A
FDIDStateDeleteChangeNo Activity
NFIRS -1Basic
MMDDYYYY
StationIncident NumberExposureIncident Date
*****
,,
$
,,
B
Location
Street addressIntersectionIn front ofRear of Adjacent toDirections
Check this box to Indicate that the address for this incident is provided on the Wildland FireModule In Section B "Alternative Location Specification". Use only for Wildland fires.
*
-
Census TractNumber/MilepostPrefixStreet or HighwayStreet TypeSuffixApt./Suite/RoomCityStateZip Code
-
Cross street or directions, as applicable
CD
Incident Type
*
Incident Type
Aid Given or Received
Mutual aid received Automatic aid recv. Mutual aid given Automatic aid givenOther aid given None
*
12345 N
Their FDIDTheirStateTheirIncident Number
EEE
123Date & Times
Midnight is 0000
Check boxes ifdates are thesame as AlarmDate.ALARM always required
MonthDayYearHr Alarm ArrivalControlled Last UnitCleared Min
**
ARRIVAL required, unless canceled or did not arriveCONTROLLED Optional, Except for wildland firesLAST UNIT CLEARED, required except for wildland fires
Shift & Alarms
Local OptionShift orPlatoonAlarmsDistrict
Special Studies
Local OptionSpecialStudy ID#SpecialStudy Value
F
Actions Taken
*
Primary Action Taken (1)Additional Action Taken (2)Additional Action Taken (3)
G
1
G
2Resources
*
Estimated Dollar Losses & Values
Check this box and skip thissection if an Apparatus orPersonnel form is used.
ApparatusPersonnelSuppressionOtherEMS
Check box if resource countsinclude aid received resources.
LOSSES:
Required for all fires if known. Optionalfor non fires.
$
,,
$
,,
$
PRE-INCIDENT VALUE:
Optional
NonePropertyPropertyContentsContentsFire-2Structure-3Civil Fire Cas.-4Fire Serv. Cas.-5EMS-6HazMat-7 Wildland Fire-8 Apparatus-9Personnel-10 Arson-11
Completed Modules
H
1
H
2
H
3Casualties
*
None
FireServiceCivilian
DeathsInjuriesDetector
Detector alerted occupantsDetector did not alert them Unknown
12U
Required for Confined Fires.
Not Mixed Assembly useEducation use Medical useResidential useRow of storesEnclosed mallBus. & ResidentialOffice useIndustrial use Military useFarm useOther mixed use
Mixed Use Property
I
NN102033405153585960636500
Natural Gas:Propane gas:Gasoline:Kerosene:Diesel fuel/fuel oil:
12345
Household solvents: Motor oil:Paint:Other:
6780
None
NProperty Use
*
Structures
J
Clinic,clinic type infirmaryDoctor/dentist officePrison or jail, not juvenile1-or 2-family dwelling Multi-family dwellingRooming/boarding houseCommercial hotel or motelResidential, board and careDormitory/barracksFood and beverage sales
341342361419429439449459464519
Household goods,sales,repairs Motor vehicle/boat sales/repairGas or service stationBusiness officeElectric generating plantLaboratory/science lab Manufacturing plantLivestock/poultry storage(barn) Non-residential parking garage Warehouse
539579571599615629700819882891
Church, place of worshipRestaurant or cafeteriaBar/Tavern or nightclubElementary school or kindergartenHigh school or junior highCollege, adult educationCare facility for the aged Hospital
131161162213215241311331Hazardous Materials Release
Playground or parkCrops or orchard Forest (timberland)Outdoor storage areaDump or sanitary landfillOpen land or field
124655669807919931
Vacant lotGraded/care for plot of land Lake, river, stream Railroad right of wayOther streetHighway/divided highwayResidential street/driveway
936938946951960961962
Construction siteIndustrial plant yard
981984
Outside
Property Use
WB70113-002614400010412
Gas leak (natural gas or LPG)
X3701 W I20HWY ARLINGTON TX76016X23:00:0901:02:4823:13:01C0110X00040010TXX982Oil or gas field 86
Investigate
09172013090909171718201320132013
slow leak, no evauation or HazMat actions <21 lb. tank (as in home BBQ grill)vehicle fuel tank or portable containerfuel burning equipment or portable storagevehicle fuel tank or portablehome/office spill, cleanup onlyfrom engine or portable containerfrom paint cans totaling < 55 gallonsSpecial HazMat actions required or spill > 55gal.,Please complete the HazMat form
NFIRS-1 Revision 03/11/99
000000000000000000000000
Sec
XX
Lookup and enter a Property Use code only ifyou have NOT checked a Property Use box:
CITY OF ARLINGTON 13-002614409/17/2013WB701