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 Analytics & Intelligence Unit at 503-934-8250, 877-588-8787 (toll free) or OSFM.DATA@osfm.oregon.gov.
3. A complete NFIRS 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