Fuel Geyser Incident Reporting Form

Published on NWCG (https://www.nwcg.gov)

Fuel Geyser Incident Reporting Form

[1]

Email (optional) [email protected]
Date of Incident
Year

Month

Day

Time of Incident
Hour
: 00
am
pm
Geographic Area
Northwest
Northern California
Southern California
Great Basin
Northern Rockies
Rocky Mountain
Southwest
Southern
Eastern
Alaska
All location and time-based questions pertain to when and where the geyser incident happened.
State - None Unit
Did it occur on an incident?
Yes
No
If yes, what was the incident name?
Equipment Type *
Chain Saw
Leaf Blower
Water Pump
Fuel Transport Container
Other
Other
Make
Model
Serial Number (if available)
If this is a small engine, prior to the incident how was it running?

Approximate Air Temperature (Fahrenheit)

Approximate Elevation the Geyser Occurred
If you hiked to the location of where the geyser occurred, what was the approximate elevation at the
beginning of your hike?
If you hiked to the location of where the geyser occurred, what was the approximate distance you
hiked?
What type of work was being performed?

Were any injuries associated with the fuel geyser event?
Yes
No
Were actions taken to mitigate the impacts of a potential fuel geyser before the event occurred?
Yes
No
If actions were taken to mitigate the impacts of a fuel geyser what were they?

Fuel octane rating (if known)
Fuel ethanol content (if known)
Where was the fuel acquired?
Fire Camp
Local Unit
Gas Station
Other
Other Fuel Acquired
How old is the fuel?
< 1 week
1-2 weeks
2 weeks to 1 month
1 to 3 months
3 to 6 months
> 6 months
If the fuel was a two cycle mix, what was the mix ratio?
50:1
40:1
Other
Other Fuel Cycle Mix
Is a fuel sample available?
Yes
No
If a fuel sample is available please contact: Ralph Gonzales; San Dimas Technology Development
Center; 444 E Bonita Ave; San Dimas, CA 91773
Available Photos

Please add any photos you may have of the incident. If possible, please upload a high quality
photo, around 3 MB generally is a good size. 300 dpi is preferable.
Files must be less than 15 MB.
Allowed file types: gif jpg jpeg png.
Choose File No file chosen

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Submit
Source URL (retrieved on 2018-05-08 15:20): https://www.nwcg.gov/committees/equipment-technology-committee/fuelgeyser-incident-reporting-form
Links:
[1] https://www.nwcg.gov/committees/equipment-technology-committee/fuel-geyser-incident-reporting-form