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FIRE SAFETY
F-15.11 REG 1
Appendix B
Form A - Fire Incident Report (Insurance)
[Section 6]
FIRE SAFETY REGULATIONS
5
APPROVED September 18, 2015 - 2:15 p.m.
Appendix B
Form A - Fire Incident Report (Insurance)
[Section 6]
Em ergency Manag em ent
and Fire Safety
Basic Fire Incident Report
Page 1 of 3
Fire Department: Incident Time: Incident Date:
use 24-hour clock day/ month/ year
Incident Address: / /
street address/lot, block and plan #/land location description RM /Town/City/V illage/Hamlet postal code
Incident Type: Structure Fire Vehicle Fire Vegetation Fire Garbage Fire
Other:
provide detail of fire incident if not classified above
Note: Complete and attach to this report a “Fire Detector and Extinguishing Equipment Report” and/or a “Casualty Report” as applicable
M utual Aid Mutual Aid Received Mutual Aid Given
Resources
Num ber of Apparatus Num ber of Personnel
list total number of apparatus responded list total number of personnel responded
Values
Estim ated Dollar Value of Property: $ Estim ated Dollar Value of Damages: $
Insu ran ce File # Insurance Com pany:
Persons Involved
Insurance Co n tact: Phone:
Police Contact: Phone:
Ow ner’s Nam e : Phone:
Owner’s Address:
Occupant's Nam e Phone: