Renovation Incident Form by ciy72545

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                                                       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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