Free Incident Report Template 19
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FIRE INCIDENT REPORT
Version September 2010

FOR NOTIFICATION OF ANY FIRE OR FIRE RELATED INCIDENT
(E.g. premises evacuation, alarm activation, building / vehicle fire, obstructed exit routes)
LOCATION
DATE

TIME

DEPARTMENT

BUILDING

FLOOR AND ROOM

CALL POINT/DETECTOR HEAD*
(delete as approp) LOCATION

IF DETECTOR HEAD
- NUMBER:

INCIDENT DETAILS AND PROBLEMS IDENTIFIED

ACTION TAKEN AND FURTHER ACTION REQUIRED

DATE ACTION
COMPLETED

LINE MANAGER
PRINT NAME
AND SIGN

Tick if applicable
Alarm Activated

Fire Brigade
Attended

Extinguisher
Discharged

Building
Evacuated

CONTACT DETAILS (persons involved in incident)
NAME
DEPT

NAME
DEPT

FORM COMPLETED BY
NAME
DEPT
POSITION

EMAIL
TEL EXT

Please forward a copy to University Health & Safety Department, Exion 27, fax to 644799 or email to
[email protected] (original to be kept by reporting Dept for records)

Office Use Only
Fire 
Signature
Date Received

Malicious 
Action

Accidental 

Apparatus 

Vandalism 
Ref No