prior to the fire |

|All accessories work |Any noises heard |

|How did vehicle run prior to fire |

|Any odors |

|Short scenario leading up to fire |

| |

|Doors Left |Windows |

|open closed |up down |

|Where was fire/smoke first observed |How long for fire department response |Police present |

|Hood |

|open closed |

|Who notified fire department |

|What do you think caused the fire |

|Other information |

|Interview |

| Owner |When Purchased |From Whom |

|Driver | | |

|Passenger (s) |Financed |Financial Institution |

| |Yes No | |

|Engine Size |Amount Owed |Monthly payment (current?) |

|Amount Paid |Current Mileage |

|Extended Warranties: |Who regularly drives the vehicle |

|Mileage at time of purchase |Amount of Fuel |

|Problems/Complaints |

|Fluid Levels |Where |Reason |

|Last person to enter engine compartment |Any problems with animals |

|Date of last service |

|How often is oil changed |

|Recalls |Telephone |Accidents |

|Any add-on to vehicle |

|Alarm System |

|Parts replaced on vehicle |

|Driven/Parked (how long) |

|Where were you coming from/going to |Pulling a trailer |Any leaks prior to fire |

|What accessories were being operated prior to the fire |

|All accessories work |Any noises heard |

|How did vehicle run prior to fire |

|Any odors |

|Short scenario leading up to fire |

| |

|Doors Left |Windows |

|open closed |up down |

|Where was fire/smoke first observed |How long for fire department response |Police present |

|Hood |

|open closed |

|Who notified fire department |

|What do you think caused the fire |

|Other information |

|Vehicle Involved |Expires/State/License# |

|Year |Make |Model |Color Top/Bottom |

|VIN: |

|LEIN Holder |Investigator's Name |

|Address |

|City/State/Zip |

|Insurance |

|Company |Agent |

|Address |Address |

|City, State, Zip |City/State/Zip |

|Telephone Fax |Phone Fax |

|Adjuster |Date of Issue |

|Address |Date of Expiration |

|City/State/Zip |Phone Fax |

|Policy Type: |

|Full Coverage PLPD None |

|Injury |

|Name |Race/Gender |Date of Birth |

|1) | | |

|Address | | |

| |Civilian F.D. Other |L K |

|Next Of Kin Notified | |

|Yes No |By Whom |

|Medical Examiner |

|Removed From Scene By: |

| |

|Transported By: To: |

|Autopsy |

|Yes No BAC CO level Drug screen X-ray |

|Hospital Morgue (Full Address and Information) |

| |

| |

|Doctor: |

|Present at autopsy |

| |

|Cause of Death |

| |

| |

| |

|Injury |

|Name |Race/Gender |Date of Birth |

|2) | | |

|Address | | |

| |Civilian F.D. Other |L K |

|Next Of Kin Notified | |

|Yes No |By Whom |

|Medical Examiner |

|Removed From Scene By: |

| |

|Transported By: To: |

|Autopsy |

|Yes No BAC CO level Drug screen X-ray |

|Hospital Morgue (Full Address and Information) |

| |

| |

|Doctor: |

|Present at autopsy |

| |

|Cause of Death |

| |

| |

| |

|Injury |

|Name |Race/Gender |Date of Birth |

|3) | | |

|Address | | |

| |Civilian F.D. Other |L K |

|Next Of Kin Notified | |

|Yes No |By Whom |

|Medical Examiner |

|Removed From Scene By: |

| |

|Transported By: To: |

|Autopsy |

|Yes No BAC CO level Drug screen X-ray |

|Hospital Morgue (Full Address and Information) |

| |

| |

|Doctor: |

|Present at autopsy |

| |

|Cause of Death |

| |

| |

| |

|Exterior Areas (note damage) |Drivers side rear door open closed By: |

|Front bumper |

|Hood |

|Forced By: |

|Grill |

|Drivers front quarter |

|Drivers door open closed By: |

|Drivers rear quarter panel |Passenger front door open closed |

|Trunk lid |

|Forced By: |

|Rear bumper |

|Roof |Drivers side cargo door |Passenger side cargo door |

| |open closed |open closed |

|Passenger rear quarter panel |

|Passenger rear door open closed |

|Passenger front quarter panel |

|Van Only |

|Rear cargo doors |

|open closed |

|Body Condition/Exterior Fire Damage |

| |

| |

| |

| |

| |

| |Type |Wheel cover |Treadwear |No. of lugs missing |

| | | | | |

| | | | | |

| | | | | |

|Tires/Wheels |

|Tires |

|Left front |Intact |Melted |Punched |Missing |

|Right front | | | | |

|Left rear | | | | |

|Right rear | | | | |

|Doors |

|Cylinders |Locks |

|Left front door |broken |melted |cracked |out |intact |up down unknown |

|Right front door |broken |melted |cracked |out |intact |up down unknown |

|Left rear door |broken |melted |cracked |out |intact |up down unknown |

|Right rear door |broken |melted |cracked |out |intact |up down unknown |

| |

| |

| |

|Glass Condition |

|Windshield |broken |melted |cracked |out |intact |up down unknown |

|Rear |broken |melted |cracked |out |intact |up down unknown |

|Drivers |broken |melted |cracked |out |intact |up down unknown |

|Passengers |broken |melted |cracked |out |intact |up down unknown |

|Right rear |broken |melted |cracked |out |intact |up down unknown |

|Left rear |broken |melted |cracked |out |intact |up down unknown |

|Sunroof |

|Convertible |

|Electric windows |

|Comparisons |

| |intact |damaged |missing |

| |intact |damaged |missing |

| |

| |

|Under Vehicle |

|Catalytic converter |

|Exhaust |

|Fire Damage |

| |Fuel line Nylon Metal |

| |Fill pipe Nylon Metal |

| |

|Fuel System |Intact |Consumed |Damaged |

|Gas Diesel CNG LP Electric |Open |Limited (hood jammed) |Forced By: |

|Fuel tank |Intact |Partially stripped |Burned |Missing |

|Nylon Metal | | | | |

|Gas cap |Intact |Low |Consumed |Condition: |

|Nylon Metal | | | | |

|Engine Compartment |Intact |Melted |Removed |Location: |

|Hood |Intact |Melted |Removed |Damaged |

|Engine accessibility |Intact |Consumed |Removed |Damaged |

|Engine |Intact |Consumed |Removed |Damaged |

|Oil |Intact |Consumed |Removed |Damaged |

|Battery |Fluid Condition: |

|Battery cables |Intact |Consumed |Removed |

|Radiator |Automatic |Standard |Fluid level: |

|Upper radiator hoses |

|Lower radiator hoses |

|Radiator Level |

|Belts |

|Transmission |

|Engine parts missing |

|Burglar alarm |Intact |Consumed |Partially missing/Consumed |

|Engine fire damage |Intact |Consumed |Partially missing |

|comparisons | | | |

| |Intact |Consumed |Partially missing |

| |Intact |Consumed |Personal effects present |

|Internal Examination -- Passenger Compartment |

|Dashboard |Intact |Consumed |Partially missing |Defeated |

|Radio |In ignition |At scene |None found |

|Speakers |Intact |locked |Tampered with |Consumed |

|Glove box |Intact |Consumed |Partially missing |

|Firewall |Intact |Consumed |Partially missing |

|Ignition |Intact |Consumed |Partially missing |N/A |

|Ignition key |Yes |No |Sun Roof T Tops |

|Steering Column |Oil change sticker |

|Drivers front seat |

|Passenger front seat |

|Rear seat |

|Power seats |

|Odometer reading |

|Title history |

| |

| |

|Personal effects in passenger compartment |

| |

| |

|Interior fire damage |Pickup |Van |Utility vehicle |Other: |

| |Open |Closed |

| |Melted |Intact |Punched -- by: |

| |Yes |No |Unknown |

|Trunk Compartment |Intact |Missing |Tire changing |Intact |Missing |

| | | |equipment: | | |

|Passenger vehicle |

|Trunk |

|Trunk lock |

|Trunk release button |

|Spare tire |Number of samples |K-9 used yes no |

|Other contents/personal effects: |

| |

| |

|Evidence/Property Seized |

|Samples taken yes no |

|Description/location of samples |

|1. |

|2. |

|3. |

|4. |

|5. |

|6. |

|7. |

|8. |

|9. |

|10. |

|Photographs/Video |

| |

| |

| |

| |

| |

| |

|Fire Origin |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Fire Cause |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Fire Status / Further Investigation |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

Rev. 9/1/04

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download