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RAMSEY FIRE DEPARTMENT INCIDENT REPORT tALL #: ICR#: Date: I Alarm Time: I In Route: I Arrival Time: 1 Station Cleared: Station(s) / / : 1 2 Both Day (6am-6pm) I Night (6pm-6am) I Weekend Day I Weekend Night I Fire 1 RescueIMedical Mutual Aid pccupant Name (Drive if Vehicle) Address of Incident Occupant Telephone C 0 m Type of Property City: p Property Owner Name: Owner Address (Include City and Zip Code) Owner Telephone 1 e t e Dispatched as (Describe type of Call) f Situation Found (Circle One) 0 r II. Fire in a Structure 30. Rescue CaIl 45. Arching, Shorting Equipment 62. Wrong Location A 12. Other Fire (Outside of Structure) 32. Emergency Medical CalI 47. Spill, w/o ignition Washdown 63. Controlled Burning 13. Vehicle Fire 34. Search 53. Smoke, Odor Removal 65. Steam, Gas, Mistaken Smoke 1 14. Tree, Brush, Grass Fire 35. Extrication 55. Assist Police 71. Mischievous False CaIl 1 15. Dumpster Fire 41. Spill of Natural Gas (No Fire) 56. Unauthorized Burning 72. Bomb Scare I 16. Expiosion (No Fire) 43. Chimney Fire, Excessive Heat 57. Standby Mutual Aid 73. System Malfunction n 17. Outside Spill (With Fire) 44. Power Line Down 61. Smoke Scare 74. Unintentional Test (Burnt Food C; 99. Other Types ofCaIls (Includes C.O. Alarms) Describe in Detail: 1 d Action Taken (Circle One) 1. Extinguishment 2. Rescue or Assist 3. Investigate Only 4. Remove Hazard e n 5. Standby 6. Salvage 8. Mutual Aid Given Other (Describe in Detail) t Methof of Alarm (Circle One) Mutual Aid From/To: S 3. Private Alarm System 4. Radio Ignition Factor: (What Started the Fire?) 5. Verbal Report to Station 7. 911 or Phone Other (Describe in Detail): Incident Commander: Firefighter Filling Out Report: Safety Officer: Number of Injuries Other: Number of Falalities Other Complete Appropriate Fire Service: Fire Service Forms ~~ Area of Fire Origin Type of Equipment involved in Ignition: p 1 1 1 Form of Heat or Ignition Type of Material Ignited Form of Material r~ Method of Extinguishment (Circle One) e 1 I. Self Extinguished 3. Fire Extinguisher 4. Sprinkler 5. Hose & Water From Tank r 6. Home & Water from Hydrant 7. Stand pipes 8. Master Stream Devices fe Other (Describe in Detail): OS flow Far AbovelBelow the Ground Did the Fire Start? 1 Estimated Dollar Loss r Type of Building Construction (Circle One) I. Fire Resistive 2. Heavy Timber 3. Protected Non-combustible 4. Unprotected Non-combustible 5. Protected Ordinary 6. Unprotected Ordinary 7. Finished Wood Frame C 8. Unfinished Wood Frame Other (describe in Detail): 0 m Extent of Flame Damage: 1. Confined to Object or Origin 5. Confined to Floor of Origin P Enter Appropriate #) 2. Confined to Part of Room/Origin 6. Confined to Structure of Origin 1 Extent of Smoke Damage: 3. Confined to Room of Origin 7. Extended Beyond Structure e (Enter Appropriate #) 4. Confined to Fire Related Compartment 9. No Damage t e Detector Performance (Cirlce One) Sprinkler Performance (Cirlce One) f I. In Room and Operated 2. Not in Room and Operated I. Equipment Operated 2. Should have Operated but Didn't 0 3. In Room of Origin a nd Did Not Oerate 4. Not in Room of Origin and Did not Operate 3. Prsent, but Did No1fPerate 4. None Present in Room of Origin r 5. In Room of Origin, Fire Too SmaIl 8. No Detector Present A Number of Floors in Building (Including Basement: \ 1 If Smoke Spread Beyond Type of Material Generating Most Smoke I A venue of Smoke Travel 1 Room Of Origin S Form of Material Generating Most Smoke t r u c If Mobile Property Year Make Model Serial Number License Number Insurance Company t U r If Equipment Involved Year Make Model Serial Number Misc. Information e in Ignition 1: 1 r e See Back of Sheet for Additional Information S