Fire Casualty Report

Must be sent within 24 hrs

PLEASE NOTE:
1. Fire Agencies in Oregon are required to submit this report on all deaths or serious injuries within 24 hours.
2. For questions about submitting this form contact the Center for Fire Analytics, Intelligence and Research at 503-934-8250, 877-588-8787 (toll free) or OSFM.DATA@osfm.oregon.gov.
3. A complete Fire Report for this victim must also be submitted into the state repository.

Fire Agency Information

Fire Agency Name

The name of the primary fire agency.

N/A

County

Deputy State Fire Marshal Response

NoYes

Deputy State Fire Marshal Name

OSFM Report Number

This NFI report number format should follow this example: YYYYInitialsreportnumber (YYYYABC123)

Fire Agency Contact Name

Fire Agency Contact Email

Fire Agency Contact Phone

Incident Information

Date of Fire

Incident Number

Occupancy

Occupancy Other *

Please Specify

Detector (Smoke Alarm) Present

Detector (Smoke Alarm) Activated

Failure Reason