NFIRS Module 1 - Basic

National Fire Incident Reporting System (NFIRS) Version 5.0

NFIRS Module 1 - Basic

OMB: 1660-0069

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1660-0069 can be found here:

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NFIRS 5.0 Self-Study Program

Basic Module:
NFIRS-1

Objectives
After completing the Basic Module, the student will be able to:
1. Describe when the Basic Module is to be used.
2. Demonstrate how to complete the Basic Module correctly, given the
scenario of a hypothetical incident.
3. Identify other NFIRS modules that would need to be completed, based
on information captured on the Basic Module.

1-1

Table of Contents
Pretest #1 - Basic Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
Using The Basic Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4
Section A: FDID, State, Incident Number, Incident Date, Exposure Number. . . . . . . . . . . . . . 1-4
Section B: Location. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
Section C: Incident Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
Section D: Aid Given or Received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6
Block E1: Dates and Times. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
Block E2: Shifts and Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
Block E3: Special Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
Section F: Actions Taken . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8
Block G1: Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8
Block G2: Estimated Dollar Losses and Values. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
Block H1: Casualties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
Block H2: Detector Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
Block H3: Hazardous Materials Release. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10
Section I: Mixed Use Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10
Section J: Property Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11
Section K1: Person/Entity Involved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11
Section K2: Owner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12
Section L: Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12
The Narrative Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13
Section M: Authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13
Example: Fire in Metal Trash Can . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14
Exercise Scenario 1-1: Food on Stove. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-17
Exercise Scenario 1-2: Cary Street House Fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22
Basic Module Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-25

NFIRS 5.0 Self-Study Program

Pretest #1 - Basic Module
1. The Basic Module is required for every type of incident to which a department responds.

(a) True.

(b) False.

2. A Basic Module could be the only module completed in certain situations.

(a) True.

(b) False.

3. A Basic Module should not be completed if the department has no responses for the month.

(a) True.

(b) False.

4. For an incident involving multiple departments, the receiving department is responsible for the
incident. The departments providing the aid do not complete a report but give the information
to the receiving department.

(a) True.

(b) False.

5. A fire that is confined to a vehicle in a structure is not a exposure but a vehicle fire.

(a) True.

(b) False.

1-3

NFIRS 5.0 Self-Study Program

Using The Basic Module

he Basic Module is the cornerstone of the NFIRS reporting system and is required for every type
of incident to which a department responds. Entries in the Basic Module determine what other
modules need to be completed, based on the type of incident involved. State agencies responsible
for incident reporting will determine which optional modules (EMS, Hazardous Materials, Wildland
Fire, Apparatus, Personnel, Arson) are also required to be submitted.
If the State does not mandate the use of optional modules, the local fire department still may elect
to use the module(s). The type of incident reported or the nature of a particular incident, such as
release of hazardous materials at a fire after the arrival of the fire department, may trigger one or
more of these additional modules, if your fire department decides to use these options.
For certain incident types, NFIRS Basic Module is the only module that must be completed:
• confined fires, i.e., food on stove;
• small vegetation fires;
• outside rubbish fires;
• explosions;
• incident type 100; and
• nonfires.
The Basic Module meets the need for an abbreviated method of incident reporting for those fires and
other emergencies routinely encountered by the fire department.

Section A: FDID, State,
Incident Number, Incident Date, Exposure Number
MM

YYYY

Delete

NFIRS–1

Change
FDID

State

Location Type

Incident Date

Station

Incident Number

Exposure

Check this box to indicate that the address for this incident is provided on the Wildland Fire
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Basic

No Activity
Census Tract

UseBthis Street
section
to record information that will identify the fire department, each incident, and
address
exposure.Intersection
Some
fields
in this section are required to be completed. These fields (FDID, State, Incident
In front of
Rear
of
Date, Incident Number, and Exposure Number) uniquely identify the incident and must
be known
to
to recall Adjacent
the
incident
from
the
computer
program
or
to
print
a
paper
copy
of
the
incident
report.
Directions
US National Grid

Number/Milepost

Prefix

Apt./Suite/Room

City

Street or Highway

Street Type

State

Suffix

ZIP Code

Cross Street, Directions or National Grid, as applicable

The fire department identifier (FDID) is assigned at the State level. It must be entered for all
C Incident Type
E1 Dates and Times
E2 Shifts and Alarms
incidents.
Month
Day
Year
Hour Min
Midnight is 0000

Local Option

Check boxes if
dates are the
same as Alarm
Date.

Incident Type

ALARM always required

A unique
number is assigned
by the Alarm
fire department for every incident to which the departGiven or Received
None
D Aid incident
ment
isMutual
called.
The incident number and exposure number, used in conjunction with
the incident
1
aid received
Arrival
E3 Special Studies
2 uniquely
Auto. aid received
date,
identifies the incident.
Shift or
Platoon

Alarms

District

ARRIVAL required, unless canceled or did not arrive

Local Option

3
4
5

Mutual aid given
Auto. aid given
Other aid given

Their FDID

CONTROLLED optional, except for wildland fires

Their
State

Controlled
Last Unit
Cleared

Their Incident Number

Actions Taken

Resources

1-4

Check this box and skip this block if an
Apparatus or Personnel Module is used.
Primary Action Taken (1)

Apparatus
Suppression

Additional Action Taken (2)

Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires

Personnel

Special
Study Value

Estimated Dollar Losses and Values

LOSSES:

Required for all fires if known.
Optional for non-fires.

Property

Contents

None

NFIRS 5.0 Self-Study Program

A fire incident may have several fire exposures. The exposure number, also assigned by the fire
department, indicates how many exposures there were for a single fire. The original fire is coded as
000 and each exposure is coded in sequential, numeric order – i.e., 001, 002, etc. Each exposure
requires a separate incident report.

A
FDID

Section B: Location
YYYY

Incident Date

State

Location Type

Station

Incident Number

Delete

Check this box to indicate that the address for this incident is provided on the Wildland Fire
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Street address
Intersection
In front of
Rear of
Adjacent to
Directions
US National Grid

Number/Milepost

Prefix

NFIRS–1

Change
Exposure

Basic

No Activity
Census Tract

Street or Highway

Street Type

Suffix

Apt./Suite/Room

City

State

ZIP Code

Cross Street, Directions or National Grid, as applicable

Dates and Times

Incident Type

Shifts and Alarms

Midnight is 0000

C
E1
2
Month
Day
Year
Hour
This
section provides fields to identify
the specific location
and vicinity
(in Min
front Eof,
rear of, next to)
information
pertaining to an incident. “Location”
is a required section, so as much information as
Alarm
Given or Received
None
D Aidshould
possible
be entered.
Local Option

Check boxes if
dates are the
same as Alarm
Date.

Incident Type

ALARM always required

Shift or
Platoon

Alarms

District

ARRIVAL required, unless canceled or did not arrive

1
2
3
4
5

Mutual aid received
Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Arrival

Special Studies

NOTE: If the Wildland Fire Module is used in lieu of the Fire Module, the “Alternate Location Specification” is used instead.
Their FDID

Local Option

CONTROLLED optional, except for wildland fires

Their
State

Controlled

This section is primarily narrative and should
indicate the correct address of the incident location.
Last Unit
Cleared
Use road, street names, directional prefixes/suffixes,
and other identifiable locations.
Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires

Special
Study Value

Their Incident Number

Resources

Actions Taken

Estimated Dollar Losses and Values

F Census Tract information can be
G1 filled in. Census Tract numbers
G2
The
can provide valuable socio
LOSSES:
None
economic and other characteristics of the population where problems
are
occurring
(by
providing
$
,
,
Property
Apparatus Personnel
MM
DD
YYYY
links to other databases, such as the U.S. Census Bureau databases).
,
,
Contents $
Check this box and skip this block if an
Apparatus or Personnel Module is used.

Required for all fires if known.
Optional for non-fires.

Primary Action Taken (1)

Suppression

VALUE:
Incident
DatePRE-INCIDENT
FDID
Station jurisdiction.
Incident Number
State Tract
The U.S. Census Bureau may be contacted
for Census
coding
information
for your
EMS
Property
$
,
Other
They have 12 regional offices, and the telephone
number for an office in your area
may, be obtained
Check this box
to indicate$that the address
Contents
Location Type
, for this, incident is provided on the Wildland Fire
Module in Section B, “Alternative
Location
Specification."
only for wildland fires.
through your phone company,Bor access
the Internet at www.census.gov
to obtain
the
phoneUse
number
Street address
for Completed
your regional
office.
Mixed Use
Hazardous Materials Release
None
Modules
Casualties
Intersection
None
Additional Action Taken (2)

Optional

Additional Action Taken (3)

Fire–2
Structure Fire–3
Civilian Fire Cas.–4
Fire Service Cas.–5
EMS–6
HazMat–7
Wildland Fire–8
Apparatus–9
Personnel–10
Arson–11

Check box if resource counts include aid
received resources.

In front
Deaths Injuries

Fire
Service
Civilian

H2
1
2
U

Number/Milepost

Prefix

Not mixed

Property
Street or Highway

10
Assembly use
Natural gas: slow leak, no evacuation or HazMat actions
20
Education use
Propane gas: <21-lb tank (as in home BBQ grill)
33
Medical use
Apt./Suite/Room
City
Gasoline: vehicle fuel tank or portable container
40
Residential use
51
Row of stores
Kerosene: fuel burning equipment or portable storage
53
Enclosed mall
Diesel fuel/fuel Cross
oil: vehicle
fuelDirections
tank or portable
storageGrid, as applicable
Street,
or National
58
Business & residential
Household solvents: home/office spill, cleanup only
59
Office use
Motor oil: from engine or portable container
60
Industrial use
63
Military use
Paint: from paint cans totaling <55 gallons
65
Farm use
Month
Day
Other: special HazMat actions required or spill > 55 gal
00
Other mixed use
(Please complete the HazMat form.)
Check boxes if
ALARM always required

Rear1 of
2
Adjacent
to
3
Directions
4
5
US National
Grid

Section C: Incident Type

Detector

6
7
Incident
Detector alerted occupants
8
Detector did not alert them
0
Required for confined fires.

Unknown

Incident Type

Property Use
None
Structures
Church, place of worship
131
1
Restaurant or cafeteria
161
2
Bar/tavern or nightclub
162
Elementary school, kindergarten
213
3
High school, junior high
215
4
College, adult education
241
5
Nursing home
311
Hospital
331

Type

341 Given
Clinic,
Aid
or clinic-type
Receivedinfirmary

539
None

Dates and Times

dates are the
same
as Alarm
Household
Date.

Midnig

Year

Alarmsales, repairs
goods,

342
Doctor/dentist office
service station
Enter the type of incident (a three-digit
code)
to better identify the571
typesGas
of orincidents
to which
ARRIVALfire
required, unless canceled or did no
361
579
Prison or jail, not juvenile
Motor vehicle/boat sales/repairs
Mutual
aid
received
Arrival
419
599
1or
2-family
dwelling
Business
office
departments respond. The major categories are listed below and defined in
the Handbook.

• 100 Series: Fires;

Auto. aid
received dwelling
429
615
Multifamily
Their FDID
Their
439
629
Rooming/boarding
house
Mutual aid
given
State
449
700
Commercial
hotel or motel
Auto. aid
given
459
819
Residential,
board and care
Other aid
given
464
882
Dormitory/barracks
Their Incident Number
519
891
Food and beverage sales

• 200 Series: Pressure Ruptures (no fire);
• 300 Series: Rescue and EMS;936

Outside
Playground or park
124
Crops or orchard
655
Forest (timberland)
669
Outdoor storage area
807
Dump or sanitary landfill
919
Open land or field
931

Vacant lot

Graded/cared
for plot of land
938
Actions
Taken

Lake,
stream
946
• 400 Series: Hazardous Conditions
(notriver,
a fire);
Railroad right-of-way
951

Other street
960
Primary 961
Action Taken
(1)
Highway/divided
highway
Residential street/driveway
962

1-5

981
984

Electric-generating plant
CONTROLLED optional, except for wildland f
Laboratory/science laboratory
Controlled
Manufacturing
plant
Livestock/poultry storage LAST
(barn)
Last
Unit garageUNIT CLEARED, required except for w
Non-residential
parking
Warehouse Cleared
Construction site

Resources
plant yard
GIndustrial
1

Look up and enter a
Property Use code and
description only if you
have NOT checked a
Property Use box.

Check this box and skip this block if an
Property
Use
Apparatus
or Personnel
Module is used.

Est

LOSSES

Code

Apparatus

Property Use Description

Suppression

Additional Action Taken (2)

EMS
Other

Personnel

NFIRS–1 Revision 01/01/05

Property

Contents

PRE-INC

Property

NFIRS 5.0 Self-Study Program

• 500 Series: Service Calls;
• 600 Series: Good Intent Calls;
• 700 Series: False Alarms and False Çalls;
• 800 Series: Severe Weather and Natural Disasters; and
• 900 Series: Other Types of Incidents.
MM

YYYY

A also may determine which additional modules to complete. This is
The code entered in this section
Incident Date
FDID
Station
Incident Number
State
a required field, so you must enter
a code. The incident
type
entered does not have
to be the
same
incident type as the one dispatched.
It should reflect the situation
found at the incident scene upon
Check this box to indicate that the address for this incident is provided on the Wildland Fire
B Location Type
Module in Section B, “Alternative Location Specification." Use only for wildland fires.
arrival.
Street address

Exp

Intersection
If the incident scene involves combinations
of potentialNumber/Milepost
incident types
such
as fire, EMS, and Hazmat,
Prefix
Street or Highway
In front of
the precedence should be to code the
lowest
numbered incident type (100 Series: Fires first, then
Rear
of
EMS, then Hazmat).
Adjacent to
Apt./Suite/Room
City
Directions
US National Grid

Cross Street, Directions or National Grid, as applicable

Type
C Incident
E1 Dates and Times
Section
D: Aid
Given or Received
Month
Incident Type

Aid Given or Received

None

Check boxes if
dates are the
same as Alarm
Date.

Midnigh

Day

Year

ALARM always required

Alarm

ARRIVAL required, unless canceled or did no

1
2
3
4
5

Mutual aid received
Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Arrival
Their FDID

CONTROLLED optional, except for wildland f

Their
State

Controlled
Last Unit
Cleared

Their Incident Number

LAST UNIT CLEARED, required except for w

Resources
Actions
Aid Given or Received refers F
to the
givingTaken
or receiving of assistance from
fire department
G1 another
Check this box and skip this block if an
to help resolve an incident. That assistance can be in the form of personnel orApparatus
equipment
or Personnelfrom
Module isone
used.
or more departments. This section
is
intended
to
link
data
records
between
giving
and
receiving
Primary Action Taken (1)
Apparatus Personnel
departments.
Suppression

Options are provided to indicate whether mutual, automatic, or other aid was EMS
given or received, or
if there was no aid. When mutual or automatic aid is given, there is space toOther
capture the receiving
department’s FDID, State, and incident
number.
Additional Action
Taken (3)
Check box if resource counts include aid
Additional Action Taken (2)

Est

LOSSES

Property

Contents

PRE-INC

Property

Contents

received resources.

The receiving department completes the Basic Module and other required or optional modules. A
department giving mutual aid also
should Modules
fill out a Basic
indicating
what
did at the
inci- Release
Hazardous
Materials
Completed
Casualties
None
H3they
H1 Module,
Fire–2 for any of their department members injured or killed.
dent, and a Fire Service Casualty Module
Deaths Injuries
Structure Fire–3

Civilian Fire Cas.–4
Fire Service Cas.–5
EMS–6
HazMat–7
Wildland Fire–8
Apparatus–9
Personnel–10
Arson–11

Fire
Service
Civilian

H2
1
2
U

Detector
Required for confined fires.

Detector alerted occupants
Detector did not alert them
Unknown

Property Use
None
Structures
Church, place
131
1-6of worship
Restaurant or cafeteria
161
Bar/tavern or nightclub
162
Elementary school, kindergarten
213

341
342
361
419
429
439

1
2
3
4
5
6
7
8
0

Natural gas: slow leak, no evacuation or HazMa
Propane gas: <21-lb tank (as in home BBQ gril
Gasoline: vehicle fuel tank or portable container
Kerosene: fuel burning equipment or portable s
Diesel fuel/fuel oil: vehicle fuel tank or portabl
Household solvents: home/office spill, cleanu
Motor oil: from engine or portable container
Paint: from paint cans totaling <55 gallons
Other: special HazMat actions required or spill >
(Please complete the HazMat form.)

Clinic, clinic-type infirmary
Doctor/dentist office
Prison or jail, not juvenile
1- or 2-family dwelling
Multifamily dwelling
Rooming/boarding house

539
571
579
599
615
629

Location Type

Check this box to indicate that the address for this incident is provided on the Wildland Fire
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Street address
Intersection
In front of
Rear of
Adjacent to
Directions
US National Grid

Number/Milepost

Prefix

Apt./Suite/Room

City

Census Tract

NFIRS 5.0 Self-Study Program

Street or Highway

Street Type

Suffix

Block E1: Dates and Times
State

ZIP Code

Cross Street, Directions or National Grid, as applicable

Incident Type

Dates and Times

Incident Type

Aid Given or Received

None

Midnight is 0000

Month

Check boxes if
dates are the
same as Alarm
Date.

Day

Year

Hour

Min

Shifts and Alarms
Local Option

ALARM always required

Shift or
Platoon

Alarm

Alarms

District

ARRIVAL required, unless canceled or did not arrive

Mutual aid received
Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Their FDID

YYY
ry Action Taken (1)
Station

onal Action Taken (2)

Special Studies
Local Option

CONTROLLED optional, except for wildland fires

Their
State

Controlled
Last Unit
Cleared

Their Incident Number

Actions Taken

Arrival

Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires

Special
Study Value

Dollar
and Values
Block E1 permits the capture
of date and time of alarm, arrival,
control, and
lastLosses
unit cleared.
Hours
G1 Resources
G2 Estimated
Check this box and skip this block if an
Required for all fires if known.
and minutes for all sections Apparatus
are recorded
24-hour
time: LOSSES:
midnight Optional
is 0000.
None
or Personnel in
Module
is used.
for non-fires.
Delete
$
,
NFIRS–1Property
The line for alarm date and time always
must
be completed.
Note that
the alarm
date ,is always the
Personnel
Apparatus
Change
Basic
,
Incident
Exposure
,
Contents $
same
as Number
the incident date
in Block A.
Suppression
No Activity

PRE-INCIDENT VALUE: Optional
EMS
Census
Tract the unit was cancelled or did not arrive. The controlled time
Arrival information is required
unless
Property
$ time is, required
, except for
Otherfires. In contrast, the last-unit-cleared
is optional except for wildland
Contents $
Check box if resource counts include aid
,
,
wildland fires.
received resources.

hat the address for this incident is provided on the Wildland Fire
native Location Specification." Use only for wildland fires.

ional Action Taken (3)

Street or Highway
YYY

mpleted Modules
Station

Street Type
Delete

Number
HIncident
1 Casualties

Suffix

NFIRS–1
Hazardous
Materials
Release
Basic
None
State
ZIP Code
H
3
Exposure
No Activity
Change

Fire–2
Deaths Injuries
Structure
Fire–3
hat
the as
address
for this incident is provided on the Wildland Fire
l Grid,
applicable

None

Block E2: Shifts and Alarms

1 Census
Tract gas: slow leak, no evacuation or HazMat actions
Natural
2
Propane gas: <21-lb tank (as in home BBQ grill)
Midnight is 0000
Shifts
and Alarms
Dates and Times
Fire
3
Gasoline:2vehicle
fuel tank or portable container
1 Service Cas.–5
Local Option
Civilian
Month
Day
Year
Hour
Min
4
Kerosene:Street
fuel burning
equipment
EMS–6
Street or Highway
Type
Suffix or portable storage
ck boxes if
ALARM always required
5
Diesel
fuel/fuel
oil:
vehicle
fuel tank or portable storage
HazMat–7
es are the
Detector
Shift or
Alarms
District
2 Required for confined fires.
6
me as Alarm
Alarm
Household
solvents:
home/office
spill, cleanup only
Wildland
Fire–8
Platoon
ZIP Code
e.
7State Motor
oil: from engine or portable container
ARRIVAL
required,
unless
canceled
or
did
not
arrive
Apparatus–9
1
Detector alerted occupants
8
Paint: from paintSpecial
cans totaling
<55 gallons
Studies
Arrival
Personnel–10
2
Detector did not alert them
3Use
al Grid, as applicable
0
2 is a local
Completion
of
Block
E
option.
it
to
record
shift
or >platoon,
Other:
special
HazMat
actions
required
or spill
55 gal
Local
Option
Unknown
UCONTROLLED
Arson–11
optional, except for wildland fires
(Please complete the HazMat form.)

Fire

native Location
Use only for wildland fires.
Civilian
Fire Specification."
Cas.–4
Service

Dates Controlled
and Times

Property Use

Month

Shifts and Alarms
ESpecial
2
Special

Midnight is 0000

Day

Year341

Option
Hour
Min clinic-typeLocal
Clinic,
infirmary

Mixed Use
Property
10
20
33
40
51
53
58
59
60
63
65
00

Not mixed

Assembly use
Education use
Medical use
Residential use
Row of stores
Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

alarms, and district.

539
Household goods, sales, repairs
Study ID#
Study Value
342
571
Doctor/dentist3 office
Gas or service station
Shift or
Alarms
District
361
579
Prison or jail,
not juvenile
Motor vehicle/boat sales/repairs
Platoon
Restaurant or cafeteria
1
419
599
1- orDollar
2-family
dwelling
Business office
ARRIVAL required, unless canceled or Estimated
did not arrive
Resources
Losses
and Values
G21 Bar/tavern
G2 429
or nightclub
615
Multifamily dwelling
Electric-generating plant
Special Studies
Arrival
this box and skip this block if an
Eif3known.Localhouse
Required for all fires
Elementary
school, kindergartenLOSSES:
3 Check
439
629
Rooming/boarding
Option
Laboratory/science laboratory
None
Apparatus or Personnel Module is used.
Optional
for non-fires.
CONTROLLED
wildland fires
High school, junior
highoptional, except for 449
5
700
Commercial
hotel
or
motel
Manufacturing plant
$
,
,
Property
Controlled
College,
adult education
1
Personnel
Apparatus
459
819
Residential,Special
board and Special
care
Livestock/poultry storage (barn)
Nursing
home
1
except
fires
464for wildland$Dormitory/barracks
882
, Study ID# ,
Study Value
Non-residential parking garage
uppression
Last Unit LAST UNIT CLEARED, requiredContents
Hospital
1
519
891
Food and beverage sales
Cleared
Warehouse
PRE-INCIDENT VALUE: Optional
utsideEMS
Vacant lot
936
981
Construction site
Property
$Graded/cared
, can
E3 providesGtemporary
dataDollar
elements
that
be used for
collection
of information that is of
Resources
Estimated
and
Values
, Losses
PlaygroundBlock
or park
for
plot
of
land
G4 1 Other
2 938
984
Industrial plant yard
Crops
or
Check
this ifbox
andorchard
skip
this block
if an
for
all firesstream
known.
special
interest
to local,
or national
or data centers.
Lake,
river,
5
946State,$Required
Contents
Check
box
resource
counts
include
aid
, ifdepartments
,
LOSSES:
None
Apparatus
or Personnel Module is used.
Look up and enter a
Optional for non-fires.
received
resources.
Forest
(timberland)
Property Use
Railroad right-of-way
9
951
Property Use code and
$Other street
, capture
, information
description
if you
Typically,
Special Studies
to
on only
emerging
trends, problem areas,
or
Property
Outdoor
storage
area
Code
7
960are required
Personnel
Apparatus
have NOT checked a
or sanitary
landfill
Mixed
Use
Hazardous
Materials
Release
None
Highway/divided
highway
9one HDump
961
Property
Use
box.
a specific issue being
studied.$ Special
fields
can
be defined by the local
fire department, the
I Studies
,
3
,
Contents
Not mixed
uppression
Property Use Description
Open land or field
Property
street/driveway
1
962 DataResidential
State,
or
the
National
Fire
Center
(NFDC).
NFIRS–1 Revision 01/01/05
es
10
VALUE:
Optional
Assembly use
1EMS Natural gas: slow leak, no evacuationPRE-INCIDENT
or HazMat actions
None required except for wildland fires
LAST UNIT CLEARED,

Last Unit ALARM always required
eck
boxes if
tructures
es are the
Cleared
Church,
place of worship
1 as Alarm
me
Alarm
e.

Block E : Special Studies

Property
2
Propane gas: <21-lb tank (as in home
BBQ grill) $
Other
3
Gasoline: vehicle fuel tank or portable container
Contents $
Check box if resource counts include aid
4
Kerosene: fuel burning equipment or portable storage
received
resources.
5
Diesel fuel/fuel oil: vehicle fuel tank or portable storage
6
Household solvents:
home/office
spill, cleanup only
Hazardous
Materials
Release
None
one
7 3 Motor oil: from engine or portable container

20
Education use
,
33,
Medical use
40
Residential use
,
,
51
Row of stores
53
Enclosed mall
58
Business & residential
Mixed Use
59
Office use
Not mixed
60
Industrial use
Property

1-7

Incident Type

Aid Given or Received

None

Check boxes if
dates are the
same as Alarm
Date.

ALARM always required

Alarm
ARRIVAL required, unless canceled or did not arrive

1
2
3
4
5

A
Location Type

YYYY

Controlled
Last Unit
Cleared

Their Incident Number

Station
Actions Taken

Incident Number

Check this box to indicate that the address for this incident is provided on the Wildland Fire
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Street address
Intersection
In front of
Rear of
Adjacent to
Directions
US National Grid

LAST UNIT CLEARED, required except for wildland f

Delete

Exposure
Resources

NFIRS–1

Basic

No Activity

Check this box and skip this block if an
Apparatus orCensus
Personnel
Module is used.
Tract

Primary Action Taken (1)

Apparatus

Personnel

Prefix

Street or Highway

Street Type

Additional Action Taken (2)

EMS
Apt./Suite/Room

Additional Action Taken (3)

ZIP Code

Check box if resource counts include aid
received resources.

Cross Street, Directions or National Grid, as applicable

LOSSES:

Re
Op

Property

Contents

Suffix

Other State

City

Estimat

G2
-

Suppression
Number/Milepost

PRE-INCIDE
Property

Contents

In this section you will enter a two-digit
code
to explain Casualties
the most significant
actions taken by theShifts
fireRelease
Completed
Modules
Midnight is 0000
None
and Alarms No
Dates
and Times
H3 Hazardous Materials
H1 information on
1
Etaken
2
Fire–2
service personnel at the incidentEscene.
You should enter
the
primary
action
in
Local
Option
Month Deaths
Day
Year
Hour Min
Injuries
Structure
Fire–3are provided to list two additional
1
Check
boxes ifalso
slow leak, no evacuation or HazMat actio
Natural gas:
response to the incident. However,
lines
actions
taken.
Fire
Incident Type
ALARM always required

Incident Type

Aid Given or Received

None

dates
are theFire
Civilian
same as Alarm
Fire Service
Date.

Cas.–4

Alarm

Service

Arrival

Detector
H2CONTROLLED
6
Required foroptional,
confinedexcept
fires. for wildland fires

Propane gas: <21-lb
tank (as
in homeDistrict
BBQ grill)
Shift or
Alarms

Platoon
fuel tank or portable container
Together with the incident type, these data Cas.–5
help a fire
department document3 the Gasoline:
variety vehicle
of activities
Civilian
ARRIVAL required, unless canceled or did 4
not arriveKerosene: fuel burning equipment or portable storage
EMS–6
performed
and
resources
required
to
respond
to
a
range
of
emergency
situations.
Special Studies
Mutual aid received
5
Their FDID

Wildland Fire–8

Their
State

Block G : Resources
Cleared

Property Use
JG
Resources
Structures
1

Actions Taken

None

Church,
ofthisworship
131
Check
this boxplace
and skip
block if an
Apparatus
or Personnel
Module is used.
Restaurant
or cafeteria
161
Bar/tavern or nightclub
162
Apparatus Personnel
Elementary school, kindergarten
213
Suppression
High school, junior high
215
College, adult education
241
EMS
Nursing
home
311
Hospital
331
Other

Primary Action Taken (1)

Additional Action Taken (2)

Diesel fuel/fuel oil:
3 vehicle fuel tank or portable stora
Local Option
Household solvents: home/office
spill, cleanup only
7
Motor
oil:
from engine or portable container
Apparatus–9 Controlled
1
Detector alerted occupants
8
Paint: from paintSpecial
cans totaling <55Special
gallons
Personnel–10
2
Detector
did not alert
them
LAST
UNIT CLEARED,
required
except for0wildlandOther:
fires
special HazMat
actions required
or spill > 55 ga
Study ID#
Study Value
1
Last
Unit
Unknown
U
Arson–11
(Please complete the HazMat form.)
HazMat–7

Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Their Incident Number

CONTROLLED optional, except for wildland fires

Their
State

Section F: Actions Taken

Incident Date

State

1
2
3
4
5

Arrival

Change
FDID

Mutual
aid 5.0
received
NFIRS
Self-Study Program
Auto. aid received
Their FDID
Mutual aid given
Auto. aid given
Other aid given

341

Clinic, clinic-type infirmary
Doctor/dentist office
Required
for allnot
fires juvenile
if known.
361
Prison
or jail,
LOSSES:
Optional for non-fires.
419
1- or 2-family dwelling
$
,
,
429
PropertyMultifamily
dwelling
439
Rooming/boarding
house
$
, or motel
,
Contents
449
Commercial hotel
459
Residential,
boardOptional
and care
PRE-INCIDENT
VALUE:
464
Dormitory/barracks
PropertyFood
$ and beverage
,
519
sales,

G342
2

539

Estimated Dollar Losses and Values571
579
599
615
629
700
819
882
891

None

H
G
M
B
E
L
M
L
N
W

Outside
936
$ lot
ContentsVacant
Check box if resource counts include aid
981
,
,
received
resources. or park
Playground
Graded/cared for plot of land
124
938
984
Crops or orchard
Lake, river, stream
655
946
Look up and enter a
Forest
(timberland)
Railroad
951
Use code an
Hazardous
Materials
None right-of-way
CompletedInModules
Casualties
None
Block G1 you
record the669
total numbers
of apparatus
andRelease
personnel
separated
into
threeUse
cat- Property
I Mixed
3
1 will
description
only if you
Not mixed
Outdoor
storage
area
Other
street
807
960
Property
Fire–2
have NOT checked a
egories: Suppression,Deaths
EMS, and
Other. Dump or sanitary landfill
Highway/divided
highway
Injuries
919
961
Property Use box.
10
Assembly use
Structure Fire–3
1OpenNatural
or HazMat
actions
land orgas:
fieldslow leak, no evacuation
Fire
Residential
street/driveway
931
962
20
Education use
Additional Action Taken (3)

Civilian Fire
Cas.–4
NOTE:
This

section
is required unless the Apparatus
Personnel
is used.
2 or the
Propane
gas:module
<21-lb tank
(as in home BBQ grill)
Service

Fire Service Cas.–5
EMS–6

Civilianinclude mutual aid
If resource counts

HazMat–7
Wildland Fire–8
Apparatus–9
Personnel–10
Arson–11

H2
1
2
U

Detector
Required for confined fires.

Detector alerted occupants
Detector did not alert them
Unknown

Property Use
None
Structures
Church, place of worship
131
Restaurant or cafeteria
161
Bar/tavern or nightclub
162
Elementary school, kindergarten
213
High school, junior high
215
College, adult education
241
Nursing home
311
Hospital
331
Outside
Playground or park

3
Gasoline: vehicle fuel tank or portable container
40
received,
checkfuelthe
boxequipment
at the bottom
of the section.
51
4
Kerosene:
burning
or portable storage
53
5
Diesel fuel/fuel oil: vehicle fuel tank or portable storage
58
6
Household solvents: home/office spill, cleanup only
59
7
Motor oil: from engine or portable container
60
8
63
Paint: from paint cans totaling <55 gallons
65
0
Other: special HazMat actions required or spill > 55 gal
(Please complete the HazMat form.)

Medical use
Residential use
Row of stores
Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

341
342
361
419
429
439
449
459
464
519

Clinic, clinic-type infirmary
Doctor/dentist office
Prison or jail, not juvenile
1- or 2-family dwelling
Multifamily dwelling
Rooming/boarding house
Commercial hotel or motel
Residential, board and care
1-8
Dormitory/barracks
Food and beverage sales

539
571
579
599
615
629
700
819
882
891

Household goods, sales, repairs
Gas or service station
Motor vehicle/boat sales/repairs
Business office
Electric-generating plant
Laboratory/science laboratory
Manufacturing plant
Livestock/poultry storage (barn)
Non-residential parking garage
Warehouse

936

Vacant lot

981

Construction site

None

Check boxes if
dates are the
same as Alarm
Date.

ALARM always required

Alarm

FDID

Shift or
Incident Date Platoon

State

Alarms

District

Station

Incident Number

Exposure

ARRIVAL required, unless canceled or did not arrive

Arrival

Street address
Intersection
Number/Milepost Special
Prefix
Street
or Highway
Special
In front
of
required except for wildland fires
Study ID#
Study Value
2
Last Unit LAST UNIT CLEARED,
Rear of
Cleared
Adjacent to
Apt./Suite/Room
City
Directions
Resources
Estimated Dollar Losses and Values
G1
G2 Grid Cross Street, Directions or National Grid, as applicable
US National
Check this box and skip this block if an
Required for all fires if known.
LOSSES: Optional for non-fires.
None
Apparatus or Personnel Module is used.
Dates and Times
Incident Type
C
E, 1
$
,
Property
Controlled

Block G : Estimated Dollar Losses and Values

Number

Apparatus

Personnel

A
D

Suppression
EMS

Incident Type

Aid
FDID

Given

YYYY
Check boxes if
Contents
dates are the
same as Alarm
or Received
Incident Date None
State
PRE-INCIDENT
VALUE: Optional Date.

$
$

Property

Other

1
Mutual aidType
received
Location
B
2
Auto.
aid
received
Contents
Check box if resource counts include aid

None

Street address

Month

, Their

State

Year

Hour

Min

ALARM always required

Alarm
Station

Incident Number

Exposure

ARRIVAL required, unless canceled or did not arrive

Census Tract

CONTROLLED optional, except for wildland fires

State

Number/Milepost

ZIP Cod

Midnight is 0000

Day

Check this box to indicate that the address for
this incident is provided on the Wildland Fire
Arrival
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Their FDID

3
Mutual aid given
Intersection
4
Auto.
aid given
In front
of
Other
aid given
5
Hazardous Materials
Release

received resources.

lties

Controlled

Prefix

Street or Highway

S
S

None I Mixed Use
Last
Unit complete the loss inforH
3 Block G2 to record
Use
property
and content
losses for fires only.
must
Rear
of
NotYou
mixed
T
Cleared
Property

LAST UNIT CLEARED, required except for wildland fires

heir Incident Number

eaths Injuries

to loss is Apt./Suite/Room
City
State
ZIP Cod
mation for all fire loss Adjacent
when the
known. Entry
of
loss information is optional for other inci10
Assembly use
1
evacuation or HazMat actions
Natural gas: slow leak, noDirections
20
Education useResources
Estimated Dollar Lo
Actions
Taken
dent
types.
2
G1
G2
Propane gas: F
<21-lb tank (as in home BBQ grill)
US National Grid

or confined fires.

alerted occupants
did not alert them

341
342
361
419
429
439
449
459
464
519
936
938
946
951
960
961
962

33
use as applicable
Cross Street, Directions
orMedical
National Grid,

Check this box and skip this block if an
Required for all fires
3
vehicle fuel tank or portable container
40
LOSSES:
Apparatus
or Personnel
used.
Optional for non-fire
Loss Gasoline:
estimates
shouldequipment
consider
both the structure
and Residential
contentsuse
and be
basedModule
on isdamage
caused
by
51
Row of stores
Midnight is 0000
4
Kerosene: fuel burningIncident
or portable storage
Dates and Times
Type
1
Primary
Action Taken (1)
$
,
53
Enclosed mall
smoke,
water,
Recording
and
contents
is Year
aProperty
local Hour
5fire, Diesel
fuel/fuel
oil: and
vehicleoverhaul.
fuel tank or portable
storage preincident values of property
Personnel
Apparatus
Month
Day
Min
58
Business & residential
6option.
$
Check boxes if
Household solvents:Incident
home/office
,
Type spill, cleanup only
ALARM always required
Contents
59
Office
use
Suppression
dates
are the
7
Motor oil: from engine
or Action
portable
container
60
Industrial
use
same
as
Alarm
Additional
Taken
(2)
Alarm
Aid Given or Received
None
PRE-INCIDENT VALUE:
8
Date.use EMS
63
Military
Paint: from paint cans totaling <55 gallons
ARRIVAL required, unless canceled or did not arrive
65
Farm use
0
Other: special HazMat actions required or spill > 55 gal
Property
$
,
1 complete
00
Other mixed Other
use
Mutual
received
Arrival
(Please
the aid
HazMat
form.)
Additional
Action
Taken
(3)
2
Auto. aid received
Contents $
Check box if resource counts include aid
1 Their
,
CONTROLLED optional, except for wildland fires
Their FDID
received resources.
Mutual aid given539
Clinic, clinic-type3 infirmary
HouseholdState
goods, sales, repairs
Controlled
4
Auto. aid given
571
Doctor/dentist office
Gas or service station
S
Other
aid
given
UNIT CLEARED,
required except for wildland
fires
5Completed Modules
Hazardous
Materials
Release
None
Casualties
None
Last Unit LAST
I MixS

tor

garten

Census Tract

CONTROLLED optional, except for wildland fires

Their
State

Check this box to indicate
that the Studies
address for this incident is provided on the Wildland Fire
Special

E3 B,Program
in Section
“Alternative Location Specification." Use only for wildland fires.
NFIRS Module
5.0 Self-Study
Local Option

Location Type

Block H : Casualties

579 H1 Motor vehicle/boat sales/repairs
Prison or jail, not juvenile
H3 Cleared
Their Incident Number
Pro
Fire–2
599
1- or 2-family dwelling
Business
office
Deaths Injuries
10
Multifamily dwellingStructure Fire–3 615 FireElectric-generating plant1
Natural gas: slow leak, no evacuation or HazMat actions
20 Lo
Resources
Dollar
Actions
Civilian
FireTaken
Cas.–4629 Service
Rooming/boarding
Laboratory/science
Propane gas: <21-lb tank (as in home
grill)
F house
Glaboratory
1 2
G2BBQEstimated
33
Check
this
box
and
skip
this
block
if
an
Required
for
all
fires
Commercial hotel orFire
motel
Service Cas.–5700
3
Manufacturing plant
Gasoline: vehicle fuel tank or portable
container
40
LOSSES:
Apparatus
or
Personnel
Module
is
used.
Optional
for
non-fire
Civilian
51
819
Residential, board and
care
Livestock/poultry storage4 (barn)
Kerosene: fuel burning equipment or portable storage
EMS–6
Primary Action Taken (1)
$
53,
5
882
Dormitory/barracks
Non-residential
parking garage
Diesel
fuel/fuel oil:
vehicle fuel tankProperty
or portable storage
Personnel
Apparatus
HazMat–7
Detector
58
6
Food and beverage Wildland
sales Fire–8 891 H2 Warehouse
Household
solvents:
home/office
spill,
cleanup
only
$
Required for confined fires.
59,
Contents

Suppression
You will need to record casualties, injuries, and deaths in Block
H1. This includes casualties for both
7
Motor oil: from engine or portable container
60
Vacant lot
Additional
Action Taken (2) 981 1
Apparatus–9
Construction
site
fire
service
and
civilians.
Detector alerted occupants
8EMS Paint: from paint cans totaling <55 gallons
PRE-INCIDENT VALUE:
63
Graded/cared for plot of land
Personnel–10

984

Industrial
yard
Detector did plant
not alert
them

0
Other: special HazMat actions required
or spill > 55 gal
Property
$
Lake,civilian
river, stream
Unknown
U
Otheremergency
Arson–11
The
category
includes
civilians
and non-fire-service
responders
who
are
Look only
up and enter
a
(Please
complete the HazMat
form.)
Property Use
Railroad right-of-way
Additional Action Taken
(3) Use code and
Property
Contents $
Check box if resource counts include aid
injured
or killed as a result ofdescription
a fireonly
incident.
if you
Code resources.
Other street
received

65
00,

341
Property have
UseNOT checked a
539
Clinic, clinic-type infirmary
Household
None
Highway/dividedJhighway
Property Use box.
Structures
342Fire Casualty
571
Doctor/dentist
office
Gas or serv
NOTE:
If
you
report
a
casualty
in
this
field
you
must
complete
a
Civilian
Module
for
each
casualty
reported.
Property
Use
Description
Residential street/driveway
Mix
Hazardous
Materials
Church,
place of worship
131
Completed
Modules
None Revision
361
I vehic
or jail, not
juvenileRelease 579 None
Motor
NFIRS–1
HPrison
3 01/01/05
H
1 Casualties
Pro
161
Fire–2 Restaurant or cafeteria
419
599
1- or 2-family dwelling
Business
o
10
Bar/tavern
or nightclub Deaths Injuries
162
Structure
Fire–3
429
615
Multifamily
dwelling
Electric-gen
1
slow
leak,
no
evacuation
or
HazMat
actions
Natural
gas:
Fire
20
kindergarten 439
213
CivilianElementary
Fire Cas.–4 school,
629
house
Laboratory/
2Rooming/boarding
Propane gas: <21-lb
tank (as in home BBQ
grill)
Service
33
2
High
school,
junior
high
215
449
700
Commercial
hotel
or
motel
Manufactur
Fire Service Cas.–5
3
Gasoline: vehicle fuel tank or portable container
40
Civilian
241
459
819storageLivestock/p
andequipment
care or portable
51
4Residential,
Kerosene:board
fuel burning
EMS–6College, adult education
53
Nursing home
311
464
882
Dormitory/barracks
5
Non-residen
Diesel
fuel/fuel
oil:
vehicle
fuel
tank
or
portable
storage
HazMat–7
Detector
58
Hospital
331
H2 Required for confined fires.519 6FoodHousehold
891 onlyWarehouse
and beverage
sales
solvents:
home/office spill, cleanup
Wildland Fire–8
59
7
Outside
Motor
60
Vacant
lotoil: from engine or portable container
936
981
Constructio
Apparatus–9
1
Detector alerted occupants
8 Graded/cared
63
Paint: from paint
cans
totaling
<55 gallons 984
Playground or park
for
plot
of
land
124
938
Industrial
p
Personnel–10
2
Detector did not alert them
65
0
Other:
special
HazMat
actions
required
or
spill
>
55
gal
Crops
or
orchard
Lake, river, stream
655
946
Unknown
U
00
Arson–11
Look up
and enter a
(Please complete the HazMat
form.)
Forest (timberland)
Pro
Railroad right-of-way
669
951
Property Use code and
description only if you
Outdoor storage area
Other street
807
960
have
NOT
checked
a
341
Property
Use
539
Clinic, clinic-type infirmary
Household
None
Dump
or sanitary landfill
J919
Highway/divided highway
961
Property Use box.
Structures
342
571
Doctor/dentist
office
Gas orProperty
serv
Open land or field
Residential street/driveway
931
962
Church, place of worship
131
361
579
Prison or jail, not juvenile
Motor vehic
Restaurant or cafeteria
161
599
1- or 2-family dwelling
Business o
1-9 419
Bar/tavern or nightclub
162
429
615
Multifamily dwelling
Electric-gen
Elementary school, kindergarten 439
213
629
Rooming/boarding house
Laboratory/
High school, junior high
215
449
700
Commercial hotel or motel
Manufactur

Block H : Detector Performance

Mutual aid received
Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Their FDID

Special Studies

Arrival

Local Option

CONTROLLED optional, except for wildland fires

Their
State

Controlled
Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires
Last Unit
NFIRS
5.0 Self-Study Program
Cleared

Their Incident Number
YYYY

Delete

Special
Study Value

NFIRS–1

Resources
Estimated
Dollar Losses
the Incident
case Number
of confined
you must fill out NoBlock
H2 Basic
-GDetector
Performance.
Enterand
theValues
code that
Gfires
1 Exposure
2
Activity
Check
this
box
and
skip
this
block
if
an
Required
for
all
fires
if
known.
indicates whether the detector
alerted or did not alert occupants,
if thisfor non-fires.
is unknown.
LOSSES:orOptional
None
Apparatus or Personnel Module is used.
Change

Actions Taken
StationIn

ate that the address for this incident is provided on the Wildland Fire
Location
yAlternative
Action Taken
(1) Specification." Use only for wildland fires.

Census Tract

$
,for carbon
,
This field also may be used to indicate
if the
detector Property
alerted occupants
monoxide
Personnel
Apparatus
$
incidents.
,
,
Contents
Suppression

Street Taken
or Highway
nal Action
(2)

Street Type

EMS

OtherState

ZIP Code

PRE-INCIDENT VALUE: Optional
Property

Contents $ Release
Block H3: Hazardous Materials
,

nal Action Taken (3)

Check box if resource counts include aid
received resources.

tional Grid, as applicable

and Times Casualties
mpleted
Modules
E1 Dates
H1

re–2
Check boxes if
ructure
dates are Fire–3
the

Suffix

Month

Day

Shifts and Alarms

Midnight is 0000

None
Year

Release
2
HHour
3 HazardousEMaterials
Min

None

Local Option

Deaths
ALARM always
required Injuries

1
Natural gas: slow leak, no evacuation or HazMat actions
Shift or
Alarms
District
2
Propane gas:Platoon
<21-lb tank (as in home BBQ grill)
re Service Cas.–5
ARRIVAL required, unless canceled or did 3
not arrive Gasoline: vehicle fuel tank or portable container
Civilian
Special
Studies
4
Kerosene: fuel 3
burning
equipment
or portable storage
MS–6
Arrival
Local Option
5
Diesel
fuel/fuel
oil:
vehicle
fuel
tank or portable storage
azMat–7
CONTROLLED
Detectoroptional, except for wildland fires
2
6
Household solvents: home/office spill, cleanup only
ildland Fire–8 Controlled Required for confined fires.
7
Motor oil: from
engine or portable
container
Special
Special
pparatus–9
1
LAST UNIT CLEARED,
required except for wildland fires
Study ID#
Value
Detector
alerted occupants
8
Last Unit
Paint: from paint
cans totalingStudy
<55 gallons
ersonnel–10
2
Detector did not alert them
Cleared
0
Other: special HazMat actions required or spill > 55 gal
Unknown
U
son–11
(Please complete the HazMat form.)

same as
Alarm
Alarm
vilian
Fire
Cas.–4
Date.

Fire
Service

,
,

Mixed Use
Property
10
20
33
40
51
53
58
59
60
63
65
00

Not mixed

Assembly use
Education use
Medical use
Residential use
Row of stores
Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

Estimated Dollar Losses and Values
G1 Resources
G
2
341
Property
Use
539
Clinic,
clinic-type
infirmary
Household goods, sales, repairs
None
Check
this box and
skip
this
block
if
an
Required
for allBlock
fires if known.
3 no matter what type of incident you respond to.
NOTE: If hazardous materials
are involved,
fill
out
H
LOSSES:
None
ucturesApparatus or Personnel Module is used.
Optional for non-fires.
342
571
Doctor/dentist
office
Gas or service station
Church, place of worship
361
579 jurisdiction
Prison
or jail,
not juvenile
$ your
Motor vehicle/boat
sales/repairs
,
,
Property
If
the
box
for
“Other”
is
marked,
department’s
State
or
local
may ask that
you comRestaurant Apparatus
or cafeteriaPersonnel
419
599
1- or 2-family dwelling
Business office
$
the Hazardous 429
Materials
Module (NFIRS-7).
,
,
ContentsMultifamily
Bar/tavern orplete
nightclub
Suppression
615
dwelling
Electric-generating plant
Elementary school, kindergarten 439
629
Rooming/boarding
house
Laboratory/science laboratory
PRE-INCIDENT
VALUE:
Optional
HighEMS
school, junior high
449
700
Commercial hotel or motel
Manufacturing plant
Property
$
,
,
College,
Other adult education
459
819
Residential, board
and care
Livestock/poultry storage (barn)
Nursing
464
882
$
ContentsDormitory/barracks
Non-residential parking garage
Check boxhome
if resource counts include aid
,
,
received resources.
Hospital
519
891
Food and beverage sales
Warehouse
tside
Vacant lot
936
981
Construction site
None I Mixed Use
NonePlayground
or parkMaterials Release
Graded/cared
for plot of landNot mixed
H3 Hazardous
938
984
Industrial plant yard
Property
Lake, river, stream
946
juriesCrops or orchard
10
Assembly use Look up and enter a
Forest
(timberland)
1
or HazMat
actions right-of-way
Natural gas: slow leak, no evacuation
Property Use
Railroad
951
20
Education use Property Use code and
description only if you
Outdoor
storagegas:
area
Code
2
Propane
<21-lb tank (as in home
Other street 33
960BBQ grill)
Medical use have NOT checked a
Dump
orGasoline:
sanitaryvehicle
landfill
3
fuel tank or portable
containerHighway/divided
highway
961
40
Residential useProperty Use box.
Property Use Description
51
Row of stores
Open
or fieldfuel burning equipment or
4 land
Kerosene:
portable storage
Residential street/driveway
962

pants
them

Section I: Mixed Use Property

5
6
7
8
0

Diesel fuel/fuel oil: vehicle fuel tank or portable storage
Household solvents: home/office spill, cleanup only
Motor oil: from engine or portable container
Paint: from paint cans totaling <55 gallons
Other: special HazMat actions required or spill > 55 gal
(Please complete the HazMat form.)

53
58
59
60
63
65
00

Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

NFIRS–1 Revision 01/01/05

341
342
361
419
429
439
449
459
464
519

539
Clinic, clinic-type
infirmary
Household
sales,
repairs
The Mixed
Use Property section
records
datagoods,
on the
overall
use of the structure(s) on a property. If a
571
Doctor/dentist office
Gas or service station
structure
has
two
or
more
property
uses,
or
if
a
property
has
two or more structures with different
579
Prison or jail, not juvenile
Motor vehicle/boat sales/repairs
property
uses, the mixed-use
applies.
599 designation
1- or 2-family
dwelling
Business office
615
Multifamily dwelling
Electric-generating plant
Examples:
629
Rooming/boarding
house
Laboratory/science laboratory
700
Commercial hotel or motel
Manufacturing plant
A bank
inand
a grocery
would Livestock/poultry
be a structure with
two property
uses - assembly use and business/
Residential,
board
care store 819
storage
(barn)
Dormitory/barracks
Non-residential
garage
office use. The mixed-use882
designation
would beparking
business
and residential use.
891
Food and beverage sales
Warehouse

936
938
946
951
960
961

Vacant lot
Graded/cared for plot of land
Lake, river, stream
Railroad right-of-way
Other street
Highway/divided highway

981
984

Construction site
Industrial plant yard

Look up and enter a
Property Use code and
description only if you
have NOT checked a
Property Use box.

1-10

Property Use
Code

Primary Action Taken (1)

Apparatus

Personnel

Suppression
Additional Action Taken (2)

Contents

PRE-INCIDENT VALUE: Optional

EMS

NFIRS
Other 5.0 Self-Study Program
Additional Action Taken (3)

Property

Check box if resource counts include aid
received resources.

Property

Contents

ACompleted
warehouse
on the property of anNone
amusement
park would qualify as two
structures with different
None I Mixed Use
Modules H1 Casualties
H3 Hazardous Materials Release
Not mixed
Property
property
Fire–2 uses.
Deaths Injuries
Structure Fire–3

Fire

Natural gas: slow leak, no evacuation or HazMat actions

5
6
7
8
0

53
58
59
60
63
65
00

Assembly use

Education use
Civilian Fire Cas.–4
A stand-alone
service
station would not 2be mixed
use<21-lb
even
it may
have a20
driveway
or a parkPropane gas:
tankthough
(as in home BBQ
grill)
Service
33
Medical use
Fire Service Cas.–5
3
Gasoline: vehicle fuel tank or portable container
40
Residential use
ing EMS–6
lot.
Civilian
51
Row of stores
4
Kerosene: fuel burning equipment or portable storage

HazMat–7

Detector

Wildland Fire–8
Apparatus–9
Personnel–10
Arson–11

Required for confined fires.

Section J: Property Use

1
2
U

Detector alerted occupants
Detector did not alert them
Unknown

(Please complete the HazMat form.)

Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

341
342
361
419
429
439
449
459
464
519

539
571
579
599
615
629
700
819
882
891

Outside
Playground or park
124
Crops or orchard
655
Forest (timberland)
669
Outdoor storage area
807
Dump or sanitary landfill
919
Open land or field
931

936
938
946
951
960
961
962

Vacant lot
Graded/cared for plot of land
Lake, river, stream
Railroad right-of-way
Other street
Highway/divided highway
Residential street/driveway

981
984

Construction site
Industrial plant yard

Look up and enter a
Property Use code and
description only if you
have NOT checked a
Property Use box.

Property Use
Code
Property Use Description
NFIRS–1 Revision 01/01/05

This section identifies the specific use of the property where the incident occurred and whether it is
a structure or an open piece of land. You are required to complete Section J.
Several property use options are provided. The property use codes listed on the paper form are the
most frequently used. When you are using the automated system all codes will be provided. When
using paper forms you will not need to look up a code unless none of the boxes on the list are
appropriate.
Mark the box based on the use of the particular area of the property where the fire occurred. Do not
base your choice on the overall use of the “mixed property use” designation.

Section K1: Person/Entity Involved
K1

Person/Entity Involved
Local Option

Check this box if same
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Business Name (if applicable)

Mr., Ms., Mrs.

First Name

Number

Prefix

Post Office Box

State

Area Code

Phone Number

Last Name

Street or Highway

Suffix

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.
Same as person involved?

Owner
Then check this box and skip
K2 section
This
identifies
the person/entity
involved in the incident. LinesAreaare
available
for a business
the rest of this block.
Business Name (if applicable)
Code
Phone Number
name (if applicable), telephone number, and an individual’s name and address.
Local Option

Check this box if same
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Mr., Ms., Mrs.

Number

Post Office Box

First Name

Prefix

Street or Highway

Last Name

1-11

Apt./Suite/Room

Suffix

Street Type

City

Suffix

NFIRS 5.0 Self-Study Program

Person/Entity Involved
Local Option

Business Name (if applicable)

Area Code

Phone Number

If more
than one person is involved, mark the box provided at the bottom of the K1 Block and attach
Check this box if same
address as incident
First Name
MI automated
supplemental
forms
as necessary.
If you are using the
system, open a new blockSuffix
for each
Mr., Ms., Mrs.
Last Name
Location (Section B).
Then skip the three
additional
person.
duplicate address
lines.

Number

Prefix

Post Office Box

State

Street or Highway

Street Type

Apt./Suite/Room

Suffix

City

Section K2: Owner

ZIP Code

More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Same as person involved?
Then check this box and skip
the rest of this block.

Owner
Local Option

Business Name (if applicable)

Person/Entity Involved

Area Code

Local Option

Business Name (if applicable)
Check this box if same
address as incident
Mr., Ms., Mrs.
First Name
Location (Section B).
this box if same
Then Check
skip the
three
address as incident
duplicate address
First Name
Mr., Ms., Mrs.
Location (Section B).
lines.Then skip the three
Number
Prefix
Street or Highway
duplicate address
lines.

Number

Prefix

Post Office Box

Phone Number

Last Name

Suffix

Last Name

Suffix

Street Type

Street or Highway

Street Type

Apt./Suite/Room

Post Office Box

StateState

Area Code

Phone Number

Suffix
Suffix

City

Apt./Suite/Room

City

ZIPZIP
Code
Code

More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.
Remarks:
FillLKout
Block
K2 to record the owner of the property involved. If the person/entity involved and the
2 Owner
owner are the same, check the “Same as Person Involved” box in Block K2.
Local
Option
Local
Option

Check this box if same
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Same as person involved?
Then check this box and skip
the rest of this block.

Business Name (if applicable)

Area Code

Phone Number

If the owner is a different person, enter the business name (if applicable), telephone number, name,
and address.
Mr., Ms., Mrs.

First Name

Number

Prefix

Street or Highway

Street Type

Apt./Suite/Room

City

ZIP Code

Fire Module Required?

Complete Fire & Structure Modules
Complete Fire Module &
Section I, Structure Module
Basic Module Only
Confined 113–118
Complete Fire Module
Mobile property 120–123
Complete Fire Module
Vehicle 130–138
Complete Fire or Wildland Module
Vegetation 140–143
Outside rubbish fire 150–155 Basic Module Only
Complete Fire or Wildland Module
Special outside fire 160
Special outside fire 161–163 Complete Fire Module
Complete Fire or Wildland Module
Crop fire 170–173
Buildings 111
Special structure 112

Local Option

ITEMS WITH A

Suffix

Check the box that applies and then complete the Fire Module
based on Incident Type, as follows:

Remarks:

Suffix

Section L: Remarks

Post Office Box

State

Last Name

MUST ALWAYS BE COMPLETED!
Fire Module Required?

Check the as
boxnecessary.
that applies and then complete the Fire Module
More remarks? Check this box and attach Supplemental Forms (NFIRS–1S)
based on Incident Type, as follows:
Complete Fire & Structure Modules
Complete Fire Module &
Section I, Structure Module
Basic Module Only
Confined 113–118
Complete Month
Fire Module
120–123
Position orMobile
rank property Assignment
Day
Year
Complete Fire Module
Vehicle 130–138
Complete Fire or Wildland Module
Vegetation 140–143
Outside rubbish fire 150–155 Basic Module Only
Complete Month
Fire or Wildland
outside fire
160
Position orSpecial
rank
Assignment
Day Module
Year
Special outside fire 161–163 Complete Fire Module
Complete Fire or Wildland Module
Crop fire 170–173
Buildings 111
Special structure 112

Authorization

Check box if
same as
Officer in
charge.

Officer in charge ID

Signature

Member making report ID

Signature

ITEMS WITH A

MUST ALWAYS BE COMPLETED!

More remarks? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Authorization

Check box if
same as
Officer in
charge.

Officer in charge ID

Signature

Member making report ID

Signature

Position or rank

1-12

Position or rank

Assignment

Month

Day

Year

Assignment

Month

Day

Year

State

ZIP Code

More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Owner

Local Option

Same as person involved?
Then check this box and skip
the rest of this block.

NFIRS 5.0 Self-Study Program

Business Name (if applicable)

Area Code

Phone Number

Check this box if same
address as incident

Mr., Ms., Mrs.
MI
Last Name
Suffix
Location
(Section
You
may
useB). this
sectionFirsttoName
include a narrative description
of the incident. If more remarks are
necesThen skip the three
duplicate address
sary
and you are using paper forms, supplemental forms can be completed and attached.
lines.
Number

Prefix

Street or Highway

Street Type

Suffix

Should a Fire Module be required because of the nature of the incident, the system may automatiOfficeyou
Box
City
cally set one upPostfor
and attach it toApt./Suite/Room
this Basic Module.
On the paper form, a box within Section
L can be used to note whether or not completion of the Fire Module is required.
State

ZIP Code

The Narrative Report

Remarks:

Local Option

It is important for you to understand the importance of the narrative report. The incident report
serves as an official, legal record of an incident and must accurately describe the incident and the
actions taken to mitigate it. While many of these facts can be collected in uniform code fields, some
information can be presented only in a detailed narrative. Critical information may be left out unless
Fire Module Required?
the narrative report is completed.
Check the box that applies and then complete the Fire Module
based on Incident Type, as follows:

Information that should be included in the narrative includes
observations Complete
and actions
taken. They
Fire & Structure Modules
Buildings 111
Complete Fire Module &
Special structure 112
should be reported in a logical order - usually chronological.
Section I, Structure Module
Confined 113–118

Basic Module Only

Crop fire 170–173

Complete Fire or Wildland Module

Complete
Fire Module
Mobilesummarize
property 120–123 the
Use the narrative report to paint a picture of the scene and
incident.
Describe the
Complete Fire Module
Vehicle 130–138
Complete
Fire or Wildland
Moduleyou
140–143
scene conditions including property damage. Also describeVegetation
the
condition
of
the
premises
when
Outside rubbish fire 150–155 Basic Module Only
Complete
Fire
or
Wildland
Module
Special
outside
fire
160
left and report any remaining hazards.
Special outside fire 161–163 Complete Fire Module

ITEMS WITH A

MUST ALWAYS BE COMPLETED!

Section M: Authorization

More remarks? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Authorization

Check box if
same as
Officer in
charge.

Officer in charge ID

Signature

Position or rank

Assignment

Month

Day

Year

Member making report ID

Signature

Position or rank

Assignment

Month

Day

Year

Use this section to record the identification number, name, position/rank, and assignment for
both the officer in charge and the person completing the incident report. The date of completion
should also be recorded. If the officer in charge is the person filling out the report, check the box
provided.

SUMMARY
NFIRS-1, the Basic Module, is used for every incident. State agencies that are responsible for incident
reporting will determine which optional modules must be submitted.
For many incident types, the Basic Module is the only report that must be completed. It meets the
need for an abbreviated form of incident reporting for some fires.

1-13

NFIRS 5.0 Self-Study Program

Example: Fire in Metal Trash Can
Directions: Read the call information in the example below.Then look at the completed Basic Module Form. Look at each section and follow along with the proper use of the information as applicable to the Basic Module.
Department FDID #TR100 is called at 0918 on March 6, 1999 to a reported fire at the Super Rest
Motel, 755 Lancaster Road in Paradise City, Wisconsin, 12345. Upon arrival at 0921, Engine 1
finds that the fire is confined to a metal trash can - no flame damage occurs outside of the trash
can. However, smoke damage has affected the room of the incident. Engine 1’s officer sends two
firefighters to extinguish the fire and ventilate the area. The fire is controlled at 0925 and the last
unit clears the scene at 0945. Damage to the structure is estimated at $1,000. Mr. Jon Lee, the
building owner, has offices at the motel. The incident number is reported as #9700876.

1-14

NFIRS 5.0 Self-Study Program

Example—Fire in Metal Trash Can
A TR100
FDID

YYYY

1999

State

9 7 0 0 8 7 6

Station

Incident Number

Delete

000

Prefix

Census Tract

Street or Highway

Street Type

Paradise City
Apt./Suite/Room

Basic

No Activity

Lancaster

755
Number/Milepost

NFIRS–1

Change

Exposure

Check this box to indicate that the address for this incident is provided on the Wildland Fire
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Street address
Intersection
In front of
Rear of
Adjacent to
Directions
US National Grid

City

12345

State

Suffix

ZIP Code

Cross Street, Directions or National Grid, as applicable

Incident Type

Dates and Times

118

Aid Given or Received

None

Midnight is 0000

Month

Check boxes if
dates are the
same as Alarm
Date.

Incident Type

001

Incident Date

Location Type

Day

Year

Hour

ALARM always required

Min

Local Option

0918

Alarm

Shifts and Alarms

01 001

Shift or
Platoon

Alarms

District

ARRIVAL required, unless canceled or did not arrive

1
2
3
4
5

Mutual aid received
Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Their FDID

Their
State

X
X

Actions Taken

Controlled
Last Unit
Cleared

0945

Apparatus

Ventilate the area

Suppression

Personnel

0001 0003

Additional Action Taken (2)

Additional Action Taken (3)

Civilian Fire Cas.–4
Fire Service Cas.–5
EMS–6
HazMat–7
Wildland Fire–8
Apparatus–9
Personnel–10
Arson–11

Check box if resource counts include aid
received resources.

Casualties

None

Deaths Injuries
Fire
Service
Civilian

H2
1
2
U

Detector
Required for confined fires.

Detector alerted occupants
Detector did not alert them
Unknown

341
342
361
419
429
439
449
459
464
519

Outside
Playground or park
124
Crops or orchard
655
Forest (timberland)
669
Outdoor storage area
807
Dump or sanitary landfill
919
Open land or field
931

936
938
946
951
960
961
962

Estimated Dollar Losses and Values

LOSSES:

Required for all fires if known.
Optional for non-fires.

Property

Contents

1 , 000

None

Property

Contents

Hazardous Materials Release

1
2
3
4
5
6
7
8
0

Natural gas: slow leak, no evacuation or HazMat actions
Propane gas: <21-lb tank (as in home BBQ grill)
Gasoline: vehicle fuel tank or portable container
Kerosene: fuel burning equipment or portable storage
Diesel fuel/fuel oil: vehicle fuel tank or portable storage
Household solvents: home/office spill, cleanup only
Motor oil: from engine or portable container
Paint: from paint cans totaling <55 gallons
Other: special HazMat actions required or spill > 55 gal

None

(Please complete the HazMat form.)

Special
Study Value

PRE-INCIDENT VALUE: Optional

EMS
Other

Fire–2
Structure Fire–3

Local Option

Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires

Check this box and skip this block if an
Apparatus or Personnel Module is used.

Extinguished Fire

Completed Modules

Special Studies

0925

Resources

Primary Action Taken (1)

CONTROLLED optional, except for wildland fires

Their Incident Number

0921

Arrival

Mixed Use
Property
10
20
33
40
51
53
58
59
60
63
65
00

Not mixed

Assembly use
Education use
Medical use
Residential use
Row of stores
Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

539
571
579
599
615
629
700
819
882
891

Vacant lot
Graded/cared for plot of land
Lake, river, stream
Railroad right-of-way
Other street
Highway/divided highway
Residential street/driveway

981
984

Construction site
Industrial plant yard

1-15

Look up and enter a
Property Use code and
description only if you
have NOT checked a
Property Use box.

Property Use
Code
Property Use Description
NFIRS–1 Revision 01/01/05

NFIRS 5.0 Self-Study Program
Super Rest Motel

Person/Entity Involved

Local Option

this box if same
X Check
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Business Name (if applicable)

Jon

Number

Prefix

1 2 3 4

Last Name

Suffix

Street or Highway

Post Office Box

State

123
Phone Number

Lee

First Name

Mr., Ms., Mrs.

555
Area Code

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Owner

Local Option

Business Name (if applicable)

Area Code

Mr., Ms., Mrs.

First Name

Number

Prefix

1 2 3 4

Last Name

Suffix

Street or Highway

Post Office Box

State

123
Phone Number

Lee

Jon

X Check this box if same X
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

555

Same as person involved?
Then check this box and skip
the rest of this block.

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

Remarks:

Local Option

Fire Module Required?
Check the box that applies and then complete the Fire Module
based on Incident Type, as follows:
Complete Fire & Structure Modules
Complete Fire Module &
Section I, Structure Module
Basic Module Only
Confined 113–118
Complete Fire Module
Mobile property 120–123
Complete Fire Module
Vehicle 130–138
Complete Fire or Wildland Module
Vegetation 140–143
Outside rubbish fire 150–155 Basic Module Only
Complete Fire or Wildland Module
Special outside fire 160
Special outside fire 161–163 Complete Fire Module
Complete Fire or Wildland Module
Crop fire 170–173
Buildings 111
Special structure 112

ITEMS WITH A

MUST ALWAYS BE COMPLETED!

More remarks? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Authorization

Check box if
same as
Officer in
charge.

Joe Officer

Captain

1999

Officer in charge ID

Signature

Position or rank

Assignment

Month

Day

Year

Member making report ID

Signature

Position or rank

Assignment

Month

Day

Year

1-16

NFIRS 5.0 Self-Study Program

Exercise Scenario 1-1: Food on Stove
Directions: Read the call information in the exercise below. Use the information provided to complete the Basic Module form.
Compare your work to the answers provided on the subsequent completed Basic Module form. If your answers are different from
the ones provided, read over the Basic Module again.
On Saturday May 23, 1998 at 1513 hours a call is received for a fire at 112 Main Street, Mill City,
WI 12345. Engine 23, Engine 12, Ladder 2, Battalion 2 respond. They arrive at 1518 to find smoke
coming from the rear of the house. Crew from E-23 enters the house to find that the smoke is
coming from the kitchen area as a result of unattended cooking. The incident is confined to the
pot on the stove.
E23 removes the pot from the stove with Ladder 2 establishing ventilation. The fire did not extend
beyond the pot. Damage is confined to the pot, the food, with minimal smoke damage in the
kitchen area. The homeowner, Ms. Sally Jones, reports that she was notified of the fire by the
smoke detector.
The value of the property is set at $185,000 and contents at $47,000. There is no loss as a result
of the fire.
The incident was controlled at 1530 and the units cleared at 1620. There was no mutual aid
received nor were there any injuries. The incident number assigned was 9700181. There were no
exposures.
The shift on duty was C Platoon with a one-alarm assignment. The District was #112.
The FDID is TR100 and the officer in charge was Captain Joe Officer from Battalion 2.

1-17

NFIRS 5.0 Self-Study Program
MM

Delete

Incident Date

State

Location Type

Station

Incident Number

Exposure

NFIRS–1

Number/Milepost

Prefix

Basic

No Activity

Check this box to indicate that the address for this incident is provided on the Wildland Fire
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Street address
Intersection
In front of
Rear of
Adjacent to
Directions
US National Grid

Census Tract

Street or Highway

Street Type

Suffix

Apt./Suite/Room

City

State

ZIP Code

Cross Street, Directions or National Grid, as applicable

Incident Type

YYYY

Change
FDID

Aid Given or Received

None

Dates and Times

Midnight is 0000

Month

Check boxes if
dates are the
same as Alarm
Date.

Day

Year

Hour

Min

Shifts and Alarms
Local Option

ALARM always required

Shift or
Platoon

Alarm

Alarms

District

ARRIVAL required, unless canceled or did not arrive

1
2
3
4
5

Mutual aid received
Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Their FDID

Last Unit
Cleared

Resources

Primary Action Taken (1)

Apparatus

Personnel

Suppression
Additional Action Taken (2)

Civilian Fire Cas.–4
Fire Service Cas.–5
EMS–6
HazMat–7
Wildland Fire–8
Apparatus–9
Personnel–10
Arson–11

Check box if resource counts include aid
received resources.

Casualties

None

Deaths Injuries
Fire
Service
Civilian

H2
1
2
U

Detector
Required for confined fires.

Detector alerted occupants
Detector did not alert them
Unknown

H3
1
2
3
4
5
6
7
8
0

Special
Study Value

Estimated Dollar Losses and Values

LOSSES:

Required for all fires if known.
Optional for non-fires.

Property

Contents

None

PRE-INCIDENT VALUE: Optional

EMS
Other
Additional Action Taken (3)

Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires

Check this box and skip this block if an
Apparatus or Personnel Module is used.

Fire–2
Structure Fire–3

Local Option

Controlled

Actions Taken

Completed Modules

Special Studies

CONTROLLED optional, except for wildland fires

Their
State

Their Incident Number

Arrival

Property

Contents

Hazardous Materials Release

None

Mixed Use
Property
10
20
33
40
51
53
58
59
60
63
65
00

Not mixed

Assembly use
Education use
Medical use
Residential use
Row of stores
Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

341
342
361
419
429
439
449
459
464
519

539
571
579
599
615
629
700
819
882
891

Outside
Playground or park
124
Crops or orchard
655
Forest (timberland)
669
Outdoor storage area
807
Dump or sanitary landfill
919
Open land or field
931

936
938
946
951
960
961
962

Vacant lot
Graded/cared for plot of land
Lake, river, stream
Railroad right-of-way
Other street
Highway/divided highway
Residential street/driveway

981
984

Construction site
Industrial plant yard

1-18

Look up and enter a
Property Use code and
description only if you
have NOT checked a
Property Use box.

Property Use
Code
Property Use Description
NFIRS–1 Revision 01/01/05

NFIRS 5.0 Self-Study Program
Person/Entity Involved

Local Option

Check this box if same
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Business Name (if applicable)

Mr., Ms., Mrs.

First Name

Number

Prefix

Post Office Box

State

Area Code

Phone Number

Last Name

Suffix

Street or Highway

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Owner

Local Option

Check this box if same
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Same as person involved?
Then check this box and skip
the rest of this block.

Mr., Ms., Mrs.

Business Name (if applicable)

First Name

Number

Prefix

Post Office Box

State

Area Code

Phone Number

Last Name

Suffix

Street or Highway

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

Remarks:

Local Option

ITEMS WITH A

MUST ALWAYS BE COMPLETED!

More remarks? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Authorization

Check box if
same as
Officer in
charge.

Officer in charge ID

Signature

Position or rank

Assignment

Month

Day

Year

Member making report ID

Signature

Position or rank

Assignment

Month

Day

Year

1-19

NFIRS 5.0 Self-Study Program

Example—Food on Stove
A TR100
FDID

YYYY

1998

State

Incident Number

Delete

000

Prefix

Basic

No Activity
Census Tract

Street or Highway

Street Type

Mill City
Apt./Suite/Room

NFIRS–1

Change

Exposure

Main

112
Number/Milepost

City

12345

State

Suffix

ZIP Code

Cross Street, Directions or National Grid, as applicable

Incident Type

Aid Given or Received

Dates and Times

Food on Stove
None

Midnight is 0000

Month

Check boxes if
dates are the
same as Alarm
Date.

Incident Type

9 7 0 0 1 8 1

Station

Check this box to indicate that the address for this incident is provided on the Wildland Fire
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Street address
Intersection
In front of
Rear of
Adjacent to
Directions
US National Grid

113

002

Incident Date

Location Type

Day

Year

Hour

ALARM always required

Min

Local Option

1513

Alarm

Shifts and Alarms

01 112

Shift or
Platoon

Alarms

District

ARRIVAL required, unless canceled or did not arrive

1
2
3
4
5

Mutual aid received
Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Their FDID

Their
State

X
X

Actions Taken

Controlled
Last Unit
Cleared

1620

Apparatus

Ventilate area

Suppression

Personnel

0003 0012

Additional Action Taken (2)

EMS
Other
Additional Action Taken (3)

Fire–2
Structure Fire–3
Civilian Fire Cas.–4
Fire Service Cas.–5
EMS–6
HazMat–7
Wildland Fire–8
Apparatus–9
Personnel–10
Arson–11

Casualties

None

Deaths Injuries
Fire
Service
Civilian

H2
1
2
U

Detector
Required for confined fires.

Detector alerted occupants
Detector did not alert them
Unknown

341
342
361
419
429
439
449
459
464
519

Outside
Playground or park
124
Crops or orchard
655
Forest (timberland)
669
Outdoor storage area
807
Dump or sanitary landfill
919
Open land or field
931

936
938
946
951
960
961
962

Estimated Dollar Losses and Values

LOSSES:

Required for all fires if known.
Optional for non-fires.

Property

Contents

Property

None

Contents

185 , 000
, 47 , 000
,

Hazardous Materials Release

1
2
3
4
5
6
7
8
0

None

(Please complete the HazMat form.)

Special
Study Value

PRE-INCIDENT VALUE: Optional

0001 0001

Check box if resource counts include aid
received resources.

Local Option

Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires

Check this box and skip this block if an
Apparatus or Personnel Module is used.

Extinguish Fire

Completed Modules

Special Studies

1530

Resources

Primary Action Taken (1)

CONTROLLED optional, except for wildland fires

Their Incident Number

1518

Arrival

Mixed Use
Property
10
20
33
40
51
53
58
59
60
63
65
00

Not mixed

Assembly use
Education use
Medical use
Residential use
Row of stores
Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

539
571
579
599
615
629
700
819
882
891

Vacant lot
Graded/cared for plot of land
Lake, river, stream
Railroad right-of-way
Other street
Highway/divided highway
Residential street/driveway

981
984

Construction site
Industrial plant yard

1-20

Look up and enter a
Property Use code and
description only if you
have NOT checked a
Property Use box.

Property Use
Code
Property Use Description
NFIRS–1 Revision 01/01/05

NFIRS 5.0 Self-Study Program
Person/Entity Involved

Local Option

this box if same
X Check
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Business Name (if applicable)

X
Mr., Ms., Mrs.

Sally

Prefix

Phone Number

Jones

First Name

Number

Last Name

Suffix

Street or Highway

Post Office Box

State

Area Code

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Owner

Local Option

Check this box if same
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Same as person involved?
Then check this box and skip
the rest of this block.

Mr., Ms., Mrs.

Business Name (if applicable)

First Name

Number

Prefix

Phone Number

Last Name

Suffix

Street or Highway

Post Office Box

State

Area Code

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

Remarks:

Local Option

Incident was confined to the pot on the stove, smoke
detector activated, no losses.

ITEMS WITH A

MUST ALWAYS BE COMPLETED!

More remarks? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Authorization

Check box if
same as
Officer in
charge.

Joe Officer

Captain

Batt. 2

1999

Officer in charge ID

Signature

Position or rank

Assignment

Month

Day

Year

Member making report ID

Signature

Position or rank

Assignment

Month

Day

Year

1-21

NFIRS 5.0 Self-Study Program

Exercise Scenario 1-2: Cary Street House Fire
Directions: Read the call information in the exercise below. Use the information provided to complete the entire Basic Module
form. Compare your work to the answers provided in Appendix A. If your answers are different from the ones provided, read over
the Basic Module again.
The Alberta Fire Department (FDID 92188) received a call for a reported house fire at 5 East
Cary Street, Brunswick, Virginia 23351 on May 1, 2002. Engine 1, Engine 2, and Truck 1 were
dispatched at 1253 hours and arrived on location at 1305. Each piece of apparatus was staffed
with 4 firefighters and A shift was on duty. The dispatcher assigned the incident (#5432). The
owner of the single-family dwelling, Mrs. Christy Gordon, said that she was warming her lunch
on the stove when the grease from the pan began to burn. She was alerted when the smoke
detector activated. The kitchen filled with smoke. She called 9-1-1. The firefighters ventilated
the kitchen. There was no loss to property or contents. The last unit cleared the scene at 1340
hours. FF1 Adam C. Wallner, Badge No. 224, completed the report after returning to Station
No. 2. Captain Tonya Gordon, Badge No. 105, was the officer in charge. The incident was in
Census Tract 501.10, District A12.

1-22

NFIRS 5.0 Self-Study Program
MM

Delete

Incident Date

State

Location Type

Station

Incident Number

Exposure

NFIRS–1

Number/Milepost

Prefix

Basic

No Activity

Check this box to indicate that the address for this incident is provided on the Wildland Fire
Module in Section B, “Alternative Location Specification." Use only for wildland fires.

Street address
Intersection
In front of
Rear of
Adjacent to
Directions
US National Grid

Census Tract

Street or Highway

Street Type

Suffix

Apt./Suite/Room

City

State

ZIP Code

Cross Street, Directions or National Grid, as applicable

Incident Type

YYYY

Change
FDID

Aid Given or Received

None

Dates and Times

Midnight is 0000

Month

Check boxes if
dates are the
same as Alarm
Date.

Day

Year

Hour

Min

Shifts and Alarms
Local Option

ALARM always required

Shift or
Platoon

Alarm

Alarms

District

ARRIVAL required, unless canceled or did not arrive

1
2
3
4
5

Mutual aid received
Auto. aid received
Mutual aid given
Auto. aid given
Other aid given

Their FDID

Last Unit
Cleared

Resources

Primary Action Taken (1)

Apparatus

Personnel

Suppression
Additional Action Taken (2)

Civilian Fire Cas.–4
Fire Service Cas.–5
EMS–6
HazMat–7
Wildland Fire–8
Apparatus–9
Personnel–10
Arson–11

Check box if resource counts include aid
received resources.

Casualties

None

Deaths Injuries
Fire
Service
Civilian

H2
1
2
U

Detector
Required for confined fires.

Detector alerted occupants
Detector did not alert them
Unknown

H3
1
2
3
4
5
6
7
8
0

Special
Study Value

Estimated Dollar Losses and Values

LOSSES:

Required for all fires if known.
Optional for non-fires.

Property

Contents

None

PRE-INCIDENT VALUE: Optional

EMS
Other
Additional Action Taken (3)

Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires

Check this box and skip this block if an
Apparatus or Personnel Module is used.

Fire–2
Structure Fire–3

Local Option

Controlled

Actions Taken

Completed Modules

Special Studies

CONTROLLED optional, except for wildland fires

Their
State

Their Incident Number

Arrival

Property

Contents

Hazardous Materials Release

None

Mixed Use
Property
10
20
33
40
51
53
58
59
60
63
65
00

Not mixed

Assembly use
Education use
Medical use
Residential use
Row of stores
Enclosed mall
Business & residential
Office use
Industrial use
Military use
Farm use
Other mixed use

341
342
361
419
429
439
449
459
464
519

539
571
579
599
615
629
700
819
882
891

Outside
Playground or park
124
Crops or orchard
655
Forest (timberland)
669
Outdoor storage area
807
Dump or sanitary landfill
919
Open land or field
931

936
938
946
951
960
961
962

Vacant lot
Graded/cared for plot of land
Lake, river, stream
Railroad right-of-way
Other street
Highway/divided highway
Residential street/driveway

981
984

Construction site
Industrial plant yard

1-23

Look up and enter a
Property Use code and
description only if you
have NOT checked a
Property Use box.

Property Use
Code
Property Use Description
NFIRS–1 Revision 01/01/05

NFIRS 5.0 Self-Study Program
Person/Entity Involved

Local Option

Check this box if same
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Business Name (if applicable)

Mr., Ms., Mrs.

First Name

Number

Prefix

Post Office Box

State

Area Code

Phone Number

Last Name

Suffix

Street or Highway

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Owner

Local Option

Check this box if same
address as incident
Location (Section B).
Then skip the three
duplicate address
lines.

Same as person involved?
Then check this box and skip
the rest of this block.

Mr., Ms., Mrs.

Business Name (if applicable)

First Name

Number

Prefix

Phone Number

Last Name

Suffix

Street or Highway

Street Type

Apt./Suite/Room

Post Office Box

State

Area Code

Suffix

City

ZIP Code

Remarks:

Local Option

ITEMS WITH A

MUST ALWAYS BE COMPLETED!

More remarks? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Authorization

Check box if
same as
Officer in
charge.

Officer in charge ID

Signature

Position or rank

Assignment

Month

Day

Year

Member making report ID

Signature

Position or rank

Assignment

Month

Day

Year

1-24

NFIRS 5.0 Self-Study Program

Basic Module Test
1. Which incident type would require more than the Basic Module?

(a) Controlled burning.

(b) Fire confined to the chimney.

(d) Landfill fire.

2. If a fire department was dispatched to a grass fire in another department’s area and was cancelled prior to arriving because the receiving department determined that the incident was a
controlled burn, what incident type would the department giving aid use?

(a) Authorized controlled burning.

(b) Grass fire.

(d) None - no report is needed.

3. What would be the incident type if the incident involved EMS, fire, and hazardous materials?

(a) Fire.

(b) EMS.

(d) The most severe situation.

4. How many civilian casualties would be recorded in H1 (Number of Casualties section), if a
police officer was injured rerouting traffic and two firefighters were injured extinguishing the
fire?

(a) None.

(b) One.

(d) Three.

5. High schools and dentist offices are examples of this data element.

(a) Location.

(b) Mixed Use Property.

(d) Property Use.

1-25

File Type	application/pdf
File Modified	2008-02-12
File Created	2008-02-12