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Labour and Advanced Education
FIRE INCIDENT REPORT
Office of the Fire Marshal
PO Box 697 B3J
2
T
8
Halifax, Nova S
c
otia
Ph: 902
424
-
5721
Fax: 902
424
-
3239
Toll Free: 1-800-559-3473
www
.go
v
.ns.ca/lae
**** COMPLETE FORM & FAX TO PROPERTY SERVICES 538-4741 ****
Please complete the following Incident Report Form for every fire incident that occurs within the premises of your facility.
Each report should be fully completed and forwarded to the following address no later then 10 days after the date of
incident. Office of the Fire Marshal
PO Box 697
Halifax, Nova Scotia
B3J 2T8
If you have any questions or require any assistance please contact the Office of the Fire Marshal.
INCIDENT DETAIL
Date of Incident (yyyy/mm/dd)
Time of Incident (24-hour clock)
Civic Address
Community
Postal Code
Building Name
Contact Person Contact Phone Number
Did a Fire Department Respond? Yes No
If
yes,
which
department?
FIRE DETAIL
Property Classification
Fire Origin
Igniting Object
Fuel or Energy
Material First Ignited
Possible Cause
Description
Injuries Yes No Fatalities Yes No Estimate of Damage
Submission Date (yyyy/mm/dd) Name Signature