Location Address: (Required) City: State: Select One one AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA ME MD MI MO MN MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: County: Incident Number: (Required) Date: Time: Building Information Type of Occupancy: (Required) Select Single Family max 3 stories above grade Single Family max 4 stories above grade Townhouse max 3 stories above grade Townhouse max 4 stories above grade Garden Apartments max 4 stories above grade Apartments/Condo/Residential more than 4 stories Commercial Number of Stories: Did the fire start inside the building? Select Internal External Story of Origin: Room of Origin: (Required) Sprinkler Information Number of Heads in Room: Number of Heads Activated: Type of Sprinkler Heads Activated: Select Pendant Upright Concealed Sidewall Open Special Spray Select Standard Quick Response ESFR Extended Coverage Unknown Other Notes Reason For Activation: (Required) Select Fire Vandalism Broken Head Unknown Other Notes Smoke Detection Smoke Detector Present: Select Yes No Smoke Detector Activation: Select Yes No Unknown Damage Structure: $ Contents: $ Estimated Money Saved: Compared to a total loss. $ Number of People Home During Fire: Number of People Hurt/Killed During Fire: Fire Contained to Point of Origin: Select Yes No Point of Origin includes an area of approximately 4 square feet and one or two items ignited but not consumed. Person Reporting System Put Back In Service: Select Yes No Name and Rank/Title of Person Providing Information: (Required)