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pdfNFIRS 5.0 Self-Study Program
Hazardous Materials
Module: NFIRS-7
Objectives
After completing the Hazardous Materials Module the students will be
able to:
1. Describe when the Hazardous Materials Module is to be used.
2. Demonstrate how to complete the Hazardous Materials Module and
identify appropriate other modules, given the scenario of a hypothetical incident.
7-1
Table of Contents
Pretest #7 - Hazardous Materials (HazMat) Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3
Using the Hazardous Materials Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4
Section A: FDID, State, Incident Number, Incident Date, Exposure Number,
HazMat Number. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4
Section B: HazMat ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5
Section C: Container Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7
Section D: Estimated Release. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8
Section E: Physical State When Released and Released Into. . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8
Section F: Released From and Population Density. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9
Section G: Area Affected, Area Evacuated, Estimated Number of People Evacuated, and
Estimated Number of Buildings Evacuated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10
Section H: HazMat Actions Taken. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11
Section I: Fire or Explosion Involved With a Release. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11
Section J: Cause of Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11
Section K: Factors Contributing to Release. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12
Section L: Mitigating Factors or Impediments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12
Section M: Equipment Involved in Release. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12
Section N: Mobile Property Involved in Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13
Section O: HazMat Disposition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14
Section P: HazMat Civilian Casualties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15
EXAMPLE: Chlorine Leak Incident. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-16
EXERCISE SCENARIO 7-1: Cargo Tank Rollover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-18
EXERCISE SCENARIO 7-2: HazMat I-95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-21
Hazardous Materials Module Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-25
NFIRS 5.0 Self-Study Program
Pretest #7 - Hazardous Materials (HazMat) Module
1. The Basic Module must be completed if the Hazardous Materials Module is completed.
(a) True.
(b) False.
2. The Hazardous Materials Module is a required NFIRS module.
(a) True.
(b) False.
3. The number of civilians injured as a result of contact or exposure to a hazardous material is
recorded as Casualties on the Basic Module.
(a) True.
(b) False.
4. The Hazardous Materials Module can be used to record more than one hazardous material
involved at the incident.
(a) True.
(b) False.
5. The reportable HazMat incident can be any incident type.
(a) True.
(b) False.
7-3
NFIRS 5.0 Self-Study Program
Using the Hazardous Materials Module
U
se the optional Hazardous Materials Module when the Basic Module (Block H3 – Hazardous
Materials Release) indicates “other” for hazardous materials. Its purpose is to document reportable HazMat incidents. A reportable HazMat incident is one in which specialized HazMat resources
were dispatched or used, or should have been dispatched or used, for assessing, mitigating, or managing the situation. The Hazardous Materials Module also is used when an incident involves a release
or spill of hazardous materials that exceeds 55 gallons.
NOTE: Nothing in the NFIRS reporting system definition is meant to alter compliance with State or local HazMat reporting requirements. In States with mandatory reporting, the State program manager determines which optional modules (EMS,
Hazardous Materials,Wildland, etc.) are to be submitted to the State.
The Hazardous Materials Module permits hazardous materials incidents to be profiled in depth for
incident management analysis and response-strategy development. It collects relevant information on:
• hazardous materials identification;
• container information;
• release amounts and location;
• actions taken; and
• mitigating factors.
If more than one hazardous material is involved, complete one module for each HazMat released.
Note that the term release is intended to include a spill.
Section A: FDID, State, Incident Number, Incident Date,
Exposure Number, HazMat Number
This information is essentially the same as the information in the Basic Module with the exception
of the HazMat Number (Haz No.). As noted above, if more than one HazMat was involved, complete
one module for each HazMat released.
MM
A
FDID
DD
YYYY
Delete
Incident Date
State
Station
Incident Number
Exposure
Change
Haz No.
NFIRS–7
HazMat
Chemical
B HazMat ID number
Sequentially
each
HazMatCASreleased
in the field HazMat
Number in Section A. Begin with
Name
DOT Hazard
UN Number
Registration Number
Classification
“01” for the first chemical, “02” for the second, and so forth. In an automated system, some systems
may allow
you to enter data
one time
and Capacity
it will automatically
fill in all fields where thatPhysical
information
State
Estimated
Container
C1 Container
D1 Estimated Amount Released
E1 When Released
None C2
Type
is required in Section A. When using hard copies, you will have to enter the Section A information
,
,
,
,
1
Solid
for every module.
Capacity: by volume or weight
Amount released: by volume or weight
Container Type
More hazardous
materials? Use
additional sheets.
C3
11
12
13
14
15
16
Units: Capacity
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
D2
Check one box
21
22
23
24
WEIGHT
Ounces
Pounds
Grams
Kilograms
11
12
13
14
MICRO UNITS 15
Enter Code 16
7-4
Units: Released
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
None
Check one box
21
22
23
24
WEIGHT
Ounces
Pounds
Grams
Kilograms
MICRO UNITS
2
3
U
Liquid
Gas
Undetermined
E2
Released Into
Released into
Enter Code
HazMat Actions Taken
NFIRS 5.0 Self-Study Program
MM
A
FDID
B
DD
Incident Date
State
Section B: HazMat ID
YYYY
Station
Incident Number
HazMat ID
DOT Hazard
Classification
UN Number
Delete
Exposure
NFIRS–7
HazMat
Change
Haz No.
Chemical
Name
CAS Registration Number
Physical State
Container of Section
Estimated Container Capacity
Amount Released
The
hazardous
materials
involved inEan
incident
as
C1 purpose
1 Estimated
1 When
None C2 B is to identify the specific D
Released
Type
accurately as possible. Several different
identification
systems have
can aid fire
, been, developed that
,
,
1
Solid
by volume or weight
Amount released: by volume or weight
department personnel withCapacity:
identifying
hazardous materials.
2
Liquid
Container Type
C3
Units: Capacity
D2
Check one box
Units: Released
Check one box
3
Gas
U
Undetermined
• UN Number (United
Nations Standards
for the Identification
of Hazardous
Materials);
VOLUME
WEIGHT
VOLUME
WEIGHT
More hazardous
materials? Use
additional sheets.
11
Ounces
13
Barrels: 42 gal. 23
15
Cubic feet
Cubic meters
21
Ounces
11
Ounces
Grams
13
Barrels: 42 gal. 23
21
Ounces
• DOT Hazard Classification
(Department
of Transportation
12
Gallons
22
Pounds
Gallons Classification);
Pounds
12
22
E2
Released Into
Grams
14
Liters
24
Kilograms
LitersClassification);
Kilograms
24
• CAS Registration
Number
(Chemical
Abstract14Service
and
16
• Chemical Name.
MICRO UNITS 15
Enter Code 16
Cubic feet
Cubic meters
MICRO UNITS
Released into
Enter Code
HazMat Actions
Population
Density
NotComplete
all ofthethese
needed
to identify
the Evacuated
hazardous None
materials.
fact, inTaken
an automated
remaindersystems
F2 are
G2 Area
H Enter upInto three
actions taken
of this form only for the
NFIRS
system,
many 1of these
data
elements
are
cross-referenced
in
the
database.
By
entering one
first hazardous
material
Urban
Square feet
1
,
involved in this incident.
2
Suburban
Blocks
2
piece of information, the
system
will automatically
fill some
identification
Enter or all of the
Primaryother
action takenHazMat
(1)
3
Rural
measurement
Square miles
3
fields.
F1
Released From
1
Area Affected
G3
Estimated Number of
Additional action taken (2)
G1
People Evacuated
Example:
Below grade
Additional action taken (3)
Square feet
1
If you enter the CAS Registration
Number, the NFIRS
Client Tool
Software System will
,
Blocks
2
If fire or explosion is involved with a
Inside/on
fillstructure
in all other HazMat
ID
fields.
No
further
lookup
is
necessary.
Square
miles
I
3
release, which occurred first?
G4 Estimated Number of
Check all applicable boxes
Story of release
Buildings Evacuated
1
Ignition Materials
Undetermined
U
, Fire Administration (USFA) publication
Chemicals
are listed in the U.S.
Hazardous
Guide for First
None
2
Outside of structure
2
Release
Enter measurement
,
Responders.
Cause of Release
Factors Contributing to Release
Factors Affecting Mitigation
None
K than one piece of information
L toEnteridentify
InJ some cases, it may take more
aorhazardous
material
up to three factors
impediments that affected
the
mitigation of the incident
Enter up to three contributing factors
accurately.
1
Intentional
2
3
4
5
U
Unintentional release
Container/containment failure
Act of nature
Cause under investigation
Cause undetermined after
investigation
Factor contributing to release (1)
Factor or impediment (1)
Example:
The UN Number does not necessarily identify a specific chemical. To accurately idenFactor contributing to release (2)
or impediment (2)
tify the chemical, it must be used in conjunction with theFactor
chemical
or trade name for
that specific chemical.
Factor contributing to release (3)
Factor or impediment (3)
The UN Number is a four-digit number assigned to the hazardous material
Mobile Property Involved in
HazMat Disposition
Equipment Involved
that
to United Nations
None
None (UN) standards for the identification
Oof hazM conforms
N Release
in Release
ardous materials in international transportation. These numbers may be
found
1
Completed by fire service only
2
Completed w/fire service present
in a variety of reference materials. The North American Emergency Response Guidebook
Mobile property type
3
Released to local agency
Equipment involved in release
(NAERG) published by the Research and Special Programs Administration,
4
Released to county agency
5
Released to state agency
BrandDepartment of Transportation (DOT)
U.S.
one reference.
Mobile propertyis
make
6
7
8
Released to federal agency
Released to private agency
Released to property owner or
manager
HazMat Civilian Casualties
The Hazardous Materials Guide for First
Responders published by
the U.S. Fire
Model
Year
Serial #
Administration
is another important reference document. In some cases, a
plate number
State
single
UN Number will be assignedLicense
to several
materials with similar
properP
Year
Deaths
ties. Not all hazardous materials have
been
assigned
UN
Numbers.
DOT number/ ICC number
Model
Injuries
NFIRS–7
Revision 01/01/06
The primary hazards associated with various hazardous materials categories are described by the
DOT Hazard Classification System. Hazardous materials warnings should appear on placards or
labels on the materials during transportation. Since many materials have multiple hazards, the DOT
7-5
NFIRS 5.0 Self-Study Program
hazard classification may not describe all of the potential hazards faced by emergency responders at
a HazMat incident.
The DOT hazard classification consists of a single digit hazard-class code followed by a decimal point
and a single digit code for the division. For the purpose of documentation, this two-part hazard
class/division code has been converted to a two-digit code. The proper entry in this field is the twodigit code that corresponds with the hazard classification and division as found on a placard or label
of the hazardous material.
DOT Hazard Classifications Codes
Class 1 – Explosives
Class 5 – Oxidizers and Organic peroxides
11
Division 1.1 Explosives with mass explosion hazard
51
Division 5.1 Oxidizers
12
Division 1.2 Explosives with projectile hazard
52
Division 5.2 Organic peroxides
13
Division 1.3 Explosives with predominant fire hazard
Class 6 – Toxic material and Infectious Substances
14
Division 1.4 Explosives with no significant blast
61
Division 6.1 Toxic materials
15
Division 1.5 Very insensitive explosives; blasting
62
Division 6.2 Infectious substances
16
Division 1.6 Extremely insensitive detonating articles
Class 2 – Gases
21
Division 2.1 Flammable gases
22
Division 2.2 Non-flammable
23
Division 2.3 Gases toxic by inhalation
24
Division 2.4 Corrosive gases (Canada)
Class 3 – Flammable/Combustible Liquids
30
Flammable/combustible liquids
Class 4 – Flammable Solids
41
Division 4.1 Flammable solids
42
Division 4.2 Spontaneously combustible materials
43
Division 4.3 Dangerous when wet materials
Class 7 – Radioactive Materials
70
Radioactive materials
Class 8 – Corrosive Materials
80
Corrosive materials
Class 9 – Miscellaneous Dangerous Goods
91
Division 9.1 Miscellaneous dangerous goods
(Canada)
92
Division 9.2 Environmentally hazardous substances
(Canada)
93
Division 9.3 Dangerous wastes (Canada)
By itself, the DOT hazard class and division does not identify a specific chemical. To do so, it must
appear in conjunction with the CAS Number or chemical or trade name.
The CAS Registration Number is the identification number assigned to a chemical by the Chemical
Abstract Service (CAS) of the Chemical Abstract Society. This number may be found in reference
materials, on Material Safety Data Sheets (MSDS), and on some product labels. Not all hazardous
materials have an assigned CAS Number.
7-6
NFIRS 5.0 Self-Study Program
In an automated system, entry of the CAS Registration Number should fill in all other HazMat ID
fields without any further lookup.
The Chemical Name is the standard chemical or trade name by which the hazardous material is
known commonly. Products from different manufacturers with similar chemical ingredients may
have different trade names.
The proper entry in this field is the chemical or trade name of the hazardous material as shown on
the MSDS, product label, packaging, or container.
Example:
A common herbicide used for household applications may be entered by the trade
name “Weed-B-Gone™,” or by the chemical name “2,4-Dichlorophcnoxyacctic acid
(2-4D).”
Section C: Container Information
MM
YYYY and/or store the hazSection C identifies the type or configuration
of the container used
to DDtransport
A
ardous material and the amount of material the
was designed
information
Incident Date to hold. Complete
FDID container
Station
Incident Number
State
on the types of containers involved in HazMat incidents will provide guidance to regulators that estabChemical
lish container design requirements, and will
aid in ID
prevention
andDOT
code
development
efforts.
B HazMat
Name
Hazard
UN Number
CAS Registration Number
Exposure
Classification
C1
Container
Type
None
C2
Estimated Container Capacity
,
D1
C3
More hazardous
materials? Use
additional sheets.
Units: Capacity
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
11
12
13
14
15
16
Amount released: by volume or weight
Check one box
21
22
23
24
,
,
,
Capacity: by volume or weight
Container Type
Estimated Amount Relea
D2
WEIGHT
Ounces
Pounds
Grams
Kilograms
Units: Released
Check one
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
11
12
13
14
MICRO UNITS 15
Enter Code 16
21
22
23
24
W
O
P
G
K
MICR
YYYY
Block C1, Container
Type, refers to theMMtypeDDor configuration
of the container, equipment, or facility Delete NFIRS–7
A
HazM
NoneHazMat
Population Density
Area Evacuated
Complete
the
remainder
F
G
2 correspondH Enter up
used to transport FDID
and/or storeStatethe hazardous
material.
Enter
the
two-digit
code forExposure
the
Change
Incident Date
Station 2
Incident Number
Haz No.
of this form only for the
firstthe
hazardous
material
1
Urban
ing container type from the list provided in
NFIRS
Handbook
or the Complete Reference
Square feet Guide
1
,
involved in this incident.
2
Suburban
Blocks
2
HazMat
ID
Chemical
Enter
Primary action
(CRG).
B
3
Rural
Name
DOT Hazard
measurement
UN Number
CAS Registration Number
Square miles
3
Classification
Released From
C1
Container
Type
None
C2
F1
Check all applicable boxes
G1
Estimated
Container Capacity
Below grade
,
Container Type
More hazardous
materials? Use
additional sheets.
Complete the remainder
of this form only for the
first hazardous material
involved in this incident.
F1
C3
11
12
13
14
15
16
F2
1
2
3
Released From
Check all applicable boxes
G1
,
1
2
3
Additional actio
Number of
Area Affected
G3 Estimated
Physical State
People Evacuated
D1 Estimated Amount Released
E1 When
Released
Square feet
,
,
Additional actio
,
Blocks
Amount released: by volume or weight
Square miles
Estimated
1
If fire
Solid
1
Inside/on
structure
Capacity:
by volume
or weight
I releas
Number
of
2
Liquid
G4
Story of release
Buildings
Evacuated
box
3
Gas
Units: Capacity Check one box
1
D2, Units: Released Check one
Ign
U
Undetermined
None
2
Outside of structure
2
Rel
Enter
measurement
,
VOLUME
WEIGHT
VOLUME
WEIGHT
Ounces
21
Ounces
Ounces
Ounces
11
21
Released Into
GallonsCause of Release
22
Pounds
Gallons
Pounds
Factors Contributing
to Release E2
Factors Af
12
22
J
L Enter up to three
Barrels:
42 gal. 23
Grams
Grams
13 K Barrels: 42 gal. 23
mitigation of the
up to three contributing factors
Liters
24
Kilograms 14 EnterLiters
Kilograms
24
1
Intentional MICRO UNITS 15
Cubic
feet
Cubic feet
MICRO UNITS
Released into
2
Unintentional release
Cubic
meters
Cubic meters
Enter Code
Enter Code 16
Factor or impediment (1
3
Container/containment failure Factor contributing to release (1)
4
Act of nature
HazMat Actions Taken
None
Population
Density
5
Cause
under investigation
G2 Area Evacuated
H
Factor contributing to release (2) Enter up to three actions taken
Factor or impediment (2)
U
Cause undetermined after
Urban
Square feet
1
investigation
,
Suburban
Blocks
2
Enter
action taken (1)
Factor
contributing to releasePrimary
(3)
Factor or impediment (3
Rural
measurement
Square
miles
3
7-7
Area Affected
G3
Equipment Involved
Additional action taken (2)
Estimated Number of
Mobile Property Involved in
People None
Evacuated
None
Ha
NFIRS 5.0 Self-Study Program
Enter the estimated amount of material the container was designed to hold, by volume or weight, in
Block C2. Report the container capacity as two data elements. One is a numeric entry and expresses
quantity. The other defines the unit of measure—either volume or weight. Check the appropriate box
in Block C3. Both must be reported for the data to be meaningful.
MM
A
FDID
YYYY
Delete
Incident Date
State
Station
DOT Hazard
Classification
UN Number
Container
Type
C1
None
C2
Incident Number
Estimated Container Capacity
,
C3
D1
Complete the remainder
of this form only for the
first hazardous material
involved in this incident.
HazMat
Units: Capacity
,
,
Amount released: by volume or weight
D2
Check one box
21
22
23
24
State
E1 Physical
When Released
Estimated Amount Released
,
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
11
12
13
14
15
16
More hazardous
materials? Use
additional sheets.
Change
Haz No.
Chemical
Name
CAS Registration Number
Capacity: by volume or weight
Container Type
Exposure
NFIRS–7
Section D: Estimated Release
HazMat ID
B
Units: Released
WEIGHT
Ounces
Pounds
Grams
Kilograms
11
12
13
14
MICRO UNITS 15
Enter Code 16
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
Check one box
21
22
23
24
WEIGHT
Ounces
Pounds
Grams
Kilograms
MICRO UNITS
1
2
3
U
Solid
Liquid
Gas
Undetermined
E2
Released Into
Released into
Enter Code
HazMat Actions Taken
None
Population
Density
TheFquantity
of hazardous
materials
released also
isHreported
as two data elements. Again, both must
2
G
2 Area Evacuated
Enter up to three actions taken
1
Urban
be reported
for the data to1be Square
meaningful.
Express
the
estimated
amount of material released from a
feet
,
2
Suburban
Blocks
2
Primary action
(1)
container—by
volume or weight—as
a Enter
whole number
in taken
Block
D1.
3
Rural
measurement
Square miles
3
Released From
F1
Check all applicable boxes
Below grade
Inside/on structure
Mark one
box in Block D2Gto3 identify
appropriate
unit
of (2)measure. Information on the amount
Additional
action taken
Estimatedthe
Number
of
G
1 Area Affected
People
Evacuated
of material released provides an important measure of the magnitude of the hazardous materials
Additional action taken (3)
Square feet
,
release12 problem.
Blocks
3
Story of release
DD
Station
Cause of Release
OT Hazard
lassification
DD
Square miles
,
YYYY
Outside of structure
t Date
J
DD
CAS Registration Number
I
Estimated Number of
Buildings Evacuated
,
Delete
None
If fire or explosion is involved with a
release, which occurred first?
1
Ignition
NFIRS–7
2
Release
HazMat
U
Undetermined
Section E: Physical State
Factors Contributing to Release
Factors Affecting Mitigation
When ReleasedL and Released Into
Enter measurement
Incident Number
K
G4
Exposure
Haz No.
Change
None
Chemical
Name
Enter up
to three contributing factors
Enter up to three factors or impediments that affected the
mitigation of the incident
YYYY
Intentional
NFIRS–7
Delete
Unintentional release
HazMat
Change
Date
Station
Incident Number
contributing to release (1) Exposure
Haz No.
Factor or impediment
State (1)
Estimated
Container Capacity
Container/containment
failure DFactor
1 Estimated Amount Released
E1 Physical
When Released
Act of nature
Cause
,
, (2)
, under investigation
,
Chemical to release
Factor contributing
Factor or impediment (2)
1
Solid
Capacity:
by volume
or
weight
Amount released: by volume or weight
Name
OT
Hazard
CAS
Registration
Numberafter
Cause
undetermined
2
Liquid
assification
investigation
Check one box
3
Gas
Units: Released
Units: Capacity Check one box
DFactor
2 contributing
to release (3)
Factor or impediment (3)
U
Undetermined
Physical
State
Estimated Container Capacity
VOLUME
WEIGHT
VOLUME Amount Released
WEIGHT
D1 Estimated
E1 When Released
Ounces
21
Ounces
Ounces
Ounces
11
21
Released Into
Mobile
Property
Involved in E2
,
,
Gallons
22 , Pounds
Equipment
Involved
22 , Pounds
12
None
None Gallons
1
Solid
O HazMat Disposition
Capacity:
by
volume
or
weight
Amount
released:
by
volume
or
weight
M
N
Barrels:
42 gal. 23
Grams
Barrels:
42 gal. 23
Grams
Release
13
in Release
2
Liquid
Liters
24
Kilograms 14
LitersReleased 24Check one
Kilograms
1
Completed by fire1 service only
box
3
Gas
Units:feet
Capacity Check one box
D2 Units:
Cubic
Cubic feet
Completed w/fire service present
MICRO UNITS U Released
MICRO UNITS 15
into 2
Undetermined
Cubic
meters
Mobile property
type
Cubic
meters
VOLUME
WEIGHT
VOLUME
WEIGHT
3
Released to local agency
Enter Code
Enter Code 16
quipment involved in release
Ounces
21
Ounces
Ounces
Ounces
11
21
4 IntoReleased to county agency
Released
E2
Gallons
22
Pounds
Gallons None
Pounds
22 HazMat
12
5
Released to state agency
Brand
Actions Taken
Mobile property make
Population
Density
Evacuated
G2 Area13
23
Barrels:
42 gal.
Grams
Barrels: 42 gal.H23 Enter Grams
6
Released to federal agency
up to three actions taken
Liters
24
Kilograms 14
Liters
Kilograms
24
7
Released to private agency
Model
Urban
Square
feet
1
Model
Year
Cubic feet
, feet
Cubic
15
Released to property owner or
MICRO
UNITS
MICRO UNITS
Released into 8
Suburban
Blocks
2
Enter
Primary action taken (1)
Serial # meters
Cubic
Cubic
meters
16
manager
Enter
Code
Enter
Code
Rural
measurement
Square miles
3
License plate number
State
HazMat Civilian Casualties
P
Year
action taken
(2)
HazMat
Actions
Taken
None Additional
Estimated
Number of
Deaths
Injuries
Population
Density
Evacuated
Area Affected
G23 Area
H
NFIRS–7
People Evacuated
DOT number/ ICC number Enter up to three actions taken
Revision 01/01/06
Urban
Square feet
Additional action taken (3)
1
Square feet
,
,
Suburban
Blocks
2
Blocks
Enter
Primary
(1)
If action
fire taken
or explosion
is involved with a
Rural
measurement
Square miles
Square miles
3
G4 Estimated Number of I release, which occurred first?
Buildings Evacuated
Additional
action taken (2)
1
Number of
Ignition
Undetermined
U
Area, Affected
G3 Estimated
People
Evacuated None 2
Release
ter measurement
,
Record the simple physical State of the material (i.e., solid, liquid, gas, or undetermined) during
release or when it became hazardous by marking one box in Block E .
7-8
Square feet
,
Additional action taken (3)
NFIRS 5.0 Self-Study Program
The purpose of Block E2 is to provide information on the general environmental impact and, when
used in conjunction with other data elements, how extensive that impact is. This field identifies the
general region(s) of the environment contaminated by the hazardous material after its release.
Released Into
Enter the code that best describes the environment contaminated by the hazardous
material.
1. Air
2. Water
MM
A
3. Ground
FDID
4. Water and ground
YYYY
Incident Date
State
Station
Incident Number
HazMat ID
B
DOT Hazard
Classification
UN Number
5. Air and ground
Container
Type
C1
6. Water and air
DD
None
C2
Chemical
Name
CAS Registration Number
Estimated Container Capacity
,
7. Air, water, and ground
D1
Container Type
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
21
22
23
24
,
,
Amount released: by volume or weight
Check one box
Capacity
3 Units:
8. Confined, no environmental impact - not released Cinto
air, water,
ground
11
12
13
14
15
16
Estimated Amount Relea
,
Capacity: by volume or weight
More hazardous
materials? Use
additional sheets.
Exposure
D2
WEIGHT
Ounces
Pounds
Grams
Kilograms
11
12
13
14
MICRO UNITS 15
Enter Code 16
Units: Released
Check on
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
NOTE: If more than one hazardous material is involved in the incident, the remainder of the module is completed only for the
first (most significant) material involved.
MM
A
DD
YYYY
Complete the remainder
of thisDate
form only for the
Incident
first hazardous material
involved in this incident.
Population Density
F2
G2
Area Evacuated
1
Urban
Section F: Released From and Population
Density
1
2
Suburban
FDID
B
State
Station
3
HazMat ID
UN Number
F1
DOT Hazard
Classification
Released
Incident Number
Rural
Chemical
Name
CAS Registration Number
From
Exposure
Square feet
2
3
Blocks
Square miles
None
Delete
Haz No.
W
O
P
G
K
MICR
21
22
23
24
H
Change
NFIR
HazM
Haz
Enter up
,
Enter
measurement
Primary action
Additional acti
Estimated Number of
People Evacuated
Physical St
Estimated Container Capacity
C1 Container
D1 Estimated Amount Released
E1 When
Additional acti
Square feet
None C2 Below grade
1
Relea
Type
,
Blocks
2
If fire
,
,
,
1
Inside/on structure,
1
Square miles
I releas
Solid
Estimated
Number of
3
Capacity: by volume or weight
Amount released:
or weight
Gby4 volume
Story of release
Liquid
Buildings Evacuated2
Container Type
1
Ign
3
Gas
Units: Capacity Check one box ,
D2 Units: Released , Check one box
None
2C3 Outside of structure
2
Re
Enter measurement
U
Undetermi
VOLUME
WEIGHT
VOLUME
WEIGHT
11
Ounces
21
Ounces
Ounces
Ounces
11 Factors
Released
More hazardous
Contributing21
to Release
Factors
AfI
Cause of Release
12
22
Pounds K 12
J Gallons
LE2 Enter up to three
Gallons 1
Pounds
22
materials? Use
13
Barrels: 42 gal. 23
Grams Enter13
42 gal. 23
Grams
mitigation of the
additional sheets.
up to three Barrels:
contributing factors
14
Liters
24
Kilograms 14
Liters
Kilograms
24
1
Intentional
15
Cubic feet
Cubic feet
2
Unintentional
release
MICRO UNITS
MICRO UNITS 15
Released into
16
Factor contributing
to release
(1)
Cubic meters
Factor or impediment (1
Cubic
meters
3
Enter Code
Enter Code 16
Container/containment
failure
4
Act of nature
5
Cause
under
investigation
HazMat Actions Taken
None
FactorEvacuated
contributing to release (2)
Population
Density
Factor or impediment (2
Complete the remainder
FU2 Cause
G2 Area
H Enter up to three actions taken
undetermined after
of this form only for the
investigation
first hazardous material
1
Urban
Square feet
1
,
involved in this incident.
2
Suburban
Factor contributing to release (3)
Factor or impediment (3
Blocks
2
Enter
Primary action taken (1)
3
Rural
measurement
Square miles
3
Check all applicable boxes
G1
Area Affected
G3
Record physical location from where the hazardous material was released in Block F . Was it below
grade? Was it inside or outside a structure? If the release was inside (or on) a structure, record which
story it occurred on?
F1
Released From
Check all applicable boxes
M1
G
Equipment
Involved
Area Affected
in Release
G3
Mobile Property
Involved
in (2)
Additional
action taken
Estimated
Number of
None
N
People Evacuated
Release
None
O
Ha
Provide a general description
of the population density in the area adjacent to the hazardous materi1
Co
Below grade
Additional action taken (3)
Square feet
1
,
urban,
als release in Block F2. Was the release in an
2
Co
Blocks suburban, or rural area?
2
If fire or explosion is involved w
1
Inside/on structure
Story of release
2
J
Outside of structure
Cause of Release
I
3
Re
release, which occurred first?
4
Re
1
5
Re
Ignition
Undetermin
U
Brand
,
Mobile property make
None
6
Re
2
Release
Enter measurement
,
7
Re
Model
Model
Year
Re
N
Factors Contributing to Release
Factors Affecting Mitigation 8
Serial #
m
K
L
Square
Equipment
involved
in miles
release
3
7-9
G4
Mobile property type
Estimated Number of
Buildings Evacuated
Enter up to three factors or impediments that affected the
DOT Hazard
Classification
UN Number
Container
Type
C1
Name
CAS Registration Number
C2 Estimated Container Capacity
NFIRS 5.0 Self-Study, Program ,
D1
None
C3
Units: Capacity
,
,
Capacity: by volume or weight
Container Type
Estimated Amount Released
Amount released: by volume or weight
D2
Units: Released
Check one box
Section G: Area Affected,
Area
Evacuated,
VOLUME
WEIGHT
VOLUME
WEIGHT
11
Ounces
21
Ounces
Ounces
Ounces
11
21
More hazardous
12 of
Gallons
22 Evacuated,
Pounds
Gallons
Pounds
12
22
Estimated
Number
People
and
materials?
Use
13
Barrels: 42 gal. 23
Grams
Barrels: 42 gal. 23
Grams
13
additional sheets.
14
Liters
24
Kilograms 14
Liters
Kilograms
24
Estimated Number
of feet
Buildings
Evacuated
15
Cubic
Cubic feet
MICRO UNITS
MICRO UNITS 15
16
Check one box
Cubic meters
Enter Code
16
Cubic meters
Physical S
E1 When
Rele
1
2
3
U
Solid
Liquid
Gas
Undeterm
E2
Released
Released into
Enter Code
HazMat Actions Taken
None
Information on the areaComplete
affected
by a hazardous
materials
used in conjunction
Densityrelease,
Area Evacuated
the remainder
F2 Population
G2 when
H Enter upwith
to three actions taken
MM
DDthis form YYYY
of
only for the
NFIRS–7
assist in understanding
the magnitude of the
release. In Delete
turn, this informaA other data elements, will
first hazardous material
1
Urban
Square feet
1
HazMat
,
involved
in
this
incident.
Change
Date
2
FDIDtion can be
Station and
Incident
Number management
Exposure Blocks
Suburban
Haz No.
Stateused Incident
to guide
future training
incident
efforts.
2
Enter
Primary action taken (1)
3
B
HazMat ID
F1
Released From
DOT Hazard
CAS Registration Number
Check all applicable boxes
Classification
UN Number
Rural
G1
Below grade
1
Estimated Container Capacity 2
1
Inside/on structure
3
Area
3
Chemical
Name
Affected
G3
Square miles
measurement
Estimated Number of
People Evacuated
Additional action taken (2)
Additional action taken (3)
Square feet
,
Physical State
Amount Released
If fire or explosion is involved w
C1
DSquare
1
E1 When
None C2
miles
I release, which occurred first?
Estimated
Number
of Released
G
4
, Buildings Evacuated
,
, Story of release
,
1
Solid
1
Ignition
Undetermi
U
Capacity: by volume or weight
Amount released: by volume or weight
,
MM
DD
YYYY
None
NFIRS–7
2 Delete
Liquid
2
Outside of structure
2
Release
Enter measurement
,
A Container Type
Check one box
3
Gas HazMat
Units: Released
box
Capacity Check one
CIncident
3 Units:
D2 Number
Change
Date
FDID
Station
Incident
Exposure
Haz No.
State
U
Undetermined
Factors Contributing
to Release
Factors Affecting Mitigation
Cause of Release
VOLUME
WEIGHT
VOLUME
WEIGHT
J
K
L Enter up to three factors or impediments that affected the
1
11
Ounces
21
Ounces
Ounces
Ounces
11
21
Released
Into
More
hazardous
HazMat
ID
Chemical
mitigation of the incident
up to three contributing factors
B materials? Use
E2
12
Gallons
22 Number
Pounds
Gallons
Pounds
12 Enter
22
Name
DOT
Hazard
UN Number
CAS Registration
1
Intentional
Classification
13 MM Barrels:
Grams
DD 42 gal.
YYYY 23
Barrels: 42 gal. 23
Grams
13
NFIRS–7
Delete
2
Unintentional
A additional sheets.
14
Liters
24 release
Kilograms 14 Factor
Liters
Kilograms
24
HazMat
contributing to release (1)
Factor
or impediment (1)
3
Container/containment
failure
Change
Date
FDID
Station
Exposure
15 IncidentCubic
No.
State
feet
Cubic feet
15 Number
Physical
MICROHaz
UNITS
Estimated
Container
Capacity
MICRO
UNITS Incident
into State
C1 Container
C
2 Cubic
D
1 Estimated Amount Released
E
1Released
4
Act of nature
None 16
meters
When Released
Cubic meters
Type
Enter Code
Enter Code 16
5
Cause under investigation
Factor contributing to release (2)
Factor or impediment (2)
,
,
,
,
HazMat
ID
Chemical
U
Cause
undetermined
after
1
Solid
B
Capacity:
weight
Amount released: by volume orHazMat
weight
Name
DOT
Hazardby volume
UN Number
CAS or
Registration
Number
Actions
Taken
None
Population
Density
investigation
2
Liquid
Complete the remainder
F2 Classification
G2 Area Evacuated
H Enter up to three actions taken
Container
of this
form Type
only for the
Check one box
3
GasFactor or impediment (3)
Units:
Released
Check one box
Factor
contributing
to release (3)
Units:
Capacity
C
3
D
2
first hazardous material
1
Urban
Square feet
U
Undetermined
1
,
Physical
State
involved
in
this
incident.
Estimated
Released
2
Suburban Container Capacity
WEIGHT
VOLUME Amount
WEIGHT
Blocks
C1 Container
D
1 Estimated
E
1 When Released
2
None C2 VOLUME
Enter
Primary action taken (1)
Type
11
3
Ounces
21
Rural
Ounces
Ounces
Ounces
measurement
Mobile Property
Involved in
11
21
Square miles
Released Into HazMat Disposition
More hazardous
3
Equipment
Involved
None
E2 Solid
,
12
,
Gallons
22 , Pounds
12 NoneGallons
22 , Pounds
O
M byinvolume
N
materials?
Use
1
Release
Release
Released
From
Capacity:
or
weight
Amount
released:
by
volume
or
weight
Additional
action
taken (2)
13
F1additional sheets.
Barrels: 42 gal. 23
Grams Estimated
Barrels:
42
gal.
Grams
Number
of
13
23
2
Liquid
Area
Affected
G
3
1
Completed by fire service on
Check
all applicable
boxes
G
141 Liters
Container
Type
24
Kilograms
LitersReleased 24Check one
Kilograms
People
14 Evacuated
box
3
2
Gas
Units:
Units: Capacity Check one box
2
Completed w/fire service pre
C
3 Cubic
D
2
15
feet
Cubic
feet
Below grade
MICRO
UNITS
MICRO UNITS 15
U Released
into
Additional
action taken
(3)
Undetermined
Square feet
Mobile property type
3
Released to local agency
Equipment
involved in release
,
16 1 VOLUME
Cubic
meters
Cubic
meters
WEIGHT
16
VOLUME
WEIGHT
Enter
Code
Enter
Code
Blocks
2
4 a Released to county agency
If fire or explosion is involved with
11
Ounces
21
Ounces
1
Inside/on
structure
Ounces
Ounces
11
21
Released
Into
More hazardous
I release, which occurred
Square miles
Number of
Brand
G4 Estimated
E2 first? 5 Released to state agency
12 3 Gallons
22
Pounds
Mobile property make
Gallons
Pounds
StoryUse
of2release
12
22 HazMat
materials?
Actions Taken
None
Buildings
Evacuated
6
Released to federal agency
Population
Density
Area
Evacuated
Complete the remainder
13
23
Barrels:
42
gal.
F2
G2
Grams
Barrels: 42 gal.H
Grams
13
123 Enter
Ignition
Undetermined
U
additional
sheets.
,
up to three actions taken
7
Released to private agency
of this form only for the
Model
None
14
Liters
2
Outside of structure
24
Kilograms
Liters
Kilograms
24
14
2
Release
Enter
measurement
,
first hazardous material
Model
Year
1
Urban
8
Released to property owner
Square feet
1
15
Cubic feet
,
Cubic
feet
15
involved in this incident.
MICRO UNITS
MICRO UNITS
Released into
Serial #
2
Suburban
manager
Blocks
2
16
Enter
Primary action taken (1)
Cubic meters
Cubic
meters
16
Enter Code
Enter Code
3
Rural
None HazMat Civilian Casualties
Factors Contributing
tomiles
Releasemeasurement
Factors Affecting
Mitigation State
Cause of Release
Square
License plate number
3
J
K
L
Container
Type
BlocksEstimated
Block G records the size of the area or space directly affected by the hazardous material release.
Report the area affected as two data elements. The first defines the unit of measurement (square feet,
blocks, or square miles). The second is a numeric entry that expresses the actual measurement. Both
must be reported for the data to be meaningful.
Block G , Area Evacuated, records the amount of area or space evacuated as a result of the hazardous
material release or potential release.
Block G also is reported as two data elements. The first defines the unit of measurement and the
second is the numeric expression of the measurement. Again, both entries must be made for the data
to be meaningful.
Year
Released From
F1Complete
the remainder
Enter up to three factors or impediments that affected the
P
of the
incident
Enter up to three contributing factors
Additional
action
taken
(2)
HazMat
Actions
Taken
None mitigation
Estimated
Number of
Density
Evacuated
Area Affected
G23 Area
FG21 Population
G
Hnumber
DOT number/ ICC
all applicable boxes
1 of Check
Intentional
Enter up to three actions taken
People Evacuated
this form only for the
2 firstBelow
Unintentional
hazardous
materialrelease 1
Urban
Square feet
grade
Additional action taken (3)
1
Square
Factorfeet
contributing to release (1)
Factor or impediment (1)
1
,
in this incident.
3 involved
,
Container/containment
2 failure
Suburban
Blocks
2
Blocks
Enter
Primary
(1)
2
If action
fire taken
or explosion
is involved with a
41
Act ofstructure
nature
3
Rural
Inside/on
measurement
Square miles
3
Square miles
I release, which occurred first?
Estimated Number
of
3
5
G
4
Cause Story
under
investigation
of release
Factor contributing to release (2)
Buildings EvacuatedFactor or impediment (2)
Released
From
3
U
undetermined
after
Additional
action taken (2)
F1 Cause
Estimated Number of
1
Ignition
Undetermined
U
,
Area
Affected
G
3
None
Check
all
applicable
boxes
investigation
G1 Enter measurement
2
Outside
of structure
People
Evacuated
2
Release
,
Deaths
Block G documents the estimated number of people evacuated due to the hazardous material release
or potential release.
Below grade
1
2
3
Factor contributing to release (3)
Square feet
,
Factor or Additional
impediment
(3) taken (3)
action
None
Factors Contributing to Release
Factors
Affecting
Mitigation
If fire
or explosion
is involved with
a
1J
Inside/on structure
K miles
L Enter
Square
I uprelease,
of
to three factors
or impediments
that affected
which
occurred
first?the
Mobile Property
InvolvedNumber
in
G
4 Estimated
Story ofInvolved
release
HazMat
Disposition
Equipment
of the incident
Enter up to three contributing factors
None
Buildings EvacuatedNone mitigation
M inIntentional
N Release
1 O Ignition
Release
Undetermined
U
1
,
None
2
Outside of structure
21
Release
Completed by fire service only
2
Unintentional release
Enter measurement
,
Factor or impediment
(1)
2
Completed
w/fire service present
3
Container/containment failure Factor contributing to release (1)
Mobile property type
3
Released
local agency None
4Equipment
Act
of of
nature
involved
in release
Factors Contributing to Release
Factors
Affecting to
Mitigation
Cause
Release
4 investigation
J Cause under
K
LFactor orEnter
4
Released to county agency
5
Factor contributing to release (2)
up to three
impediment
(2)factors or impediments that affected the
5 of the
Released
to state agency
UBrand Cause undetermined after
mitigation
incident
Enter up to three contributing factors
Mobile property make
6
Released to federal agency
1
Intentional
investigation
7
Released to private agency
2 Model Unintentional release
Factor contributing to release (3)
Factor or impediment (3)
Model to release (1)
Year
Factor or impediment
(1)
8
Released
to property owner or
3
Container/containment failure Factor contributing
manager
4 Serial #Act of nature
Property Involved in
5
LicenseMobile
plate number
State
Cause under
investigation
HazMat
Civilian
Casualties
Disposition
Equipment
Involved
Factor contributing to release (2)
Factor
(2)
None or impediment
None
P
Year
O HazMat
UM
N
Cause
undetermined
after
Release
in Release
Deaths
Injuries
investigation
NFIRS–7
1
Completed by fire service
only
DOT number/ ICC number
Cause of Release
Blocks
Block G notes the estimate number of the buildings evacuated as a result of the hazardous material
release or potential release.
7-10
Factor contributing to release (3)
Equipment involved in release
Mobile property type
Factor or impediment
(3)
2
Completed
3
Revision 01/01/06
w/fire service present
Released to local agency
Injuries
NFIRS
Revisio
er
,
C3
Units: Released
Check one box
Solid
Liquid
Gas
Undetermined
Section H: HazMat Actions Taken
DOT Hazard
CAS Registration Number
Classification
Population Density
F2
G2
,
,
Capacity: by volume or weight
G1
C3
Chemical
Name
Area Evacuated
Urban
Square feet
1
Estimated Container Capacity
D1
Suburban
Blocks
2
Rural
Square miles
3
Area Affected
Units: Capacity
G3
Check one box
None
HazMat Actions Taken
H
Enter up to three actions taken
Estimated
Amount Released
,
Enter
measurement
Physical State
E1 When
Released
Primary action taken (1)
,
,
Amount released: by volume or weight
Additional action taken (2)
Estimated Number of
Check one box
People Evacuated
Units:
Released
D2
A
Additional action taken (3)
FDID
WEIGHT
1
2
3
U
Solid
Liquid
DD
Gas MM
Undetermined
YYYY
Square feet
1 VOLUME
Incident Date
Station
State
WEIGHT
, VOLUME
Blocks
or explosion is involved
with
a
11 2 Ounces
21
Ounces
Ounces
11
21If fireOunces
Released
Into
Square miles
I 22release,
Number
E2 first?
which occurred
12 3 Gallons
22
Pounds
G4 Estimated
Gallons of
Pounds
12
ID
Evacuated
B HazMat
13
Barrels: 42 gal. 23
Grams Buildings
Barrels:
42
gal.
Grams
13
23
DOT Hazard
UN
Number
CAS Registration Number
1
Ignition
Undetermined
U
,
Classification
14
Liters
24
Kilograms 14
Liters None 224 Release
Kilograms
Enter measurement
,
15
Cubic feet
Cubic feet
MICRO UNITS
MICRO UNITS 15
Released into
16
Cubic meters
Cubic meters
Enter Code
Enter Code 16
Container
Estimated Container Capacity
C1 Affecting Mitigation
None
Factors Contributing to Release
Factors
None C2
K
L Enter up to threeType
factors or impediments that affected the
HazMat Actions Taken
,
,
Enter up to
three contributing factors
Density
F2 Population
G2 Area Evacuated None mitigation
H of the incident
Capacity: by volume or weight
Incident Number
Exposure
Haz N
There are particular actions taken at a hazardous material release incident scene by personnel Chemical
specifiName
cally trained and equipped to mitigate the hazards that might arise. In this section, you can document up to three of the most significant HazMat actions taken.
D1
Estimated Amount Released
D2
Units: Released
Note: Actions taken by fire service personnel who are not specifically trained and equipped to mitigate hazardous material
,
,
Amount released: by volume or weight
incidents are recorded in the Basic Module.
Enter up to three actions taken
,
Square feet
Blocks
Enter
measurement
Container Type
Factor or impediment (1)
Primary action taken (1)
C3
Units: Capacity
Check one box
Check one box
VOLUME
WEIGHT
VOLUME
WEIGH
11
Ounces
21
Ounces
Ounces
Ounces
11
21
12
Gallons
22
Pounds
Estimated Number
Gallons
Pounds
12
22
materials? Use
13
Barrels: 42 gal. 23
Grams
People Evacuated
Barrels: 42 gal. 23
Grams
13
additional sheets.
14
Liters
24
Kilograms 14
Liters
Kilogra
24
action
Factor
contributing to release (3)
Factor orAdditional
impediment
(3) taken (3)
Square
feet
1
,
15
Cubic feet
Cubic feet
15
MICRO
UN
MICRO
UNITS
Blocks
2
If fire or explosion is involved
with
a meters
16
Cubic
Cubic meters
Ente
Enter Code 16
Square miles
I
Estimated
Number
of
3
release,
which
occurred
first?
G
4
Mobile Property Involved in
HazMat Disposition
Buildings EvacuatedNone
None
N Release
1 O Ignition
Undetermined
U
HazMat Act
,
None
Complete
the remainder
F2 Population Density
G2 Area Evacuated None H Enter up to three
21
Release
Enter measurement
,
Completed by fire service only
ease
nment failure
estigation
ned after
ed
D2
Check one box
ease 1
Urban
1
Factor contributing to release (1)
2 failure
Suburban
nment
2
3
Rural
3
estigation
Factor contributing to release (2)
ned after
G3
G1 Area Affected
ed
1
2
3
U
Amount released: by volume or weight
VOLUME
WEIGHT
VOLUME
WEIGHT
11
5.0 Self-StudyReleased
Program Into
Ounces
21
Ounces
Ounces
Ounces
11
21 NFIRS
E2
12
Gallons
22
Pounds
Gallons
Pounds
12
22
DD 42 gal.
YYYY 23
13 MM Barrels:
NFIRS–7
Grams
Barrels: 42 gal. 23
Grams
13
Delete
14
Liters
24
Kilograms 14
HazMat
Liters
Kilograms
24
Change
Date
Station
Incident Number
Exposure
Haz No.
15IncidentCubic
feet
Cubic feet
MICRO UNITS
MICRO UNITS 15
Released into
16
Cubic meters
Cubic meters
Enter Code
Enter Code 16
1
22
one C
3
e
Units: Capacity
,
,
,
Capacity: by volume or weight
Square miles
Section I: Fire or Explosion Involved With a Release
More
Factor or impediment
(2) hazardous
Additional action taken (2)
of
of this form only for the
Mobile property
type
Factors
Contributing
to Release
hazardous material
2 firstCompleted
w/fire service
1 present
Urban
in this incident.
3 involved
Released
to local agency
2
None
Factors
Affecting
Mitigation
Suburban
L Enter4 up to three
Released
to county
3 the Rural
factors or impediments
that agency
affected
mitigation
incident
5 of the
Released
to state agency
ReleasedtoFrom
6F1 Released
federal agency
Check
all applicable
G1 Area Affected
7
Released
toboxes
private agency
Factor or impediment (1)
8
Released
to
property
owner or
Below grade
Square feet
1
manager
Blocks
2
State
1
Inside/on structure
HazMat
Civilian Casualties
Factor or impediment
Square miles
3
P (2) Story of release
Deaths
Injuries
1
2
3
,
Square feet
Blocks
Enter
K The purpose of this section is to collect information on the causal relationship of events
occurring
in
measurement
Square miles
Primary action taken (1)
situations involving fire or explosion in conjunction with a hazardous material release. Based on the
3 Estimated Number of
box marked, it may be possible to show which occurred first—the release or theGfire/explosion.
People Evacuated
Factor contributing to release (1)
Enter up to three contributing factors
Mobile property make
Model
Year
Licensetoplate
number
Factor contributing
release
(2)
DOT number/ ICC number
Factor contributing to release (3)
None
N
Section J: Cause of Release
,
2
Outside
of structure
Factor or impediment
(3)
Mobile Property Involved in
None
Release
Mobile property type
Mobile property make
Model
Year
Cause of Release
HazMat Disposition
J
O
11
22
33
44
55
6U
7
8
NFIRS–7
Revision 01/01/06
Enter measurement
K
Additional action taken
,
G4
Estimated Number of
Buildings Evacuated
None
,
Factors Contributing to Release
L
Enter up to three contributing factors
Completed
Intentionalby fire service only
Completed
w/fire
service present
Unintentional
release
Released
to local agencyfailure Factor contributing to release (1)
Container/containment
Released
to county agency
Act of nature
Released
to state
agency
Cause under
investigation
Factor contributing to release (2)
Released
to federal agency
Cause undetermined
after
Released
to
private
agency
investigation
Released to property owner or Factor contributing to release (3)
manager
HazMat Civilian Casualties
Mobile Property Involved in
Equipment
Deaths Involved
Injuries
None
N
NFIRS–7
Release
in Release
If fire or exp
release, wh
I
1
2
Ignition
Release
Factors Affectin
Enter up to three factors o
mitigation of the incident
Factor or impediment (1)
Factor or impediment (2)
Factor or impediment (3)
LicenseSection
plate number J to document the
Use
general cause of the release or threatened release of a hazardous mateState
P
rial. Aggregate information on the cause
M of releases can be used to guide prevention and enforce-None
DOT number/ ICC number
ment efforts.
Revision 01/01/06
Mobile property type
Example:
Equipment involved in release
A hazardous material release Brand
resulting from a rusted drum would be recorded as
Mobile property make
“Container/containment failure.”
Model
Model
Additional action taken
Year
O
1
2
3
4
5
6
7
8
Serial #
Year
7-11
License plate number
DOT number/ ICC number
State
P
HazMat
Comple
Comple
Release
Release
Release
Release
Release
Release
manage
HazMat C
Deaths
2
Incident Date
State
Station
Released From
F1
None
.
der
he
al
nt.
1
Inside/on structure
Estimated Container
Capacity
C2
2
Capacity: by volume or weight
C3
Units: Capacity
ase
ase
F2
Population Density
Blocks
2
Square
miles
Estimated
Amount
Released
3
Urban
Suburban
Rural
G1
Additional action taken (3)
None
,
measurement
AmountEnter
released:
by volume or weight
2
U
Undetermined
Release
2
Liquid
Check one box
3
Gas
D2 Units: Released Factors
None
Contributing to Release
Factors Affecting Mitigation
Cause of Release
U
Undetermined L
K
MM
DD
YYYY
Enter up to three factors or impediments that affected the
WEIGHT
VOLUME A
WEIGHT
mitigation of the incident
Enter up to three contributing factors
Ounces
Ounces
Ounces
11
21
Released Into
Incident Date
FDID
Station
Incident Number
Exposure
Haz No.
Intentional
State
E
2
Pounds
Gallons
Pounds
12
22
Unintentional release
Grams
Barrels: 42
gal.
13
23
Factor
contributing
toGrams
release (1)
Factor or impediment (1)
Container/containment
failure
Kilograms 14
Liters
Kilograms
24
ID
Chemical
B HazMat
Act of nature
Name
DOT Hazard
UN Number
CAS Registration Number
Cubic
feet
15
MICRO UNITS
MICRO UNITS
Released
into
Classification
Cause under investigation
Factor contributing to release
(2) Code
Factor or impediment (2)
Cubic meters
Enter
Enter Code 16
Cause undetermined after
investigation
Capacity
C
1 Container
C2 Estimated Container
D1 Estimated Amount Released
HazMat Actions Taken
Factor contributing
Factor or impediment (3)
G2 Area Evacuated None
HType to release (3) None
21
22
23
24
Square feet
1
Blocks
2
Equipment
Involved
Square miles
3
in Release
,
,
,
,
,
Capacity: by volume or weight
Amount released: by volume or weight
Mobile Property Involved in
Enter
Primary action
taken (1)
None
None Container
measurement
N Type
C3 Units: Capacity
Release
Disposition
Record
the release or
Check
Oone boxHazMatto
M the factors present at the time and location of the incident that contributed
D2 Units: Released Check one box
threatened release in this section. You can enter up to threeVOLUME
of the most significant
contributing
fac1 WEIGHT
Completed
by fire
service
only
VOLUME
WEIGHT
Additional action taken (2)
of
Area Affected
3 Estimated Number
2 Ounces
Completed
w/fire
service
11
Ounces
21
tors and theirGaccompanying
codes.
Ounces present
Ounces
11
21
More hazardous
People Evacuated
Mobile property type
12
Gallons
22
materials?
Use
Additional action taken (3)
13
Barrels: 42 gal. 23
additional
sheets.
Blocks
Liters with a
24
If fire or explosion14is involved
Brand
Mobile property make
Square miles
15
Cubic
first? feet
G4 Estimated Number of I release, which occurred
Buildings Evacuated
Model
16
Cubic meters
1 Model Ignition
Undetermined
U
Year
,
None
2
Release
Enter measurement
,
Serial #
Complete
theplate
remainder
License
number
State
F2 Population Density
Year Contributing to Release
ofFactors
this form only
for the Mitigation
None
Factors
Affecting
material
K
L firstEnterhazardous
1
Urban
upin
to this
three incident.
factors or impediments that affected the
involved
DOT
number/
ICC number
2
Suburban
mitigation
of
the incident
Enter up to three contributing factors
3
Rural
investigation
rmined after
If fire or explosion is involved with a
release, which occurred first?
I
Physical
State of
Estimated
Number
G4 E
1 When Released
Equipment involved in release
1
2
3
Additional action taken (2)
,
Enter up to three actions taken
1
2
3
Primary action taken (1)
measurement
Buildings Evacuated
1
Section K: Factors
Contributing
to Release
Ignition
,
,
1
Solid
,
Outside of structure
J
VOLUME
Ounces
1
Gallons
Barrels: 42 gal.2
3
Liters
4
Cubic feet
Cubic meters 5
U
release
ntainment failure
volved
HazMat
Enter
Blocks
Square Change
miles
Check one box
11
12
13
14
15
16
m
es
D1
Story of release
,
2
Haz3
No.
Number of
G3 Estimated
GChemical
1 Area Affected
People Evacuated
Name
Square feet NFIRS 5.0 Self-Study Program
1
Check all applicable boxes
CAS Registration Number
Below grade
DOT Hazard
Classification
Number
Suburban
Rural
Exposure
3
Incident Number
Square feet
,
3 Pounds
Released12
to local
agency
Gallons
Pounds
22
4 Grams
Released13
to county
agency
Barrels:
42 gal. 23
Grams
5 Kilograms
Released14
to state
agency
Liters
Kilograms
24
6
Released to federal
agency
Cubic
feet
MICRO UNITS
MICRO UNITS 15
7
Released16
to private
agency
Cubic
meters
Enter Code
Enter Code
8
Released to property owner or
manager
HazMat Action
None
Evacuated
HazMat
Civilian
Casualties
G
2 Area
H
Section L: Mitigating Factors or Impediments
Released From
F
Factor
1 or impediment (1)
Factor contributing to release (1)
Check all applicable boxes
Below grade
Factor or impediment (2)
Factor contributing to release (2)
1
Inside/on structure
Story of release
Factor or impediment (3)
Factor contributing to release (3)
2
G1
Area Affected
1
2
3
P
Enter up to three action
1
2
3
Deaths
Square feet
G3
Blocks
NFIRS–7
Revision 01/01/06
Enter
Primary action taken (1)
measurement
Estimated Number of
People Evacuated
G4
Square miles
Additional action taken (2)
Additional action taken (3)
,
Blocks
Estimated Number of
Buildings Evacuated
None
,
Enter measurement
Mobile Property Involved in
,
Square miles
Square feet
,
Outside of structure
Injuries
If fire or explos
release, which
I
1
2
Ignition
Release
Disposition mitigation of the release or threatened
None the fire
If there
were factors that impeded
department’s
O HazMat
N Release
Factors Contributing to Release
Factors Affecting M
Cause of Release
J 1present
L L. Enter up to three factors or impe
release, record the three primary ones
at theby time
andKonly
location of the incident in Section
Completed
fire service
Enter up to three contributing factors
2
Completed
w/fire
service delays
present
ThisMobile
information
is of particular 1importance
in cases
where
in mitigating the incident may mitigation of the incident
Intentional
property type
3
Released to local agency
release
have contributed to the severity of2 theUnintentional
4incident.
Released
to county agency
Factor contributing to release (1)
None
Mobile property make
Model
License plate number
Year
3
4
5
U
Factor or impediment (1)
Container/containment
5
Released to statefailure
agency
Act
nature to federal agency
6 of Released
Cause
under investigation
7
Released
to private agency
Factor contributing to release (2)
Cause
undetermined
after owner or
8
Released
to property
investigation
manager
HazMat Civilian Casualties Factor contributing to release (3)
Factor or impediment (2)
Section M: Equipment Involved in Release
State
DOT number/ ICC number
M
P
Deaths
Equipment Involved
in Release
Equipment involved in release
Brand
Factor or impediment (3)
Injuries
NFIRS–7
Revision 01/01/06
None
N
Mobile Property Involved in
None
Release
1
2
3
4
5
6
7
8
Mobile property type
Mobile property make
Model
Model
O
Year
Serial #
License plate number
Year
DOT number/ ICC number
7-12
State
P
HazMat Disp
Completed
Completed
Released to
Released to
Released to
Released to
Released to
Released to
manager
HazMat Civili
Deaths
Complete the remainder
of this form only for the
first hazardous material
involved in this incident.
F2
1
2
3
Population Density
Urban
Suburban
Rural
1
2
NFIRS
3
Released From
F1
G2
Area Affected
Area Evacuated
Square feet
None
HazMat Actions Taken
Enter up to three actions taken
,
Blocks
Enter
5.0Square
Self-Study
Program
measurement
miles
G3
H
Primary action taken (1)
Estimated Number of
Additional action taken (2)
Check all applicable boxes
1
People
Evacuated
Record
data about G
equipment
that either failed,
or while
working properly, allowed the release or
Below grade
Additional action taken (3)
Square
feet
1
threatened release of hazardous
materials in Section M., Write a description
on the lines provided and
Blocks
2
If fire or explosion is involved with a
1 enter
Inside/on
a structure
code for the equipment,
along
with
the
relevant
brand,
model,
serial
number,
and year.
Square miles
3
occurred first?
G4 Estimated Number of I release, which
Story of release
Buildings Evacuated
1
Ignition
Undetermined
, data element is the same set that is used None
NOTE:
The code set table used for this
for equipment
involvedUin ignition
in the Fire
2
Outside of structure
2
Release
Enter measurement
,
Module. Use the codes listed for that data element in the CRG.
Factors Contributing to Release
Cause of Release
Factors Affecting Mitigation
None
JInformation on the type ofKequipment involved in the release
L can
be used to guide prevention,
Enter up to three factors or impediments that affected the
mitigation of the incident
Enter up to three contributing factors
enforcement,
Intentional and product design efforts. Specific information on the year, brand, and serial number
release recall efforts.
willUnintentional
assist in product
Factor contributing to release (1)
Factor or impediment (1)
1
2
3
4
5
U
Container/containment failure
Act of nature
Cause under investigation
Cause undetermined after
investigation
Factor contributing to release (2)
Factor or impediment (2)
Section N: Mobile Property Involved in Release
Factor contributing to release (3)
M
Equipment Involved
in Release
Equipment involved in release
Brand
None
N
Factor or impediment (3)
Mobile Property Involved in
None
Release
1
2
3
4
5
6
7
8
Mobile property type
Mobile property make
Model
Model
O
Year
Serial #
License plate number
State
Year
P
HazMat Disposition
Completed by fire service only
Completed w/fire service present
Released to local agency
Released to county agency
Released to state agency
Released to federal agency
Released to private agency
Released to property owner or
manager
HazMat Civilian Casualties
Deaths
Injuries
NFIRS–7
Revision 01/01/06
DOT number/ ICC number
Record details about mobile property that either failed, or while working properly, allowed the
release or threatened release of hazardous materials here. This information can be used in prevention,
enforcement, and product design efforts.
Note: Depending on State and local laws, specific documentation on mobile property involved in the release of a hazardous material may assist the fire department in collecting reimbursement from the responsible party for the expenses incurred in mitigating
the hazardous materials incident.
The mobile property type refers to property that is designed and constructed to be mobile—movable
under its own power or towed. Enter a description and code to clarify the property type. Record the
property manufacturer on the line requesting “Mobile Property Make.”
Model refers to the manufacturer’s model name. If one does not exist, use the physical description
of the property that is used commonly. Enter the year the property was manufactured. If there is a
license plate affixed to the mobile property, note the plate number and State on the next line. The
last line is used to enter the number assigned to the commercial carrier by the DOT. That number is
generally found stenciled on the mobile property.
7-13
K 42 gal. 23 Grams
13
Barrels:
14
factors
LitersEnter up to three contributing
24
Kilograms
15
Cubic feet
MICRO UNITS
ase16
Cubic meters
Enter Code
ment failure Factor contributing to release (1)
Density
stigation
F2 Population
G2
Factor contributing to release (2)
ned after
1
Urban
1
2
Suburban
2
Factor
contributing
to
release
(3)
3
Rural
3
d
Area Affected
G1
1
2
3
None
Factor or impediment (1)
Area Evacuated
NFIRS 5.0 Self-Study Program
HazMat Actions Taken
H
Factor or impediment
Enter (2)
up to three actions taken
None
,
Section
O: HazMat Disposition
Square feet
Blocks
Enter
Primary action taken (1)
Factor or impediment (3)
measurement
Square miles
of
Mobile Property
InvolvedNumber
in
G3 Estimated
People Evacuated None
Release
Square feet
,
Additional action taken (2)
O
HazMat Disposition
Additional action taken (3)
Completed by fire service only
If fire
or explosion
is service
involvedpresent
with a
Completed
w/fire
Estimated Number of
release,
which
first?
Mobile property typeG4
Released
tooccurred
local agency
Buildings Evacuated
Released to U
county
agency
14
Ignition
Undetermined
,
None
Released to state agency
25
Release
Enter measurement Mobile property make
,
6
Released to federal agency
7
Released to private agency
Factors
Contributing to Release Year
Factors Released
Affecting to
Mitigation
Model
property owner None
or
K
L Enter8 up to three
factors or impediments that affected the
manager
mitigation of the incident
Enter up to three contributing factors
License plate number
State
HazMat Civilian Casualties
ase
ment failure
stigation
ed after
d
N
Barrels:L42 gal.
Grams
23up to three
Enter
factors or impediments that affected the
mitigation
incident
Liters
Kilograms
24 of the
Cubic feet
MICRO UNITS
Released into
Cubic meters
Enter Code
13
14
15
16
Blocks
1
I 23
Square miles
P
Injuries
Use Section O to indicate whether
theDeaths
fire department
completed the handling of the HazMat
Factor or impediment (1)
incident, or, instead, it was released to another agency. This information helps identify the extent of
fire todepartment
involvement in
Factor contributing
release (2)
Factorresolving
or impediment (2) the particular HazMat incident. The section also provides
information about how frequently other agencies or contractors are used for incident mitigation.
Factor contributing to release (1)
DOT number/ ICC number
NFIRS–7
Revision 01/01/06
Factor contributing to release (3)
None
N
Factor or impediment (3)
Mobile Property Involved in
Release
Section P:OHazMat Civilian Casualties
HazMat Disposition
None
1
2
3
4
5
6
7
8
Mobile property type
Completed by fire service only
Completed w/fire service present
Released to local agency
Released to county agency
Released to state agency
Released to federal agency
Released to private agency
Released to property owner or
manager
HazMat Civilian Casualties
In this section, record the number of civilians killed or injured as a result of their contact with or
exposure
to hazardous materials that have been spilled or released. This information will provide a
Mobile property make
concise measure of the scope of human costs associated with HazMat incidents.
Model
License plate number
Year
State
P
Deaths
Injuries
NFIRS–7
Revision 01/01/06
DOT number/ ICC number
Make one entry to record the number of civilian deaths and the number of civilian injuries as a result
of their contact or exposure to the hazardous material.
The Civilian Fire Casualty Module (NFIRS-4) should not be used for this purpose unless the release
resulted in a fire and the civilian(s) were injured or killed as a result of the fire. Instead, the optional
EMS Module (NFIRS-6) can be used for each non-fire service person killed or injured as a result of
contact with or exposure to hazardous materials.
Complete the Fire Service Casualty Module (NFIRS-5) for each fire service member killed or injured
as a result of contact with or exposure to hazardous materials.
7-14
NFIRS 5.0 Self-Study Program
SUMMARY
The optional Hazardous Materials Module is used to document reportable HazMat incidents. For
an incident to be reportable, it generally requires that specialized HazMat resources either were or
should have been dispatched or used. An incident also is reportable when releases or spills of hazardous materials exceed 55 gallons.
The need to comply with State or local HazMat reporting requirements is not altered by the completion of this module.
Accurate data from the Hazardous Materials Module can provide indepth information that can be
used for management analysis and also for response-strategy development.
7-15
NFIRS 5.0 Self-Study Program
EXAMPLE: Chlorine Leak Incident
Directions: Read the call information in the example below. Then look at the completed Hazardous Materials Module form.
Look at each section and follow along with the proper use of the information as applicable to the Hazardous Materials Module.
On 10/26/02, at 1705 hours, Eau Claire, WI, Department FDID #TR100, Station 001, is called to
an incident at an urban commercial building that stores chlorine and other similar products. A
vapor has been observed coming from a first-floor window. Engines 1 and 3, HazMat Unit 1, and
Battalion 3 are dispatched and arrive on the scene at 1718 hours. The weather is cloudy, with wind
conditions at 15 miles per hour, steady, coming from the south. It is 80 degrees Fahrenheit.
The building is almost 25 years old, constructed of noncombustible masonry walls. The roof is
metal with composition covering. A 120-unit apartment building is located approximately 500
feet northwest of the commercial building. There are no other exposures.
Units find a chlorine leak is of major proportions. As the fire department personnel arrive, the
vapor cloud is growing, affecting an area around the building of two blocks. An employee reports
that the seal at the bottom of a full 100-cubic foot chlorine gas tank has failed, and most of the
gas has escaped already. Three employees have collapsed in the parking lot, breathing with difficulty, but conscious. EMS Unit 12 was dispatched. Upon arrival at the scene, Unit 12 evacuated
the building and moved approximately 50 employees outside three blocks from the building.
The units on the scene conducted a primary search and did not locate any other victims. The
HazMat Unit initiated vapor control and control of runoff. The EMS Unit treated the three
employees for moderate chlorine gas inhalation and transported them to a local hospital, where
they recovered after several days.
The residents of the apartment building were alerted and evacuated.
The gas tank leaked until all gas was released. No other tanks were affected. The incident, reported
as # 9900034, was declared secure at 1935.
.
7-16
NFIRS 5.0 Self-Study Program
A TR100
MM
WI
FDID
Container
Type
None
Container Type
More hazardous
materials? Use
additional sheets.
Complete the remainder
of this form only for the
first hazardous material
involved in this incident.
Check all applicable boxes
Below grade
X
2
Inside/on structure
001
9 9 0 0 0 3 4
C3
11
12
13
14
15
16
000 , 000 , 100
Amount released: by volume or weight
Story of release
Outside of structure
21
22
23
24
Population Density
F2
X
1
2
3
Urban
Suburban
Rural
G1
1
2
3
WEIGHT
Ounces
Pounds
Grams
Kilograms
11
12
13
14
MICRO UNITS 15
Enter Code 16
Square feet
X
Blocks
Square miles
Blocks
G4
Square miles
0 , 002
Cause of Release
1
2
3
4
5
U
Intentional
Unintentional release
Container/containment failure
Act of nature
Cause under investigation
Cause undetermined after
investigation
K
X
M
Equipment Involved
in Release
Equipment involved in release
Brand
X
Enter up to three actions taken
Confinement
Isolate area
Additional action taken (3)
If fire or explosion is involved with a
release, which occurred first?
I
1
2
Ignition
Release
NN
Factor or impediment (2)
Factor contributing to release (3)
Factor or impediment (3)
X None
Release
O
1
2
3
4
5
6
7
8
Mobile property type
Mobile property make
Model
Model
Year
Serial #
License plate number
State
Year
DOT number/ ICC number
7-17
None
None
Factor contributing to release (2)
Mobile Property Involved in
Undetermined
Enter up to three factors or impediments that affected the
mitigation of the incident
Factor or impediment (1)
N
U
Factors Affecting Mitigation
Factor contributing to release (1)
None
1
Released into
HazMat Actions Taken
22
L
Other part
failure/Leak
Released Into
Additional action taken (2)
Enter up to three contributing factors
54
E2
Enter Code
13
None
Factors Contributing to Release
X
Solid
Liquid
Gas
Undetermined
Primary action taken (1)
Estimated Number of
Buildings Evacuated
0 , 002
Enter measurement
J
0 , 003
Enter
measurement
1
2
3
U
WEIGHT
Ounces
Pounds
Grams
Kilograms
MICRO UNITS
21
22
23
24
H
000 , 550
Square feet
X
None
Estimated Number of
People Evacuated
G3
Area Affected
X
HazMat
State
E1 Physical
When Released
Check one box
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
Area Evacuated
G2
1
2
3
Units: Released
D2
NFIRS–7
Chlorine
000 , 000 , 100
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
Change
Estimated Amount Released
D1
Check one box
Delete
Haz No.
Capacity: by volume or weight
Units: Capacity
X
00
Exposure
Chemical
Name
Estimated Container Capacity
C2
000
Incident Number
CAS Registration Number
Released From
F1
001
23
21
1
YYYY
2002
Station
DOT Hazard
Classification
UN Number
C1
26
Incident Date
State
HazMat ID
B
DD
10
P
HazMat Disposition
Completed by fire service only
Completed w/fire service present
Released to local agency
Released to county agency
Released to state agency
Released to federal agency
Released to private agency
X Released to property owner or
manager
HazMat Civilian Casualties
Deaths
0000
Injuries
0003
NFIRS–7
Revision 01/01/06
NFIRS 5.0 Self-Study Program
EXERCISE SCENARIO 7-1: Cargo Tank Rollover
Directions: Read the call information in the exercise below. Use the information provided to complete the Hazardous Materials
Module form. Compare your work to the answers provided on the completed Hazardous Materials Module form. If your answers
are different from the ones provided, read over the Hazardous Materials Module again.
At 0630 hours on Monday, May 8, 1998, Buckley Fire Communications Center (FDID #TR100,
Station #1) was notified that a cargo tanker had overturned on the southbound off-ramp from
the 5th Street Bridge to Highway 287, Buckley, WI 12345. The Communications Center assigned
the number 9802436 to the incident and dispatched two engines and one truck company (each
with a crew of three), a rescue unit (two crewmembers), and a Battalion Chief. While en route,
the dispatcher advised responding units that numerous calls were being received from the residential subdivision south of the incident. Citizens were reporting a foul odor and having difficulty breathing.
At 0636 hours, Engine 2 with a crew of four arrived on the scene and reported that a 6,000-gallon
MC-307 Mack G-200, 1990, cargo tanker with a Wisconsin license plate #12456 had rolled on
its side and was spilling its load down the street and into the river. The area affected was 1 square
mile. Engine 2 further reported that the tanker had a placard bearing the UN ID #1092. The
DOT Emergency Response Guide was used to identify the material as Acrolein, Inhibited. The truck
driver was trapped in the vehicle and considered to be either unconscious or dead. Engine 2
requested that the Gorman County Hazardous Materials Response Team (FDID #08900) and a
private ambulance with two personnel be dispatched.
Upon his arrival at 0640 hours, the Battalion Chief ordered an evacuation of, at least, 600 feet
in all directions. He also requested the police department to evacuate a downwind area 3 miles
in width and 3 miles in length. Approximately 200 homes and 96 people in this suburban area
were affected by the evacuation order. The BC also requested that six more private ambulances
with two persons each are dispatched to a Staging Area and ordered both highways shut down
to traffic. Two additional engines with a crew of three each were dispatched to assist with the
evacuation. Fire department personnel established a decontamination area and deployed protective hoselines while awaiting the HazMat Response Team.
About 30 minutes later, the two-unit, twelve-member HazMat Response Team arrived and
assumed operational control of the incident. (Their incident number was 9800226.) Over the
next 6 hours, the HazMat Team contained the spill by placing dikes in the street, absorbent booms
in the river, and stopped the leak by securing the dome cover. The driver (who apparently died
from inhalation of the vapors) was removed, decontaminated, and released to the coroner. The
incident was declared under control at 1310 hours.
Eventually, the tanker was off-loaded by a private contractor and was righted. A vacuum truck
and absorbent materials provided by a private contractor were used to remove the remaining
chemical hazard from the street and river. It was estimated that 1,000 gallons of Acrolein was
released as a result of the incident. A total of 16 civilians and two police officers complaining
of respiratory distress were transported to the hospital by private ambulances. Fire department
personnel suffered no casualties. The HazMat Team left the scene at 1525 hours and the last fire
department unit cleared the scene at 1530 hours. Upon investigation, the State Police determined
that the driver lost control of the tanker when he was exiting onto the off-ramp at an excessive
speed. Part of the problem was that the brakes failed to operate properly.
7-18
NFIRS 5.0 Self-Study Program
MM
A
FDID
DD
YYYY
Delete
Incident Date
State
Station
Incident Number
HazMat ID
B
DOT Hazard
Classification
UN Number
Container
Type
C1
None
C2
Estimated Container Capacity
D1
More hazardous
materials? Use
additional sheets.
Complete the remainder
of this form only for the
first hazardous material
involved in this incident.
C3
Units: Capacity
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
11
12
13
14
15
16
Population Density
F2
1
2
3
Urban
Suburban
Rural
Check all applicable boxes
Below grade
1
Inside/on structure
Story of release
2
Outside of structure
G1
Area Affected
1
2
3
D2
WEIGHT
Ounces
Pounds
Grams
Kilograms
Area Evacuated
G2
Blocks
G4
Estimated Number of
Buildings Evacuated
,
1
2
3
4
5
U
Intentional
Unintentional release
Container/containment failure
Act of nature
Cause under investigation
Cause undetermined after
investigation
K
None
,
Enter measurement
Factors Contributing to Release
L
Enter up to three contributing factors
M
Equipment Involved
in Release
Equipment involved in release
Brand
Enter up to three actions taken
Additional action taken (2)
If fire or explosion is involved with a
release, which occurred first?
I
1
2
Ignition
Release
Factor contributing to release (3)
Factor or impediment (3)
None
Release
O
1
2
3
4
5
6
7
8
Mobile property type
Mobile property make
Model
Year
Serial #
License plate number
State
Year
DOT number/ ICC number
7-19
Undetermined
None
Enter up to three factors or impediments that affected the
mitigation of the incident
Factor or impediment (2)
Mobile Property Involved in
U
Factors Affecting Mitigation
Factor contributing to release (2)
Model
Released into
HazMat Actions Taken
H
Factor or impediment (1)
N
Released Into
Enter Code
Factor contributing to release (1)
None
E2
Additional action taken (3)
,
Square miles
WEIGHT
Ounces
Pounds
Grams
Kilograms
MICRO UNITS
21
22
23
24
Solid
Liquid
Gas
Undetermined
Primary action taken (1)
Estimated Number of
People Evacuated
Blocks
Cause of Release
None
Enter
measurement
Square miles
G3
Check one box
1
2
3
U
,
Square feet
Square feet
J
Units: Released
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
11
12
13
14
MICRO UNITS 15
Enter Code 16
1
2
3
Released From
F1
,
,
Amount released: by volume or weight
Check one box
21
22
23
24
HazMat
State
E1 Physical
When Released
Estimated Amount Released
,
Capacity: by volume or weight
Container Type
Change
Haz No.
Chemical
Name
CAS Registration Number
,
Exposure
NFIRS–7
P
HazMat Disposition
Completed by fire service only
Completed w/fire service present
Released to local agency
Released to county agency
Released to state agency
Released to federal agency
Released to private agency
Released to property owner or
manager
HazMat Civilian Casualties
Deaths
Injuries
NFIRS–7
Revision 01/01/06
NFIRS 5.0 Self-Study Program
A TR100
FDID
None
More hazardous
materials? Use
additional sheets.
Complete the remainder
of this form only for the
first hazardous material
involved in this incident.
Check all applicable boxes
Below grade
1
Inside/on structure
Story of release
X
Outside of structure
9 8 0 2 4 3 6
C3
11
12
13
14
15
16
000 , 001 , 000
Amount released: by volume or weight
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
21
22
23
24
1
2
3
X
Urban
Suburban
Rural
G1
1
2
3
WEIGHT
Ounces
Pounds
Grams
Kilograms
Blocks
X Square miles
Blocks
G4
1
2
3
4
5
U
Intentional
Unintentional release
Container/containment failure
Act of nature
Cause under investigation
Cause undetermined after
investigation
,
200
M
Equipment Involved
in Release
X
71
Collision
30
Model
Isolate & establish
28
Protect civilians
Additional action taken (3)
If fire or explosion is involved with a
release, which occurred first?
I
1
2
Ignition
Release
None
Enter up to three factors or impediments that affected the
mitigation of the incident
18
Release on major Hwy
11
Water table
Factor contributing to release (3)
Factor or impediment (3)
14
N
Undetermined
U
Factors Affecting Mitigation
Factor or impediment (2)
Mobile Property Involved in
None
Release
Tank Truck
Mobile property type
MK
Brand
Spill Control
Factor or impediment (1)
Human Failure
25
Equipment involved in release
Enter up to three actions taken
Factor contributing to release (2)
None
7
Released into
HazMat Actions Taken
22
L
Factor contributing to release (1)
Released Into
Additional action taken (2)
Enter up to three contributing factors
X
E2
Solid
Liquid
Gas
Undetermined
Primary action taken (1)
None
Factors Contributing to Release
X
Enter Code
13
Estimated Number of
Buildings Evacuated
0
Enter measurement
K
0 , 009
Enter
measurement
1
2
3
U
WEIGHT
Ounces
Pounds
Grams
Kilograms
MICRO UNITS
21
22
23
24
H
000 , 096
X Square miles
0 , 001
Cause of Release
None
Estimated Number of
People Evacuated
Square feet
J
X
Square feet
G3
Area Affected
State
E1 Physical
When Released
Check one box
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
Area Evacuated
G2
1
2
3
Units: Released
D2
11
12
13
14
MICRO UNITS 15
Enter Code 16
Population Density
F2
Acrolein
000 , 006 , 000
Check one box
HazMat
Change
Estimated Amount Released
D1
NFIRS–7
Delete
Haz No.
Capacity: by volume or weight
Units: Capacity
X
Exposure
Chemical
Name
Estimated Container Capacity
C2
01
000
Incident Number
CAS Registration Number
Released From
F1
2
001
Station
DOT Hazard
Classification
42
Container Type
YYYY
1998
23
1 0 9 2
Container
Type
08
Incident Date
UN Number
C1
DD
05
State
HazMat ID
B
MM
WI
Mack
Mobile property make
G200
1 9 9 0
Model
Year
1 2 4 5 6
Serial #
License plate number
WI
State
Year
DOT number/ ICC number
7-20
Released in residential area
O
1
2
3
4
5
6
7
8
P
HazMat Disposition
Completed by fire service only
Completed w/fire service present
Released to local agency
Released to county agency
Released to state agency
Released to federal agency
X Released to private agency
Released to property owner or
manager
HazMat Civilian Casualties
Deaths
0001
Injuries
0018
NFIRS–7
Revision 01/01/06
NFIRS 5.0 Self-Study Program
EXERCISE SCENARIO 7-2: HazMat I-95
Directions: Read the call information in the exercise below. Use the information provided to complete the entire Hazardous
Materials Module form and other required forms. Compare your work to the answers provided in Appendix A. If your answers
are different from the ones provided, read over the Hazardous Materials Module again.
The Alberta Fire Department (FDID #92188, Station 001) received a call for a truck accident
on I-95 near mile marker 73 and Exit 2B in Brunswick, Virginia 23351 on May 3, 2005. The
dispatcher assigned the incident (#5455) to Engine Co. 2 from Shift C. The unit received the
alarm at 11:58 p.m. and arrived at the scene in 6 minutes with a four-person engine crew and a
four-person truck crew.
The dispatcher received a second call from a bystander at the incident. He reported the accident
and told the dispatcher that he saw cylinders in the cargo area of the vehicle. At 12:00 a.m., the
dispatcher notified the fire department and dispatched their five-person HazMat Truck from
Station 2. They found three cylinders in the cargo area of the vehicle. The cylinders contained
Compressed Oxygen (UN# 1072, CAS Reg. #7782-44-7, DOT Hazard Class 2.2). The largest
cylinder was leaking gas. The cylinder was a Type MM with a capacity of 122 cubic feet. The
other two cylinders were Type M60 (60 cu. ft.). The affected area was 15 square feet. The unit
established a hazard control zone of 160 square feet. Even though the hazard was on Interstate95 and in an urban center, no people or buildings had to be evacuated because of the location of
the incident. The HazMat Team moved the cylinders and stopped the leak. They estimated that
90 cubic feet of the gas escaped. There were no injuries resulting from the leak. The unit, last to
clear the scene, left at 1:05 a.m.
The officer in charge was Lieutenant Dave Sanders. Firefighter John Edgely completed the incident report on May 4, 2005.
7-21
NFIRS 5.0 Self-Study Program
MM
A
C
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
E1
Incident Type
D
YYYY
Change
FDID
B
DD
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
E2
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
G1
Resources
Primary Action Taken (1)
G2
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.
H1
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
F
E3
Arrival
Property
$
,
,
Contents
$
,
,
Hazardous Materials Release
None
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
(Please complete the HazMat form.)
I
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
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
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
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
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
J
7-22
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
K1
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
MI
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
K2
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
MI
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:
L
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.
M
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
7-23
NFIRS 5.0 Self-Study Program
MM
A
FDID
DD
YYYY
Delete
Incident Date
State
Station
Incident Number
HazMat ID
B
DOT Hazard
Classification
UN Number
Container
Type
C1
None
C2
Estimated Container Capacity
D1
More hazardous
materials? Use
additional sheets.
Complete the remainder
of this form only for the
first hazardous material
involved in this incident.
C3
Units: Capacity
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
11
12
13
14
15
16
Population Density
F2
1
2
3
Urban
Suburban
Rural
Check all applicable boxes
Below grade
1
Inside/on structure
Story of release
2
Outside of structure
G1
Area Affected
1
2
3
D2
WEIGHT
Ounces
Pounds
Grams
Kilograms
G2
G3
Area Evacuated
Blocks
G4
,
Estimated Number of
People Evacuated
1
2
3
4
5
U
Intentional
Unintentional release
Container/containment failure
Act of nature
Cause under investigation
Cause undetermined after
investigation
K
Estimated Number of
Buildings Evacuated
None
Factors Contributing to Release
L
Enter up to three contributing factors
M
Equipment Involved
in Release
Equipment involved in release
Brand
Enter up to three actions taken
Additional action taken (2)
If fire or explosion is involved with a
release, which occurred first?
I
1
2
Ignition
Release
Factor contributing to release (3)
Factor or impediment (3)
None
Release
O
1
2
3
4
5
6
7
8
Mobile property type
Mobile property make
Model
Year
Serial #
License plate number
State
Year
Undetermined
None
Enter up to three factors or impediments that affected the
mitigation of the incident
Factor or impediment (2)
Mobile Property Involved in
U
Factors Affecting Mitigation
Factor contributing to release (2)
Model
Released into
HazMat Actions Taken
H
Factor or impediment (1)
N
Released Into
Enter Code
Factor contributing to release (1)
None
E2
Additional action taken (3)
,
Enter measurement
WEIGHT
Ounces
Pounds
Grams
Kilograms
MICRO UNITS
21
22
23
24
Solid
Liquid
Gas
Undetermined
Primary action taken (1)
,
Square miles
Cause of Release
None
Enter
measurement
Square miles
Blocks
Check one box
1
2
3
U
,
Square feet
Square feet
J
Units: Released
VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters
11
12
13
14
MICRO UNITS 15
Enter Code 16
1
2
3
Released From
F1
,
,
Amount released: by volume or weight
Check one box
21
22
23
24
HazMat
State
E1 Physical
When Released
Estimated Amount Released
,
Capacity: by volume or weight
Container Type
Haz No.
NFIRS–7
Chemical
Name
CAS Registration Number
,
Exposure
Change
P
HazMat Disposition
Completed by fire service only
Completed w/fire service present
Released to local agency
Released to county agency
Released to state agency
Released to federal agency
Released to private agency
Released to property owner or
manager
HazMat Civilian Casualties
Deaths
Injuries
NFIRS–7
Revision 01/01/06
DOT number/ ICC number
7-24
NFIRS 5.0 Self-Study Program
Hazardous Materials Module Test
1. Which is not a definition of a reportable HazMat Incident?
(a) Any spill that requires the use of fire department resources.
(b) Specialized HazMat resources were dispatched or used for assessing, mitigating, or managing the situation.
(c) Specialized HazMat should have been dispatched or used for assessing, mitigating, or managing the situation.
(d) A release or spill of hazardous materials that exceeds 55 gallons.
2. Which identification system is not used in NFIRS to identify hazardous materials or their
characteristics?
(a) UN Number.
(b) DOT Hazard Classification.
(c) Chemical Name.
(d) Chemical Identifier.
3. The chemical identification system that is printed on placards or labels on the materials during
transportation is:
(a) UN Number.
(b) DOT Hazard Classification.
(c) CAS Registration Number.
(d) Chemical Name.
4.
High wind and release into water table are examples of which data element?
(a) Cause of Release.
(b) Factors Contributing to Release.
(c) Factors Affecting Mitigation.
(d) Release Into.
5. To record the Estimated Container Capacity and the Estimated Amount Released what information is needed?
(a) Container Type.
(b) DOT Hazard Classification.
(c) Amount of materials.
(d) Units of measure.
7-25
| File Type | application/pdf |
| File Modified | 2008-02-12 |
| File Created | 2008-02-12 |