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Vehicle Fire Report - Office of the Fire Marshal

Fields marked with a red star (*) are mandatory.

Fire Department Information


Fire Department: *
Please select your fire department.
Fire Department Number: *
Please enter your unique Fire Department Number.
Report Number: *
Form
Response Location and Date


Enter the civic address.
Street Number: *
Street Name: *
Street Type: *
Community: *
Date of the Fire: *
(MM/DD/YYYY)
Time:
Enter hours and minutes.
For example, enter 23:45.

Response Type


Response: *
Vehicle Accident or Collision (with fire)
Vehicle Fire - Exposure
Vehicle Fire
Vehicle - No Alarm Fire
Response Information


Response Time: *
Enter the response time in minutes.
Responding Personnel: *
How many firefighters responded to the alarm?
Manhours:
Enter the total manhours in hours.
Back in Service:
Enter in hours and minutes.
For example, 2 hrs. 45 min.

Rescues:
How many people were rescued?
Casualities:
Enter the number of casualities, if any.
Vehicle Type


Road Vehicle:
Automobile
Small Truck (Pickup‚ Van‚ etc.)
Large Truck (Excluding Truck Trailer)
Automobile and Trailer Combination
Small Truck and Trailer Combination
Tractor Trailer or Truck
      Trailer Combination
Motorcycle
Bus
Other Road Vehicle

Watercraft:
Private or Business
Commercial
Military

Aircraft:
Private or Business
Commercial
Military

Misc.or Specialty Vehicle:
Construction
Industrial
Agricultural
Other Misc. or Specialty Vehicle
Make, Model and Year:
If applicable
License No. or Registration:
If applicable
Primary Purpose:
What was the vehicle transporting?
Passengers
Flammable Liquids
Compressed Flammable Gas
Other Dangerous Goods
Dangerous Goods & General Cargo
General Cargo
Mobile Utility or Service Vehicle
Other
Other:
If you checked other, please indicate what was being transported.
Vehicle Fuel or Energy Source:
Gasoline
Diesel Fuel
Propane
Electricity
Other
Other:
If you checked other, please indicate the fuel or energy source.
Area of Origin:
Engine Area
Running Gear (wheels & braking systems)
Electrical Systems
Fuel Systems (fuel tank‚ etc.)
Operator Area (cockpit‚ bridge‚ etc.)
Passenger Area
Cargo Area
Other
Other:
If you checked other,please indicate the area of origin.
Fire Loss Information


Estimated Dollar Loss:
Insurance Coverage:
Yes
No
Unknown
Suspected Cause of the Fire


Cause:
Arson
Riot or Civil Commotion
Vandalism
Children Playing
Design
Misuse of Igniting Object
Misuse of Material Ignited
Misuse of Equipment
Mechanical/Electrical Failure
Vehicle Accident or Collision
Accidental
Undetermined
Other
Other:
If you checked other, please indicate the cause.
Alarm to the Fire Department


Alarm:
Telephone to F.D. or Central Dispatch
Still Alarm/Verbal Report to Station
Telephone from Other
      Emergency/Protection Agency
Radio
Other
Other:
If you checked other, please indicate how the department got the alarm.
Owner/Operator Information


Owner/Operator: *
Address: *
Apartment Number:
City/Community: *
Province: *
Owner:
Complete only if different from above.
Address:
City/Community:
Province:
Enter provincial code.
Additional Information


Remarks:
Chief: *
Or person submitting the form.

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Please send me an Acrobat version of the form, with the information I've entered above filled in, that I can print and save.
Please send me both the text-only version and the PDF.
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