s VFIRS (Vermont’ Fire Incident Reporting System) – Fire Prevention Division Vermont Drawer 20 – Montpelier VT 05620-3401 Phone: (802)828-2106 Fax: (802)828-2195 Department of Labor & Industry FIRE INCIDENT REPORTING SHORT FORM 1A MM DD YY __x __x __x x T x x __x x __xx __x __x x __x x __x __x V __x __x __x __x __x __x __x __x x __x __x __x x __x __x __x __x __x HFDID HState HIncident Date Station HIncident Number HExposure (See Short Form Reference Guide for Coding Information) H1B Location: x ____x x _______________________________________________________________x Street or Highway x ____x x ____________________________________________x __x x __x __x -x __x __x x __x __x __x __x__x __x Apt/Suite/Room City State Zip Code H1C Incident Type 1E Dates & Times Midnight is 0000 Month Day Year Hour Min. x ___x x ___x ___x_________________x HAlarm x ___xx ___xx ___x ___xx ___x ___x ___x ___x ___x ___x ___x ___x HArrival x ___xx ___xx ___x ___xx ___x ___x ___x ___x ___x ___x ___x ___x H 1D Mutual Aid Given or Received Controlled x ___xx ___xx ___x ___xx ___x ___x ___x ___x ___x ___x ___x ___x Mutual aid received Last Unit Cleared x ___xx ___xx ___x ___xx ___x ___x ___x ___x ___x ___x ___x ___x Automatic aid received Mutual aid given x ___x ___x H1F Actions Taken H1G1 Resources (number) Automatic aid given Their State x __x x __x _________________x Apparatus Personnel Other aid given Primary Action 1 __x __x x __x Suppression x __x __x __x None x __x x __x _________________x EMS __x __x x __x x __x __x __x Additional Action Taken 2 (Optional) Other __x __x x __x x __x __x __x x __x x __x _________________x Additional Action Taken 3 (Optional) 1G2 Estimated Dollar Loss & Value 1H1 Casualties: Injuries Fatalities 1H3 Hazards Materials Property: $ _________ Fire Service: x __x x __x __x __x x __x __x Contents: $ _________ Civilian x __x x __x __x __x Pre-incident Value None Property: $ _________ Contents: $ _________ 2D Ignition H2E1 Cause of Ignition H1J Property Use: x __x __x __x Units (Multi-family) x __x __x __x __x H x __x __x 1 Intentional Area of Origin 2 Unintentional Acres Burned x __x , x __x H x __x __x __x __x __x __x 3 Failure of equipment Heat Source 4 Act of nature H x __x __x 5 Cause under investigation 2E3 x __x __x Estimated age of Person Involved Item first ignited U Cause undetermined Age was a factor Male Female after investigation 2F1 Equipment Involved 2F2 Equipment Power 2G Fire Suppression 2H2 Mobile Property involved in the Ignition Factor in the Ignition x __x __x __x x ________________x x __x __x x __x x __x ________________xx __x Mobile Property Type __x Fire Suppression Factor 1 Brand x ________________x x __x x __x ________________xx __x Mobile Property Make __x Fire Suppression Factor 2 Model x ________________x x __x x __x ________________xx ________________________x Fire Suppression Factor 3 Mobile Property Model Serial ________________ x x Year x __x __x __x __x Year x __x __x __x __x x __x __x __x __x __x __x __x __x __x __x __x __x __x __x __x __x __x __x __x VIN Number Page 2 – Fire Incident Reporting Short Form H3I Structure Type H3I2 Building Status H3I3 Building Height H3I4 Main Floor Size 1 Enclosed building 1 Under Construction do not count the roof x , x __x , x __x __x__x __x__x __x 2 Portable/mobile structure 2 Occupied & Operating x __x __x __x OR 3 Open structure 3 Idle, not routinely used total number of stories 4 Air supported structure 4 Under major renovation at or above grade x , x __x BY x __x __x__x __x __x __x 5 Tent 5 Vacant and secured x __x __x Length in feet width in feet 6 Open Platform (e.g. piers) 6 Vacant and unsecured Total number of stories below grade 7 Underground structure (work areas) 7 Being demolished 8 Connective structure (e.g. fences) 0 Other 0 Other type of structure U Undetermined * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * *** H3J1 Fire Origin * 3L2 Detector Type 3L4 Detector Operation x __x __x __x below grade * 1 Smoke 1 Fire too small to activate (Story of fire origin) * 2 Heat 2 Operated H3J2 Fire Spread * 3 Combination smoke-heat 3 Failed to operate 2 Confined to room of origin * 4 Sprinkler, water flow detection U Undetermined 3 onfined to floor of origin * 5 More than 1 type present 4 Confined to building of origin * 0 H3L5 Detector Effectiveness Other ___________________ 5 Beyond building of origin * U Undetermined 1 Alerted, occupants responded ****************** * 2 Occupants failed to respond H3L1 Presence of Detectors 3L3 Detector Power Supply 3 There were no occupants N None present 1 Battery Only 4 Failed to alert occupants 1 Present 2 Hardwire U Undetermined ******************** 3 Plug in H3M1Presence of Automatic * 4 Hardwire with battery 3L6Detector Failure Reason Extinguishing System * 5 Plug in with battery 1 Power failure/disconnect/off N None 1 Present * 6 Mechanical 2 Improper installation or place * 7 Multiple detector & power supplies3 Defective 3M2Type of Automatic * 0 Other ___________________ 4 Lack of maintenance/cleaning Extinguishing System * * U Undetermined * * * * * * * * * * * 5 Battery missing or disconnected 1 Wet pipe sprinkler 3M4 Number of Sprinkler Heads * 6 Battery discharged/dead 2 Dry Pipe (if system operated) * 0 Other ___________________ 3 Other sprinkler system x __x __x __x * U Undetermined 4 Cry chemical system (Number of sprinkler heads operating) * * * * * * * * * * * * * * * * * * * * * * * 5 Foam system 6 Halogen type system 3M5 Automatic Extinguishing System Failure Reason 7 Carbon dioxide 1 System shut off 0 Other special hazard system 2 Not enough agent discharged U Undetermined 3 Agent discharged but did not reach fire 1SL1 Special Studies 4 Wrong type of system 3M3Automatic Extinguishing 5 Fire not in area protected __x __x __x x __x __x x __x __x __x __x __x System Operation 6 System components damaged Special Special 1 Operated & effective 7 Lack of maintenance Study ID # Study Value 2 Operated & not effective 8 Manual intervention 3 Fire too small to activate 0 Other ________________________ __x __x __x x __x __x x __x __x __x __x __x 4 Failed to operate U Undetermined Special Special 0 Other Study ID # Study Value U Undetermined Remarks: Authorization: x __x __x __x __x __x __x __________________________x x x _________x_________x ___xx ___xx ___x ___x x x ___x ___x ___x ___x Officer in Charge ID Signature Position/rank Assignment Month Day Year x __x __x __x __x __x __x __________________________x x x _________x_________x ___xx ___xx ___x ___x x x ___x ___x ___x ___x Member Making Report Signature Position/rank Assignment Month Day Year FIRE INCIDENT “SHORT FORM” REPORTING REFERENCE GUIDE H: These are required fields and MUST be completed. Please make every effort to complete all fields which apply. 1A FDID: Enter your fire dept identifier as assigned by your state. Incident Date: Enter the date that the department received the incident alarm. Station Number: Leave blank if you only have one firehouse or station in your department. Incident Number: This is a number starting with the year then consecutively after that for each incident being reported (i.e. 21[for 2001 etc.] 00001, 2100002, etc.). Exposure Enter 000 for the main incident and 001 for additional fires (i.e. 000 for the car, 001 for the garage, 002 for the house, etc.) 1B Location: Address, City, State & Zip 1C Incident Type: 100 Fires, Other 150 Outside rubbish fire, other Structure Fires 151 Outside rubbish, trash or waste fire [Note: Fires not confined to the chimney are coded 152 Garbage dump or sanitary landfill fire “111” under structure fires and “120-127” under 153 Construction or demolition landfill fire equipment involved in ignition] 154 Dumpster or other outside trash receptacle fire 111 Building Fire 155 Outside stationary compactor/compacted trash 112 Fires in Structures other than a building fire 113 Cooking Fire 160 Special Outside fire 114 Chimney or flue fire, confined to chimney or 161 Outside storage fire flue 162 Outside equipment fire 115 Incinerator overload or malfunction, fire 163 Outside gas or vapor combustion confined 164 Outside mailbox fire 116 Fuel burner/boiler malfunction, fire confined 170 Cultivated vegetation, crop fire, other 117 Commercial compactor fire, confined rubbish 171 Cultivated grain or crop fire 118 Trash or rubbish fire, container 172 Cultivated orchard or vineyard fire 120 Fire in mobile property used as a fixed 173 Cultivated trees or nursery stock fire structure, other Overpressure Rupture, Explosion, Overheat –no 121 Fire in mobile home used as fixed resident fire 122 Fire in motor home, camper, recreational 200 Overpressure rupture, explosion, overheat, vehicle other 123 Fire in portable building, fixed location 210 Overpressure rupture of steam, other 131 Passenger vehicle fire 211 Overpressure rupture of steam pipe or pipeline 132 Road freight or transport vehicle fire 212 Overpressure rupture of steam boiler 133 Rail vehicle fire 213 Overpressure rupture of pressure or process 134 Water vehicle fire vessel 135 Aircraft fire 220 Overpressure rupture from air or gas, other 136 Self-propelled motor home or recreational 221 Overpressure rupture from air or gas vehicle pipe/pipeline 137 Camper or recreational vehicle (RV fire) 222 Overpressure rupture of boiler from air or gas 138 Off-road vehicle or heavy equipment fire 223 Air or gas rupture of pressure or process vessel 140 Natural vegetation fire, other 231 Chemical reaction, rupture of process vessel 141 Forest, woods or wildland fire 240 Explosion (no fire), other 142 Brush, or brush and grass mixture fire 241 Munitions or bomb explosion (no fire) 143 Grass fire 242 Blasting agent explosion 243 Fireworks explosion (no fire) Good Intent Call 251 Excessive heat, scorch burns with no ignition 651 Smoke scare, odor of smoke Rescue & Emergency Medical Service Incidents False Alarm & False Call 351 Extrication of victim(s) from building/structure 700 False alarm or false call, other 353 Removal of victim(s) from stalled elevator 710 malicious, mischievous false call, other 357 Extrication of victim(s) from machinery 711 Municipal alarm system, malicious false alarm 370 Electrical Rescue, other 712 Direct tie to FD, malicious/false alarm 371 Electrocution or potential electrocution 713 Telephone, malicious false alarm Hazardous Conditions (No Fire) 714 Central station, malicious false alarm 400 Hazardous condition, other 715 Local alarm system, malicious false alarm 410 Flammable gas or liquid condition, other 721 Bomb scare 411 Gasoline or other flammable liquid spill 730 System malfunction, other 412 Gas leak (natural gas or LPG) 731 Sprinkler activation due to malfunction 413 Oil or other combustible liquid spill 732 Extinguishing system activation due to 424 Carbon monoxide incident malfunction 440 Electrical wiring/equipment problem, other 733 Smoke detector activation due to malfunction 441 Heat from short circuit (wiring) 734 Heat detector activation due to malfunction 442 Overheated motor 735 Alarm system sounded due to malfunction 443 Light ballast breakdown 736 CO detector activation due to malfunction 444 Power line down 740 Unintentional transmission of alarm, other 445 Arching, shorted electrical equipment 741 Sprinkler activation, no fire - unintentional 461 Building or structure weakened or collapsed 742 Extinguishing system activation 471 Explosive, bomb removal (for bomb scare, use 721) 743 Smoke detector activation, no fire - 480 Attempted burning, illegal action, other unintentional 481 Attempt to burn 744 Detector activation, no fire – unintentional 482 Threat to burn 745 Alarm system sounded, no fire - unintentional Service Calls 746 Carbon monoxide detector activation, no CO 555 Defective elevator, no occupants 1E Alarm Time: The time of day that the alarm was received by the fire dept. Arrival Date: The time of day that the FIRST fire department personnel arrived on-scene. Controlled: The date and time the fire was determined by the incident commander to be under control. Last United Cleared: The date and time that the last fire department personnel left the scene. 1F Actions Taken: Fire other 45 Removed Hazard 10 Fire, other 31 Provide first aid & check for 46 Decontaminate persons or 11 Extinguish injuries equipment 12 Salvage & Overhaul 32 Provide basic life support 47 Decontaminate occupancy or 13 Establish fire lines (wildfire) (BLS) area 14 Contain fire (wildland) 33 Provide advanced life 48 Remove hazardous materials 15 Confine fire (wildland) support (ALS) Fires, Rescues & Hazardous 16 Control fire (wildland) 34 Transport person Conditions 17 Manage prescribed fire Hazardous Condition 50 Fires, rescues & hazardous (wildland) 41 Identify, analyze hazardous conditions Search & Rescue materials 51 Ventilate 20 Search & rescue, other 42 HazMat detection, 52 Forcible Entry 21 Search monitoring, sampling & 53 Evacuate area 22 Rescue, remove from harm analysis 54 Determine if materials are 23 Extricate, disentangle 43 Hazardous materials spill non-hazardous 24 Recover body control and confinement 55 Establish safe area EMS & Transport 44 Hazardous materials leak 56 Provide air supply 30 Emergency medical services, control & containment 57 Provide light or electrical 58 Operate apparatus or vehicle Systems & Services 73 Provide manpower 82 Notify other agencies 60 Systems and services, other 74 Provide apparatus 83 Provide information to 61 Restore municipal services 75 Provide equipment public or media 62 Restore sprinkler or fire 76 Provide water 84 Refer to proper authority protection system 77 Control crowd 85 Enforce code 63 Restore fire alarm system 78 Control traffic 86 Investigate 64 Shut down system 79 Assess severe weather or Fill-in, Standby 65 Secure property natural disaster damage 90 Fill-in, standby, other 66 Remove water Information, Investigation & 91 Fill-in or move-up Assistance Enforcement 92 Standby 70 Assistance, other 80 Information, investigation & 93 Cancelled enroute 71 Assist physically disabled enforcement, other 72 Assist animal 81 Incident command 1G1 Resources - Suppression Apparatus/Personnel: Enter the number of fire apparatus and vehicles as well as personnel responding from your department. EMS: The number of personnel that responded to the incident in EMS vehicles. Other Apparatus/Personnel: The number of units that responded other than fire vehicles and the number of personnel that responded in vehicles listed as other. 1G2 Property Loss: If the building, structure, property or vehicle sustained damage from fire, smoke or suppression efforts , enter your estimate of the loss to the whole dollar. Exclude estimated loss to building and vehicle contents. Contents Loss: Enter your estimate of the contents loss due to fire, smoke or suppression efforts. Pre-Incident Property Value: Your estimate of the property value prior to the fire (excluding contents). Pre-Incident Contents Value: Your estimate of the content value prior to the fire. 1H1 Casualties: Enter in the number of injuries/fatalities to both fire service and civilians. ? For Firefighter Fatalities/Casualties or Civilian Fatalities/Casualties you MUST submit a NFIRS 4 (Civilian Fire Casualty) or NFIRS 5 (Firefighter Fire Casualty) Form in addition to the Vermont Fire Incident Reporting Short Form. For copies contact the Montpelier Central Office of the Fire Prevention Division (802)828-2106. 1H3 Hazardous Material: 1 Natural gas; slow leak, no evacuation or HazMat actions 2 Propane gas; less than 21 lb. Tank (as in home BBQ grill) 3 Gasoline; vehicle fuel tank or portable container 4 Kerosene; fuel burning equipment or portable storage 5 Diesel fuel/fuel oil; vehicle fuel tank or portable storage 6 Household solvents; home/office spill, cleanup only 7 Motor oil; from engine or portable container 8 Paint; from paint cans totaling less than 55 gallons 0 Other; special HazMat actions required or spill > than 55 gallons N None 1J Property Use: Assembly 211 Preschool grocery store, supermarket 100 Assembly 213 Elementary School 529 Textile, wearing apparel 110 Fixed use recreation places, 215 High/Jr. School sales other 241 College 539 Household goods, sales, 111 Bowling alley 254 Day Care, in commercial repairs 112 Billiard center property 549 Specialty shop 113 Electronic amusement 255 Day care, in residence, 557Person service, including center licensed barber & beauty shops 114 Ice rink; indoor, outdoor 256 Day care in residence, 559 Recreational, hobby, home 115 Roller rink; indoor or unlicensed repair sales, pet store outdoor Health Care, Detention & 571 Gas station 116 Swimming facility; indoor Correction 579 Motor vehicle or boat sales, or outdoor 300 Health care, detention & services, repair 120 Variable use amusement, correction, other 580 General retail, other recreation 311 24-hour care nursing home, 581 Department or discount 121 Ballroom, gymnasium 4 or more persons store 122 Convention center, 321 Mental 592 Bank exhibition hall retardation/development 593 Office, veterinary or 123 Stadium, arena disability facility research 124 Playground 322 Alcohol substance abuse 596 Post Office 129 Amusement center; recovery center 599 Business Office indoor/outdoor 323 Asylum, mental institution Industrial, Utility, Defense, 130 Places of worship 331 Hospital – medical or Agriculture, Mining 131 Church, mosque, psychiatric 600 Utility, defense, agriculture, synagogue 332 Hospices mining, other 134 Funeral parlor 340 Clinics, doctors office 610 Energy production plant, 140 Clubs, other 341 Clinic, clinic-type infirmary other 141 Health club 342 Doctor Office, dentist or 614 Steam or heat generating 142 Clubhouse oral surgeon 615 Electric generating plant 143 Yacht club 343 Hemodialysis unit 629 Laboratory or science 144 Casino, gambling clubs 361 Jair, prision (not juvenile) laboratory 150 Govt. building 363 Reformatory, juvenile 631 Defense, military 151 Library detention cener installation 152 Museum 365 Police Station 635 Computer center 154 Memorial structure, Residential 639 Communication cener including monuments & statues 400 Residential, other 640 Utility or distribution 155 Courthouse 419 1 & 2 Family dwelling system, other 160 Eating, drinking places 429 Multi-family dwelling 642 Electrical distribution 161 Restaurant 439 Boarding/rooming house, 644 Gas distribution, pipeline, 162 Bar residential hotels gas distribution 170 Passenger terminal, other 449 Hotel/motel, commercial 645 Flammable liquid 171 Airport passenger terminal 459 Residential board care distribution, pipeline, 173 Bus Station 460 Dormitory type residence, flammable 174 Rapid transit station other 647 Water utility 180 Studio/theater, other 462 Sorority house, fraternity 648 Sanitation utility 182 Auditorium house 655 Crops or orchard 183 Movie Theater 464 Barracks, dormitories 659 Livestock production 185 Radio, television studio 460 Dormitory 669 Forest, timberland, 186 Film/movie production Mercantile, Business woodland studio 500 Mercantile, business, other 679 Mine or quarry Educational 511 Convenience Store Manufacturing, processing 200 Educational, other 519 Food and beverage sales, 700 Manufacturing Processing Storage Outside or special property 960 Street, other 807 Outside material storage 900 Outside or special property 961 Highway or divided area 919 Dump, sanitary landfill highway 808 Outbuilding or shed 921 Bridge, trestle 962 Residential street, road or 816 Grain elevator, silo 922 Tunnel residential driveway 819 Livestock, poultry storage 926 Outbuilding, peotectve 963 Street or road in 839 Refrigerated storage shelter commercial area 849 Outside storage tank 931 Open Land 965 Vehicle parking area 880 Vehicle storage 935 Campsite with utilities 972 Aircraft runway 881 Park garage, (detached 936 Vacant Lot 973 Aircraft taxi-way residential garage) 937 Beach 974 Aircraft loading area 882 Parking garage, general 938 Graded and cared-for plots 981 Construction site vehicle of land 982 Oil or gas field 888 Fire station 940 Water area other 983 Pipeline, power line or 891 Warehouse 941Open ocean, sea or tidal other utility right of way 898 Dock or marina waters 984 Industrial plant yard – area 899 Residential or self-storage 946 Lake, river, stream NNN No property use units 951 Railroad right of way UUU Property use determined 952 Rail Yard Technical Processing Areas 2D Ignition: 30 Technical processing areas, other Area of Origin(where the fire started) 31 Laboratory Means of Egress 32 Dark room, photography area, or printing area 01 Corridor, mall 33 Treatment – first aid area, surgery area 02 exterior stairway, ramp or fire escape 34 Surgery area – major operations, operating room 03 Interior stairway or ramp 35 Computer room, control room or center 04 Escalator – exterior, interior 36 Stage area – performance, basketball, court, 05 Entrance way, lobby boxing 09 Egress/exit, other 37 Projection room, spotlight area Assembly, Sales Areas (Groups of People) 38 Processing/manufacturing area, workroom 10 Assembly or sales area, other Storage Areas 11 Arena, assembly area w/fixed seats – 100+ 40 Storage area, other persons 41 Storage room, area, tank or bin 12 Assembly area without fixed seats – 100+ 42 Closet persons 43 Storage: supplies or tools; dead storage 13 Assembly area – less than 100 persons 44 Records storage room, storage vault 14 Common room, den, family room, living room, 45 Shipping/receiving area; loading area, dock or lounge bay 15 Sales area, showroom (excluded are display 46 Chute/container – trash, rubbish, waste windows) 47 Vehicle storage area; garage, carport 16 Art gallery, exhibit hall, library Service Areas 17 Swimming pool 50 Service facilities, other Function Area 51 Dumbwaiter or elevator shaft 20 Function area, other 52 Conduit, pipe, utility, or ventilation shaft 21 Bedroom-< 5 persons; included are jail or prison 53 Light shaft 22 Bedroom –5+_ persons; included are 54 Chute; laundry or mail, excluding trash chutes barracks/dormitories 55 Display window 23 Bar area, beverage service area, cafeteria 58 Conveyor 24 Cooking area, kitchen Service, Equipment Areas 25 Bathroom, checkroom, lavatory, locker room 60 Equipment or service area 26 Laundry area, wash house (laundry) 61 Machinery room or area; elevator 27 Office 62 Heating room or area, water heater area 28 Personal service area, barber/beauty salon area 63 Switchgear area, transformer vault 64 Incinerator area 55 Model and amateur rockets 65 Maintenance shop or area, paint shop or area 56 Incendiary device 66 Cell, test Other Open Flame or Smoking Materials 67 Enclosure, pressurized area 60 Heat from other open flame or smoking Structural Areas materials 70 Structural area, other 61 Cigarette 71 Substructure area or space, crawl space 62 Pipe or cigar 72 Exterior balcony, unenclosed porch 63 Heat from undetermined smoking material 73 Ceiling & floor assembly, crawl space between 64 Match stories 65 Cigarette lighter 74 Attic; Vacant, crawl space above top story, 66 Candle cupola 67 Warning or road flare; fuse 75 Wall assembly 68 Backfire from internal combustion engine 76 Wall surface: exterior 69 Flame/torch used for lighting 77 Roof surface: exterior Chemical, Natural Heat Sources 78 Awning 70 Chemical, natural heat source, other Transportation, Vehicle Areas 71 Sunlight 80 Vehicle area, other 72 Chemical reaction 81 Operator/passenger area of transportation equip. 73 Lightning 82 Cargo/trunk area – all vehicles 74 Other static discharge 83 Engine area, running gear, wheel area Heat Spread from Another Fire 84 Fuel tank, fuel line 80 Heat spread from another fire, other 85 Separate operator/control area of transportation 81 Heat from direct flame, convection currents 86 Exterior, exposed surface 82 Radiated heat from another fire Other Area of Origin 83 Flying brand, ember, spark 90 Outside area, other 84 Conducted heat sources including multiple 91 Railroad right of way: on or near ignitions 92 Highway, parking lot, street: on or near 00 Heat source: Other 93 Courtyard, patio, porch, terrace UU Undetermined 94 Open area – outside; included are farmlands, fields Item First Ignited: 95 Wildland, Woods Structural Component, Finish 96 Construction/renovation area 10 Structural component or finish, other 98 Vacant structural area 11 Exterior roof covering or finish 00 Other 12 Exterior wall covering or finish UU Undetermined 13 Exterior trim, including doors 14 Floor covering or rug/carpet/mat Heat Source: 15 Interior wall covering excluding drapes, etc. Operating Equipment 16 Interior ceiling cover or finish 10 Heat from powered equipment, other 17 Structural member or framing 11 Spark, ember or flame from operating equipment 18 Insulation within structural area 12 Radiated, conducted heat from operating Furniture, Utensils, including built-in furniture equipment 20 Furniture, utensils, other 13 Arcing 21 Upholstered sofa, chair, vehicle seats Hot or smoldering object 22 Non-upholstered chair, bench 40 Hot or smoldering object 23 Cabinetry (including built-in) 41 Heat, spark from friction 24 Ironing board 42 Molten, hot material 25 Appliance housing or casing 43 Hot ember or ash 26 Household utensils Explosives, Fireworks Soft Goods, Wearing Apparel 50 Explosive, fireworks, other 30 Soft goods, wearing apparel, other 51 Munitions 31 Mattress, pillow 53 Blasting agent 32 Bedding; blanket 54 Fireworks 33 Linen; other than bedding 34 Wearing apparel not on a person 66 Pipe, duct, conduit or hose 35 Wearing apparel on a person 67 Pipe, duct, conduit, hose covering 36 Curtains, blinds, drapery, tapestry 68 Filter, including evaporative cooler pads 37 Goods not made up, including fabric & yard Organic Materials goods 70 Organic materials 38 luggage 71 Agricultural crop, including fruits and vegetables Adornment, Recreational Material 72 Light vegetation – not crop, including grass 40 Adornment, recreational material, signs, other 73 Heavy vegetation – not crop, including trees 41 Christmas tree 74 Animal living or dead 42 Decoration 75 Human living or dead 43 Sign, including outdoor signs such as billboards 76 Cooking materials, including edible materials 44 Chips, including wood chips 77 Feathers or fur, not on bird or animal 45 Toy or game General Materials 46 Awning, canopy 81 Electrical wire, cable insulation 47 Tarpaulin or tent 82 Transformer, including transformer fluids Storage Supplies 83 Conveyor belt, drive belt, V-belt 50 storage supplies, other 84 Tire 51, Box, carton, bag, basket, barrel 85 Railroad ties 52 Material being used to make a product 86 Fence, pole 53 Pallet, skid (empty) 87 Fertilizer 54 Cord, rope, twine 88 Pyrotechnics, explosives 55 Packing, wrapping material 91 Book 56 Baled goods or material 92 Magazine, newspaper, writing paper 57 Bulk storage 93 Adhesive 58 Palletized material stored on pallets 94 Dust, fiber, lint, including sawdust and excelsior 59 Rolled, wound material (paper, fabric) 95 Film, residue, including paint & resin Liquids, Piping, Filters 96 Rubbish, trash or waste 60 Liquids, piping, filters, other 97 Oily rags 61 Atomized liquid, vaporized liquid, aerosol 99 Multiple items first ignited 62 Flammable liquid/gas-in/from final container 00 Other item first ignited 64 Flammable liquid/gas in container or pipe UU Undetermined 65 Flammable liquid/gas – uncontained 2F1 Equipment Involved in Ignition: 143 Heater, oil filled 100 Heating, ventilating & air conditioning, other 144 Heat lamp 111 Air conditioner 145 Heat tape 112 Heat pump 151 Water heater 113 Fan 152 Steamline, heat pipe, hot air duct, 114 Humidifier Electrical Distribution, Lighting & Power 115 Ionizer Transfer 116 Dehumidifier 200 Electrical distribution, power transfer, other 117 Evaporative cooler, cooling tower 210 Electrical wiring, other 120 Fireplace, chimney, other 211 Electrical power (utility) line 121 Fireplace, masonry 212 Electrical service supply wires from utility 122 Fireplace, factory built 213 Electric meter, meter box 123 Fireplace, insert/stove 214 Wiring from meter box to circuit breaker 124 Stove, heating 215 Panelboard, switchboard, circuit breaker board 125 Chimney connector, vent connector 216 Electrical branch circuit 126 Chimney – brick, stone, masonry 217 Outlet, receptacle 127 Chimney-metal, including stovepipe flue 218 Wall switch 131 Furnace, local heating unit, built-in 219 Ground fault interrupter, GFI 132 Furnace, central heating unit 221 Transformer, distribution type 133 Boiler (power, process, heating) 222 Overcurrent, disconnect equipment 141 Heater, excluding catalytic and oil filled heaters 223 Transformer, low voltage 142 Heater, catalytic 224 Generator 225 Inverter 347 Powered jacking equipment 226 Uninterrupted power supply ( UPS) 348 Drilling machinery or equipment 227 Surge protector 351 Heat treating equipment 228 Battery charger, rectifier 352 Incinerator 229 Battery 353 Industrial furnace, kiln 230 Lamp, lighting, other 354 Tarpot, tar kettle 231 Lamp-tabletop, floor, desk 355 Casting, molding, forging equipment 232 Lantern, flashlight 356 Distilling equipment 233 Incandescent lighting fixture 357 Digester, reactor 234 Fluorescent lighting fixture, ballast 358 Extractor, waste recovery machine 235 Halogen lighting fixture or lamp 361 Conveyor 236 Sodium, mercury vapor lighting fixtures or 362 Power transfer equipment: ropes, cables, blocks lamps 363 Power take-off 237 Work light, trouble light 364 Powered valves 238 Light bulb 365 Bearing or brake 241 Nightlight 371 Picking, carding, weaving machine 242 Decorative lights, line voltage 372 Testing equipment 243 Decorative or landscape lighting, low voltage 373 Gas regulator 244 Sign 374 Motor-separate 251 Fence, electric 375 Internal combustion engine (non-vehicular) 252 Traffic control device 376 Printing press 253 Lightning rod, arrester/grounding device 377 Car washing equipment 260 Cord, plug, other Commercial & Medical Equipment 261 Power cord, plug-detachable from appliance 400 Commercial or medical equipment, other 262 Power cord, plug- permanently attached 410 Medical equipment, other 263 Extension Cord 411 Dental, medical, or other powered bed or chair Shop Tools & Industrial Equipment 412 Dental equipment, other 300 Shop or industrial equipment, other 413 Dialysis equipment 310 Power tools, other 414 Medical imaging equipment 311 Power saw 415 Medical monitoring equipment 312 Power lathe 416 Oxygen administration equipment 313 Power shaper 417 Radiological equipment, X-ray 314 Power cutting tool 418 Sterilizer; medical 315 Power drill 419 Therapeutic equipment 316 Power sander, grinder, buffer, polisher 421 Transmitter 317 Power hammer, including jackhammers 422 Telephone switching gear, including PBX 318 Power nail gun, stud drive, stapler 423 TV monitor array 320 Painting tools, other 424 Studio type TV camera 321 Paint dipper 425 Studio type sound recording/modulating 322 Paint flow coating machine equipment 323 Paint mixing machine 426 Radar equipment 324 Paint sprayer 431 Amusement ride equipment 325 Coating machine, including asphalt-saturating 432 Ski lift 331 Welding torch 433 Elevator or lift 332 Cutting torch 434 Escalator 333 Burners 441 Microfilm, microfiche viewing equipment 334 Soldering equipment 442 Photo processing equipment 340 Hydraulic equipment, other 443 Vending machine 341 Air compressor 444 Non video arcade game 342 Gas compressor 445 Water fountain, water cooler 343 Atomizing equipment 446 telescope 344 Pump 450 Laboratory equipment, other 345 Wet/dry vacuum (shop vacuum) 451 Electron microscope 346 Hoist, lift Garden Tools & Agricultural Equipment 500 Gardening tools or agricultural equipment, 710 Computer device, other other 711 Computer 511 Combine, threshing machine 712 Computer storage device: external 512 Hay processing equipment 713 Computer modem: external 513 Elevator or conveyor: farm 714 Computer monitor 514 Silo loader, unloader, screw/sweep auger 715 Computer printer 515 Feed grinder, mixer, blender 716 Computer projection device, LCD panel 516 Milking machine 720 Office equipment, other 517 Pasteurizer 721 Adding machine, calculator 518 Cream separator 722 Telephone or answering machine 521 Sprayer: farm or garden 723 Cash register 522 Chain saw 724 Copier 523 Weed burner 725 Fax Machine 524 Lawn mower 726 Paper shredder 525 Lawn, landscape trimmer, edger 727 Postage, shipping meter equipment 531 Lawn vacuum 728 Typewriter 532 Leaf blower 730 Musical instrument, other 533 Mulcher, grinder, chipper 731 Guitar 534 Snow blower, thrower 732 Piano, organ 535 Log splitter 733 Musical synthesizer or keyboard 536 Post-hole auger 740 Sound recording or receiving equipment, other 537 Post driver, pile driver 741 CD player (audio) 538 Tiller, cultivator 742 Laser disk player Kitchen & Cooking Equipment 743 Radio 600 Kitchen & Cooking equipment 744 Radio, two way 611 Blender, juicer, food processor, mixer 745 Record player, phonograph, turntable 612 Coffee grinder 747 Speakers, audio- separate components 621 Can opener 748 Stereo equipment 622 Knife 749 Tape recorder or player 623 Knife sharpener 750 Video equipment, other 631 Coffee maker or teapot 751 Cable converter box 632 Food warmer, hot plate 752 Projector: film, slide, overhead 633 Kettle 753 Television 634 Popcorn popper 754 VCR or VCR/TV promotion 635 Pressure cooker or canner 755 Video game- electronic 636 Slow cooker 756 Camcorder, video camera 637 Toaster, toaster oven, counter-top broiler 757 Photographic camera and equipment 638 Waffle iron, griddle Personal & Household Equipment 639 Wok, frying pan, skillet 800 Personal or household equipment, other 641 Breadmaking machine 811 Clothes dryer 642 Deep fryer 812 Trash compactor 643 Grill, hibachi, barbecue 813 Washer/dryer combination (within one frame) 644 Microwave oven 814 Washing machine – clothes 645 Oven, rotisserie 821 Hot tub, whirlpool, spa 646 Range with or without oven, cooking surface 822 Floor care equipment, other 647 Steam table, warming drawer/table 831 Broom – electric 651 Dishwasher 832 Carpet cleaning equipment, including rug 652 Freezer when separate from refrigerator shampooer 653 Garbage disposer 833 Floor buffer, waxer, cleaner 654 Grease hood/duct exhaust fan 834 Vacuum cleaner 655 Ice maker (separate from refrigerator) 841 Comb, hair brush 656 Refrigerator, refrigerator/freezer 842 Curling Iron Electronic and Other Electrical Equipment 843 Electrolysis equipment 700 Electronic equipment, other 844 Hair curler warmer 845 Hair dryer 871 Ashtray 846 Makeup mirror-lighter 872 Charcoal lighter 847 Razor, shaver 873 Cigarette lighter, pipe lighter 848 Suntan equipment sunlamp 874 Fire extinguisher equipment 849 Toothbrush 875 Insect trap 850 Portable appliance designed to produce heat, 876 Timer other 881 Model vehicles 851 Baby bottle warmer 882 Toy, powered 852 Blanket – electric 883 Woodburning kit 853 Heating Pad 891 Clock 854 Clothes steamer 892 Gun 855 Clothes Iron 893 Jewelry cleaning machine 861 Automatic door opener – not garage 894 Scissors 862 Burglar alarm 895 Sewing machine 863 Garage door opener 896 Shoe polisher 864 Gas detector 897 Sterilizer 865 Intercom 000 Other equipment involved in ignition 866 Smoke or heat detector, fire alarm NNN None 868 Thermostat UUU Undetermined 2F2 Equipment Power Electrical 40 Solid fuel, other 10 Electrical, other 41 Wood, paper 11 Electrical line voltage (?50 volts) 42 Coal, charcoal 12 Batteries and low voltage (<50 volts) 43 Chemicals, other Gas Fuels Compressed air 20 Gas fuels, other 52 Steam 21 Natural gas or other lighter than air gas 53 Water 22 LP gas or other heavier than air gas 54 Wind Liquid Fuels 55 Solar 30 Liquid fuel, other 56 Geothermal 31 Gasoline 57 Nuclear 32 Alcohol 58 Fluid/hydraulic power source 33 Kerosene, diesel, No. 1 & 2 fuel oil UU Power source undetermined Solid Fuels 174 Elevator shaft 2G Fire Suppression Factors: 175 Dumbwaiter Building Construction or Design Factors 176 Ducts: vertical 100 Building construction or design factors, other 177 Chute: rubbish, garbage, laundry 112 Roof collapse 181 Supports unprotected 113 Roof assembly combustible 182 Composite plywood I beam construction 121 Ceiling Collapse 183 Composite roof/floor sheathing construction 125 Holes or openings in walls or ceilings 185 Wood truss construction 131 Wall collapse 186 Metal truss construction 132 Difficult to ventilate 187 Fixed burglar protection assemblies (bars, 134 Combustible interior finish grills) 138 Internal arrangement of partitions 188 Quick release failure of bars on windows or 139 Internal arrangement of stock or contents doors 141 Floor collapse 192 Previously damaged by fire 151 Lack of fire barrier walls or doors Act or Omission 153 Transoms 200 Act or omission, other 161 Attic undivided 213 Doors left open or outside door unsecured 166 Insulation combustible 214 Fire doors blocked or did not close properly 173 Stairwell not enclosed 218 Violation of fire, building or life safety code 222 Illegal and clandestine drug operation 451 Apparatus failure before arrive at incident 232 Intoxication, drugs or alcohol 452 Hydrants inoperative 253 Riot or civil disturbance, including hostile acts 461 Airspace restriction 254 Persons interfered with operations 462 Military activity 283 Accelerant used 481 Closest Apparatus unavailable On-site Material Protective Equipment 300 Building contents, other 500 Protective equipment Factor 311 Aisles blocked or improper 510 Automatic fire suppression system problem 312 Significant/unusual fuel load structure 520 Automatic sprinkler, standpipe connection components problem 313 Significant/unusual fuel load from contents 531 Water supply inadequate: private 314 Significant/unusual fuel load from Natural 532 Water supply inadequate: public 315 Significant/unusual fuel load from man-made 543 Electrical Power outage condition 561 Failure of rated fire protection assembly 316 Storage, improper 562 Protective equipment negated 321 Radiological hazard onsite Egress/Exit Factors 322 Biological hazard onsite 600 Egress/exit problem, other 323 Cryogenic hazard onsite 611 Occupancy load above legal limit 324 Hazardous chemical, corrosive material or 612 Evacuation activity impeded FD access oxidize 613 Window type impedes egress 325 Flammable/combustible liquid hazard 614 Windowless wall 327 Explosive hazard present 621 Young occupants 331 Decorations, included are crepe paper, garland 622 Elderly Occupants 341 Natural or other lighter than air gas present 623 Physically disabled occupants 342 Liquefied Petroleum (LPG) gas present 624 Mentally disabled occupants 361 Combustible storage > 12 feet 625 Physically restrained/confined 362 High rack storage 626 Medically disabled occupants Delays 641 Special Event 400 Delays, other 642 Public Gathering 411 Delayed detection of fire Natural Conditions 412 Delayed reporting of fire 700 Natural condition, other 413 Alarm system malfunction 711 Drought or low fuel moisture 414 Alarm system shut off for valid reason 712 Humidity how 415 Alarm system inappropriately shut off 713 Humidity high 421 Unable to contact Fire Department 714 Temperature: low 424 Information incomplete or incorrect 715 Temperature: high 425 Communications problem 721 Fog 431 Blocked or obstructed roadway 722 Flooding 434 Poor or no access for fire department apparatus 723 Ice 435 Traffic delay 724 Rain 436 Trouble finding location 725 Snow 437 Size, height, or other building characteristic 732 Wind, including hurricanes or tornadoes 438 Power lines down/arcing 741 Earthquake 443 Poor access for firefighters 760 Unusual vegetation fuel loading 444 Secured area 771 Threatened or endangered species 445 Guard dogs 772 Timber sale activity 446 Aggressive animals, excluding guard dogs 773 Fire restriction 447 Delay from evaluation of HazMats at incident 774 Historic disturbance scene 775 Urban-wildland interface area 448 Locked or jammed doors 000 Fire suppression factor, other 2H2 Mobile Property Type & Make: 11 Passenger car Passenger or road transport vehicles 12 Bus, school bus, trackless trolley 10 Passenger road vehicle 13 Off-road recreational vehicle 14 Motor home, camper bookmobile Mobile Property, Miscellaneous 15 Trailer – travel, designed to be towed 71 Home, garden vehicle 16 Trailer – camping collapsible 73 Shipping container, mechanically moved 17 Mobile Home 74 Armored vehicle 18 Motorcycle, trail bike 75 Missile, rocket space vehicle Freight road vehicles 76 Aerial tramway vehicle 20 Freight road transport vehicle, other 00 Mobile property, other 21 General use truck, dump truck, fire apparatus NN No mobile property 22 Hauling rig (non-motorized), pickup truck 23 Trailer-semi, designed for freight Mobile Property Make Codes: 24 Tank truck – nonflammable cargo AC Acura 25 Tank truck – flammable or combustible liquid AM Aston Martin 26 Tank truck – compressed gas or LP Gas AR Alfa Romeo 27 Garbage, waste, refuse truck AT ATK Transport vehicles AU Audi 30 Rail transport vehicle AV Antique vehicle 31 Diner car, passenger car – rail BE Beta 32 Box, freight, or hopper car – rail BL Buell 33 Tank car – rail BM BMW 34 Container or piggyback car - rail BU Buick 35 Engine/locomotive – rail CC Crane carrier (CCC) 36 Rapid transit car, trolley – self-powered CD Cadillac 37 Maintenance equipment car CH Chevrolet Water vessels CP Caterpillar 40 Water transport vessel, other CR Chrysler 41 Boat; shorter than 65 ft. with power CV Classic Vehicle 42 Boat, ship or ? 65 ft but < 1,000 tons DA Daihatsu 43 Cruise liner or passenger ship ? DO Dodge 44 Tank ship DR Diamond Rio 45 Personal water craft DU Ducati 46 Cargo or military ship? 1,000 EA Eagle 47 Barge, petroleum balloon, towable water vessel FE Ferrari 48 Commercial fishing or processing vessel FO Ford 49 Sailboat FR Freightliner Aircraft FW FWD 50 Air transport vehicle GE Geo 51 Personal aircraft less than 12,500 lb. gross wt GM GMC (General Motors) 52 Person aircraft? 12,500 lb. gross wt HD Harley Davidson 53 Commercial transport propeller driven/fixed HI Hino wing HO Honda 54 Commercial jet: fixed wing HU Husqverna 55 Helicopter – nonmilitary HY Hyundai 56 Military fixed wing aircraft IF Infiniti 57 Military non fixed wing aircraft IN International 58 Balloon vehicles IS Isuzu Industrial, agricultural, construction vehicles IT Itaject 60 Industrial, construction, agricultural vehicle, IV Iveco other JA Jaquar 61 Construction vehicle JE Jeep 63 Loader – industrial, fork lift, tow motor, stacker KA Kawasaki 64 Crane KE Kenworth 65 Agricultural vehicle, baler, chopper (farm use) KI Kia 67 Timber harvest vehicle KT KTM LE Lexus LI Lincoln PU Peugeot LO Lotus RG Rogue (Ottowa) LR Land Rover RN Ranger Rover MA Maico RR Rolls Royce MB Mercedes Benz SA Saturn MC Mercury SB Saab MG Moto Guzzi SC Scania MH Marmon SD Simon Duplex MK Mack ST Sterling ML Maely SU Subaru MM Moto Morini SZ Suzuki MO Montesa TO Toyota MR Merku TR Triumph MS Maserati UD UD MT Mitsubishi UT Utilmaster MZ Mazda VE Vespa NA Navistar VG Volvo GMC NI Nissan VL Volvo OL Oldsmobile VO Volkswagon OS Oshkosh WG White GMC PI Pierce WK Walker PL Plymouth WL Walter PN Pontiac WS Western Star PR Porsche YA Yamaha PT Peterbilt YU Yugo Important Information: ? If you wish to report electronically, software and forms may be obtained through the Fire Prevention Division, Central Office, National Life Office Building, Drawer 20, Montpelier VT 05620-3401; or call (802)828-2106 with any questions.
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