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FIRE REPORTING FORM
Use this form if:
You are reporting the beginning or end of a fire watch,
Reporting a fire incident in a Health Care Facility, or
Reporting a fire incident at a Public School property.
Type of Report
Please select...
Beginning of Fire Watch
End of Fire Watch
Fire Occurred at Health Facility
Fire Occurred at a Public School
Other
Was this fire started by or suspected of being started by (select all that apply):
A youth
A social media challenge
Neither
Other
Please specify how the fire was started or suspected of being started
Name of Facility
Street Address of Facility
City of Facility
State of Facility
ZIP Code of Facility
Contact Person Name (First & Last)
Contact Person Phone (Including Area Code)
Contact Person Email
Other Explanation
Type of Notification
Fire alarm system needs repair and will be out of service for more than 4 hours in a 24-hour period
Fire sprinkler system needs repair and will be out of service for more than 4 hours in a 24-hour period
Type of Notification
Fire alarm system has been repaired and and is working.
Fire sprinkler system has been repaired and is working.
Date Fire Watch Began
MM/DD/YYYY
Time Fire Watch Began
Example: 11:30 AM
Date Fire Watch Ended
MM/DD/YYYY
Time Fire Watch Ended
Example: 11:30 AM
Date of Fire
MM/DD/YYYY
Other Date
MM/DD/YYYY
Frequency of Inspections
Please select...
Every 15 Minutes
Every 30 Minutes
The entire patrol area is inspected every 15 minutes in the following situations: a) The facility has people sleeping. b) The facility is currently occupied by any resident who is not capable of exercising judgment and appropriate physical action for self-preservation under emergency conditions. c) The facility contains an occupied assembly occupancy. Facilities that do not meet the requirements for a 15-minute patrol frequency should have a Fire Watch patrol frequency of every 30 minutes.
Fire Watch personnel has been established and is able to complete assigned duties.
Fire alarm monitoring company has been notified.
Local fire department has been notified.
Repair company has been contacted to fix the fire protection system(s).
A Fire Log will be kept for the duration of the Fire Watch and provided to DFPC
A Fire Log was kept for the duration of the Fire Watch and will be provided to DFPC
Fire Log Upload
You may also FAX your Fire Log to 303.239.4131
Document Upload (if applicable)
Name of Responding Fire Department
Extent of Fire Damage
Please select...
Single Item
Multiple Items in the Same Room
Entire Room
Multiple Rooms
Entire Facility
Number of Injuries
Please select...
None
Single Resident and/or Staff
Multiple Residents and/or Staff
Extent of Injuries (choose most severe)
Please select...
First Aid Provided by Staff
Treated and Released by EMS or Fire
Transported to Hospital
Deceased
Contact Information