NFIRS Module 10 - Personnel

National Fire Incident Reporting System (NFIRS) Version 5.0

NFIRS Module 10 - Personnel

OMB: 1660-0069

⚠️ Notice: This form may be outdated.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

2023-06-06 - Extension without change of a currently approved collection

Document [pdf]

Download: pdf | pdf

NFIRS 5.0 Self-Study Program

Personnel Module:
NFIRS-10

Objectives
After completing the Personnel Module you will be able to:
1. Describe when the Personnel Module is to be used.
2. Demonstrate how to complete the Personnel Module and identify
appropriate other modules, given the scenario of a hypothetical
incident.

10-1

Table of Contents
Pretest #10 – Personnel Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3
Using the Personnel Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4
Section A: FDID, State, Incident Date, Station, Incident Number, Exposure. . . . . . . . . . . . . . 10-4
Section B: Apparatus or Resources, Dates and Times, Sent, Apparatus Use,
and Actions Taken. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7
EXAMPLE: Automobile Crash. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8
EXERCISE SCENARIO 10-1: Structure Fire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-10
EXERCISE SCENARIO 10-2: Structure Fire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13
Personnel Module Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-19

NFIRS 5.0 Self-Study Program

Pretest #10 – Personnel Module
1. A Basic Module must be completed if the Personnel Module is completed.

(a) True.

(b) False.

2. The Personnel Module is a required NFIRS Module.

(a) True.

(b) False.

3. Either the Personnel Module or Apparatus or Resources Module may be used, but not both.

(a) True.

(b) False.

4. The Personnel Module can be used to help manage and track apparatus and resources used on
incidents.

(a) True.

(b) False.

5. The data element Attend allows fire departments to preprint or preenter personnel in the
Personnel Module.

(a) True.

(b) False.

10-3

NFIRS 5.0 Self-Study Program

Using the Personnel Module

he Personnel Module (NFIRS-10) is an optional module that is used to help manage and track
personnel and resources used on incidents. This module can be used in place of the Apparatus
or Resources Module (NFIRS-9) if more detail on personnel is needed.
NOTE: Either the Personnel Module or Apparatus or Resources Module may be used -- not both.

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

A
FDID

YYYY

Incident Date

State

Station

Incident Number

Exposure

Delete

NFIRS–10

Change

Personnel

Sent
Number
Apparatus Use
Actions Taken
Apparatus or
Dates and Times
B information
The
in Section A isCheck
drawn
from
A of the Basic
Use the data
in the Basic
if same date
as AlarmSection
date on
of Module.
Resources
Check ONE box for each
List up to 4 actions for
the Basic Module (Block E1)
X
apparatus to indicate its main
each apparatus and
Module to help you supply the
information.
If youPeople
are using
an
automated
system the
Month requested
Day
Year
Hour/Min
use at the incident.
each personnel.
data
need to be entered
automatically
into other modules
Sent
1
Dispatchonly once, then they will be transferred
ID
Suppression
that use the data. Arrival
EMS
Midnight is 0000

Type

Other

Clear

Personnel
ID

Action
Taken

YYYY

Action
Taken

Delete

Incident Date

State

Apparatus or
Resources

Station

Dates and Times

Incident Number

Sent

Midnight is 0000

Check if same date as Alarm date on
the Basic Module (Block E1)
Month Day

Attend

Section B: Apparatus or Resources, Dates and Times,
NFIRS–10
Sent, Apparatus Use, and Actions Taken
Personnel

FDID

Rank or
Grade

Name

Year

Apparatus Use

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

List up to 4 actions for
each apparatus and
each personnel.

Sent

Dispatch
Arrival
Dispatch
Clear
Arrival

Number
of
People

Hour/Min

Change

Exposure

Suppression
EMS
ID
Type
Suppression
Other
EMS
Type
Other
Clear
Action
Rank
or module.
Personnel
Attend Record
Action the apparatus
Action
Action
Name
You can
record multiple pieces
of apparatus in
this
ID
and apparatus
Taken
Grade
ID
Taken
Taken
Taken
X
Rank ortypeAttend
Personnel
type on
the first two lines. Codes
are in the
Complete Action
Reference Guide
(CRG).
Action
Action
Action
Namefor the apparatus
Taken
Grade
ID
Taken
Taken
Taken
X
2

Sent

DATES AND TIMES
MM

A
FDID

Apparatus or
Resources

YYYY

Incident Date

State

Station

Dates and Times

Midnight is 0000

Check if same date as Alarm date on
the Basic Module (Block E1)
Month Day

ID
Type
Type

Personnel
ID
Personnel
ID

ID
Dispatch
Arrival
Type
Dispatch
Clear
Arrival

Clear
Personnel
ID

Dispatch
Arrival

Name

Name
Rank or
Grade
Rank or
Grade

10-4

Sent
X

Hour/Min

Sent

Clear

Name

Year

Incident Number

Exposure

Number
of
People

Delete

NFIRS–10

Change

Personnel

Apparatus Use

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

List up to 4 actions for
each apparatus and
each personnel.

Sent

Suppression
Suppression
EMS
EMS
Sent
Other
Suppression
Other
EMS
Action
Rank or
AttendOtherAction
Action
Action
Attend
Action
Action
TakenAction Taken
Grade
Taken
X
Taken
Taken
Taken
Taken
X
Action
Attend
Action
Action
Action
Taken
Taken
Taken
Taken
X

Action
Taken

NFIRS 5.0 Self-Study Program

Record dates and times for Dispatch, Arrival, and Clear in the Dates and Times block. Record all times
in 24-hour time (midnight is 0000). If the alarm date is the same as the dispatch, arrival, or clear
date, check the box that appears to the left of the appropriate field.
MM

A
FDID

Station

Dates and Times

Incident Number

Sent

Midnight is 0000

Check if same date as Alarm date on
the Basic Module (Block E1)
Month Day

SENT

YYYY

Incident Date

State

Apparatus or
Resources

Year

Hour/Min

Type

Number
of
People

Delete

NFIRS–10

Change

Personnel

Apparatus Use

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

List up to 4 actions for
each apparatus and
each personnel.

Sent

Dispatch
Arrival

Exposure

Suppression
EMS
Other

Clear

Personnel
A box
ID

Action
or
Attend
Action
Action If it did,
Name
is available to indicate
whetherRank
or not
the
unit actually
responded
toAction
the incident.
Taken
Grade
Taken
Taken
Taken
X
mark the box. If the unit was held in quarters, leave it blank. (For paper copy only.)

A
FDID

Station

Dates and Times

Type

Personnel
Record the
Personnel
ID
ID
provided.

Year

Grade

Type Clear

Type

Station

Incident Number

Midnight is 0000

Year

Sent
X

Hour/Min

Midnight is 0000

Year

Dispatch
Arrival

Type Clear

el Name
Personnel
ID

Suppression
Suppression
EMS
EMS
Other
Other

Taken
Taken

Number
of
People

Taken
Taken

Delete

NFIRS–10

Change

Personnel

Apparatus Use

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

List up to 4 actions for
each apparatus and
each personnel.

Sent

Suppression
Sent
EMS
Other

Taken
Taken

Taken

Suppression
Suppression
EMS
EMS
Other
Other

Action the Action
clarify
main
useAction
of
each piece
of apparatus at the
Action
Action
Action
Action
Action
Taken
Attend
Taken
X

Action
Taken
Taken Taken
Taken
Taken
Taken

Action
Taken
Taken

Action
Taken

NFIRS–10
ACTIONS
TAKEN
Personnel
Delete

Check if same date as Alarm date on
the Basic Module (Block E1)
Month Day

List up to 4 actions for
each apparatus and
each personnel.

Exposure

Sent

Dispatch
Dispatch
Arrival
Arrival
Clear
Clear

Station

Times

Personnel

Actions Taken

Taken

X
Grade

YYYY

Date

NFIRS–10

Change

Check ONE box for each
apparatus to indicate its main
use at the incident.

Sent

or
Attend
Action to
Name choices areRank
offered
in
this
Rank section
or
Personnel Three
Attend
Name Grade
Rank or
Personnel
Taken
Name
X Grade
ID
incident.
Mark only one box.
X
Grade
ID

Delete

Apparatus Use

APPARATUS USE

Incident Date

Dispatch
3
ID
Arrival

Sent

Check if same date as Alarm date on
the Basic Module (Block E1)

Number
of
People

Hour/Min

YYYY

Month Day

Exposure

Action
or
Attend
Action
Action
Action
Name number of Rank
total
people
responding
on the
specificAction
piece ofAction
apparatus
on the line
Rank
or
Attend
Action
Action
Name

Dates and Times

Sent

Midnight is 0000

Dispatch
Dispatch
Arrival
Arrival
Clear
Clear

ID
Type

State

Incident Number

Check if same date as Alarm date on
the Basic Module (Block E1)
Month Day

NUMBER OF PEOPLE

YYYY

Incident Date

State

Apparatus or
Resources

Incident Number

Sent
X

Hour/Min

Sent
Dispatch
Arrival
Clear
Rank or
Name
Grade

Exposure

Number
of
People

Change

Apparatus Use

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

List up to 4 actions for
each apparatus and
each personnel.

SentSuppression
Sent
EMS
Other

Suppression
EMS
Other

NFIRS–10

Suppression
EMS
Other

Action
Attend
Action
Action
Action
Action
Rank or
AttendTakenAction
Action
Action Action
Rank or
Taken
Taken
Attend
Action
Action
Taken
Name
X
Taken
Grade
Taken
Taken
X Grade
Taken Taken
Taken
Taken
X

10-5

Action
Taken

Revision 01/01/04

NFIRS 5.0 Self-Study Program
A
FDID

State

YYYY

Incident Date

Station

Incident Number

Enter codes (taken from Section F of the Basic Module) here to describe actions taken by firefighters.
Sent
Apparatus
or
Dates
and Times
You can record up to four actions for each
of apparatus.
Local
fire departments Midnight
haveis 0000
the option
B piece
Check if same date as Alarm date on
Resources
the Basic Module (Block E1)
to develop plus one codes.
X
Month Day

Year

Hour/Min

PERSONNEL IDArrival
Type

MM
FDID

Attend

Action
Taken

YYYY

Incident Date

State

Rank or
Grade

Name

Station

Incident Number

Exposure

Personnel
ID

Incident Date

State

Rank or
Grade

Attend
X

Dispatch
Arrival

ID
Type

Rank or
Grade

Name

YYYY 3

use at the incident.

Sent

NAME

Type

FDID

Hour/Min

Dispatch
Arrival Personnel
ID
Clear

Year
Clear

Station

Incident Number

Exposure

Clear

Action
Taken

Delete

Sent
NFIRS–10

Change

Personnel

NFIRS–

Person

Actions Take
Su
List up to 4 actions fo
EM
each apparatus and
each personnel. Oth

Action
Taken

ID
Type

Dispatch
ArrivalPersonnel
ID
Clear

Personnel
ID

Type

Personnel
ID

use at the incident.

RANK OR
GRADE
Name
Rank or
Grade

Attend
X

Rank or
Grade

Action
Taken

each personnel.
OtherX

Suppression
Attend
Action
EMS
Taken
Other
X
Action
Taken

Action
Taken

Sent

Dispatch
Arrival

ID
Type

Hour/Min

Sent

Name

Year
Clear

Name

Sent
Rank or
Grade

Name

10-6

Rank or
Grade

Attend
X

Action
Taken

Suppression
Attend
Action
EMS
Taken
X
Other
Action
Taken

Actio
Take

Action
Taken

Ac
Ta

Actio
Take

Action
Taken

Suppression
EMS
Other

Clear

Dispatch
ArrivalPersonnel
ID
Clear

Action
Taken

Ac
Ta

Su
EM
Oth

Sent
Midnight is 0000 onSent
Number
Apparatus
Use are two
Actions
Taken
Dispatch
Apparatus or enter2Dates
and Times
AtBa minimum,
theIDlast
name of each
individual
the lines
provided.
If there
orSuppression
more
Check if same date as Alarm
date on
of Name
Resources
Rank
Personnel
Attend
Action
Check ONE box for each
List or
up to 4 actions
for
Arrival
EMS
the
Basic
Module
(Block
E1)
identical last names, be
sure to include an initialIDor a first XnamePeople
to differentiate
between
them.
apparatus to indicate
its main
each
apparatus and
Grade
Taken
Type
Month Day

Ac
Ta

Change

Suppression
Attend
Action
EMS
Taken
OtherX
Action
Taken

Check ONE
apparatus
use at the i

Delete

SentUse
0000 individual’s
Sent
Number
and
This identification isB setApparatus
by theorlocal Dates
fire2 department.
DoDispatch
not Midnight
use isthe
SocialApparatus
Security
ID Times
Check if same date as Alarm date on
of
Resources
Check ONE box for each
the Basic ModuleArrival
(Block E1)
number, as this puts the individual at risk.Type
X
apparatus to indicate its main
People
Month Day

Appara

Su
EM
Oth

Clear

Personnel
ID

Number
of
People

Sent

Dispatch

Exposure

Action
Taken

Actio
Take

s or
es

A
FDID

Apparatus or
Resources

Station

Dates and Times

Midnight is 0000

Type

Year

Station

Rank or
Grade

Incident Number

Midnight is 0000

Sent

Year

Arrival

Number

Action
Taken

Exposure

Hour/Min

Delete

NFIRS–10

Change

Personnel

Apparatus Use

Action
Taken

Actions Taken

use at the incident.

Sent

Clear

Arrival
Personnel
ID

Rank or
Grade

Attend
X

EMS
Other

Suppression

Action
Taken

Other
Attend
X

Action
Taken

Clear
For each individual,
you canSent
document up toSuppression
four actions.
entered on Lines F of the Basic Module and areEMS
in the CRG.

Personnel
ID
Name

Rank or
Grade

Name
Rank or
Grade

Attend
X

Action
Taken

Other
Attend
X

Action
Taken

Sent

Dispatch
Arrival

each personnel.

ACTION
EMS TAKEN
Rank or
Grade

Name

nel

of
box for each
List up to 4 actions for
Sent
Mark the box if the individualXresponded
toCheck
theONE
incident
copy only).
apparatus
to indicate its main(for
eachpaper
apparatus
and
Suppression
People
Month Day

Clear

Attend

Check if same date as Alarm date on
the Basic Module
(Block E1)
Dispatch

Type
Dispatch

Type
Dispatch
Arrival

List up to 4 actions for
each apparatus and
each personnel.

Suppression
EMS
Other

YYYY

Dates and Times

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

Sent

Name

Incident Date

Clear

Hour/Min

Personnel

Apparatus Use

Clear

Number

ATTEND

Personnel
ID

Sent

Change

Exposure

of
NFIRS 5.0 Self-Study
Program
X
People

Dispatch
Arrival

State

Incident Number

Check if same date as Alarm date on
the Basic Module (Block E1)
Month Day

nel

Incident Date

State

Action
Taken

Suppression
EMS
Other
Codes
should

Action
Taken
Action
Taken

SUMMARY

Action
Taken

correspond with those

Action
Taken

Use the Personnel Module as a local option to document personnel and apparatus information for
individual incidents. If a Personnel Module is completed for each apparatus sent to the scene, it is not
necessary to complete the Apparatus or Resources Module.
NFIRS–10

Sent

Dispatch
Arrival

Suppression
EMS
Other

Clear
Name

Rank or
Grade

Attend
X

Action
Taken

10-7

Action
Taken

NFIRS–10

Action
Taken

Revision 01/01/04

NFIRS 5.0 Self-Study Program

EXAMPLE: Automobile Crash
Directions: Read the call information in the example below. Then look at the completed Personnel Module form. Look at each
section and follow along with the proper use of the information as applicable to the Personnel Module.
On July 6, 1998, (FDID #TR100) Engine 1 and Ambulance 3, along with Rescue Squad 6, were
dispatched at 1705 hours to an automobile crash involving personal injuries at Main Street and
Laurel Blvd., Eau Claire, WI. Engine 1 and Ambulance 3 arrived on the scene at 1710, and the
squad arrived at 1713. The crew on Engine 1 consisted of Captain Jones (ID #JP0275), Driver
Boswell (ID #BK3451), and Wilson (ID #WS6753) was in the Bucket. Incident #9222108 was
assigned.
The crew on Ambulance 3 consisted of Paramedic Smith (ID #SB9078) and Driver/EMT Conrad
(ID #NC2165). Rescue Squad personnel included Lt. Holmes (ID #JH2580), Driver Torre (ID
#TJ3425), and FF Kerns (ID #KF4791).
The officer in charge reported a vehicle crash with one person trapped. Engine 1 personnel pulled
a hoseline and provided vehicle stabilization. Ambulance 3 personnel provided traction on the
patient’s neck until Rescue Squad 6 extricated the victim.
The victim in the second car received minor injuries but signed a release stating that he refused
treatment or transport to the hospital. After patient 1 was extricated he was placed on a long back
board and transported to the hospital. Engine 1 and Rescue Squad 6 cleared the scene at 1812. The
ambulance cleared the hospital at 1840.

10-8

NFIRS 5.0 Self-Study Program

A TR100
FDID

ID
Type

Dates and Times

Dispatch
Arrival
Clear

Type

AMB3
76

Jones
Boswell
Wilson

Dispatch
Arrival
Clear

X
X
X

Personnel
ID

Name

S B 9 0 7 8
N C 2 1 6 5

ID
Type

RS6
71

Smith
Conrad

Dispatch
Arrival
Clear

Personnel
ID

J H 2 5 8 0
J T 3 4 2 5
K F 4 7 9 1

Year

Rank or
Grade

Name

Holmes
Torre
Kerns

Incident Number

Sent
X

Attend
X

X
X
X

1705
1710
1840

Sent

Rank or
Grade

PM
EMT

000
Exposure

Number
of
People

Attend
X

X
X

003

Personnel

Actions Taken
List up to 4 actions for
each apparatus and
each personnel.

Suppression
EMS
Other
Action
Taken

73
73
73

Action
Taken

Suppression
EMS
Other
Action
Taken

Action
Taken

003

Suppression
EMS
Other

Rank or
Grade

Attend
X

Action
Taken

Lt.
Tech
FF

X
X
X

23
23
23

Action
Taken

NFIRS–10

10-9

Action
Taken

32
58

Sent

NFIRS–10

Change

Check ONE box for each
apparatus to indicate its main
use at the incident.

Action
Taken

002

Delete

Apparatus Use

Sent

Capt.
Tech
FF

1705
1713
1812

X
X
X

9 2 2 2 1 0 8

Hour/Min

1705
1710
1812

X
X
X
Name

J P 0 2 7 5
B K 3 4 5 1
W M 6 7 5 3

Midnight is 0000

Check if same date as Alarm date on
the Basic Module (Block E1)

Personnel
ID

001
Station

Month Day

YYYY

1998

Incident Date

State

Apparatus or
Resources

Action
Taken

Revision 01/01/04

NFIRS 5.0 Self-Study Program

EXERCISE SCENARIO 10-1: Structure Fire
Directions: Read the call information in the exercise below. Use the information provided to complete the Personnel Module
form. Compare your work to the answers provided on the completed Personnel Module form. If your answers are different from
the ones provided, read over the Personnel Module again.
On 11/22/2000, in Eau Claire, WI, FDID #TR100, Station 42, responded (Incident #3402341)
to a structure fire.
Engine 422 (driven and operated by FF Richardson) was dispatched at 1345 and arrived at the
8503 Spring Drive structure fire at 1347 hours. Captain Cooke, FF Groshong, and Probationary FF
McIntire advanced one 1-3/4-inch line to the first floor.
Medic 1 (driven and operated by FF/First Responder Worley) was dispatched at 1347 and arrived
on scene at 1350 hours. Paramedic Burnette found the homeowner in the front yard suffering
from smoke inhalation and administered oxygen. FF Worley treated a child for a cut received
while escaping the structure.
Truck 1 (driven and operated by FF Mitchell) was dispatched at 1345 and arrived at 1351 hours.
Captain Fritz and FF McAllister conducted a search of the second floor while FF Dupeire performed ventilation. After the fire was knocked down, the whole crew performed salvage and
overhaul.
Engine 422 cleared the scene at 1431 and was available for duty at 1445. Truck 1 was clear at 1450
and available at 1510. Medic 1 was clear of the scene at 1510 and available at 1540.
Personnel ID Numbers are as follows:
Capt. Cooke

976202020

FF Groshong

534879310

PFF McIntire

721201241

FF Richardson

711349089

Capt. Fritz

314895310

FF Mitchell

734902143

FF McAllister

675906301

FF Dupeire

368319752

FF Worley

752372291

Medic Burnette 901190111

10-10

NFIRS 5.0 Self-Study Program
MM

A
FDID

Apparatus or
Resources

Incident Date

State

Station

Dates and Times

ID
Type

Personnel
ID

Year

Sent
X

Hour/Min

Exposure

Number
of
People

Sent

Name

Rank or
Grade

Attend
X

Action
Taken

Sent

Dispatch
Arrival

Rank or
Grade

Attend
X

Action
Taken

Sent

Dispatch
Arrival

Rank or
Grade

Attend
X

Personnel

Apparatus Use

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

List up to 4 actions for
each apparatus and
each personnel.

Action
Taken

NFIRS–10

10-11

Action
Taken

Suppression
EMS
Other

Clear
Name

NFIRS–10

Change

Suppression
EMS
Other

Clear
Name

Delete

Suppression
EMS
Other

Clear

Personnel
ID

Midnight is 0000

Dispatch
Arrival

Personnel
ID

Incident Number

Check if same date as Alarm date on
the Basic Module (Block E1)
Month Day

YYYY

Action
Taken

Revision 01/01/04

NFIRS 5.0 Self-Study Program

A TR100
FDID

Dates and Times

Type

Dispatch
Arrival

7
3
2
1

6
4
1
1

2
8
2
3

0
7
0
4

Clear

2
9
1
9

Type

Name

0
3
2
0

2
1
4
8

0
0
1
9

Cooke
Groshong
McIntire
Richardson

Dispatch
Arrival

1
3
7
6

4
4
5
8

8
9
9
3

9
0
0
1

Clear

5
2
6
9

1
4
0
5

ID
Type

Name

3
1
3
7

Midnight is 0000

0
3
1
2

Fritz
Mitchell
McAllister
Dupeire

Dispatch
Arrival
Clear

Personnel
ID

7 5 2 3 7 2 2 9 1
9 0 1 1 9 0 1 1 1

Year

Name

Worley
Burnette

Attend

Capt
FF
PFF
FF

X
X
X
X

Number
of
People

004

Rank or
Grade

Attend

Capt
FF
FF
FF

X
X
X
X

NFIRS–10

Change

Personnel

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

List up to 4 actions for
each apparatus and
each personnel.

Suppression
EMS
Other
Action
Taken

Action
Taken

004

Suppression
EMS
Other

Action
Taken

20
58
20
51

Action
Taken

002

Action
Taken

12
12

Suppression
EMS
Other

Rank or
Grade

Attend
X

Action
Taken

FF
Medic

X
X

32
32

31
31

Action
Taken

NFIRS–10

10-12

11
11
11
58

Sent

Delete

Apparatus Use

Action
Taken

Sent

000
Exposure

Sent

Rank or
Grade

1347
1350
1510

X
X
X

Sent

Hour/Min

1345
1351
1450

X
X
X

Personnel
ID

3
7
6
3

Incident Number

1345
1347
1431

X
X
X

Personnel
ID

9
5
7
7

3 4 0 2 3 4 1

Check if same date as Alarm date on
the Basic Module (Block E1)

E422

042
Station

Month Day

YYYY

2000

Incident Date

State

Apparatus or
Resources

Action
Taken

Revision 01/01/04

NFIRS 5.0 Self-Study Program

EXERCISE SCENARIO 10-2: Structure Fire
Directions: Read the call information in the exercise below. Use the information provided to complete the entire Personnel
Module form and other forms needed to complete the scenario. Compare your work to the answers provided in Appendix A. If
your answers are different from the ones provided, read over the Personnel Module again.
The Alberta Fire Department (FDID #92188) received a call for a reported house fire at 5 East
Cary Street, Brunswick, Virginia 23351, on May 1, 2005. The dispatcher assigned the incident
(#5433) to Engine 1, Engine 2, and Truck 1 from Shift A. The units received the alarm at 12:53
p.m. Engine 1 and Truck 1 arrived at the scene at 12:58. Engine 2 arrive at the scene at 1:00
p.m. Each unit was staffed with four firefighters. The owner of the single-family dwelling,
Mrs. Christy Gordon (66 years old), said that she was warming her lunch on the stove when the
grease from the pan began to burn. The gas stove was a Whirlpool, Model RF330PXVN, Serial
Number F925888840, Year 2000. The fire spread from the pan to the curtains. She had fallen
asleep upstairs and was alerted when the hardwired smoke detector activated. The flame damage
was confined to the kitchen. The 2,000 square feet, two-story home was filled with smoke in
the other rooms. She called 911. Crews from Engine 1 and 2 worked to extinguish the fire while
the crew from Truck 1 performed ventilation, salvage, and overhaul. The fire was brought under
control at 1:25 p.m. There was $24,000 fire loss to property and $9,600 content loss. The value
of the property was $161,000 and the content value was $80,400. All units cleared the scene at
2:40 p.m. FF1 Adam C. Wallner, Badge No. 224, completed the report after returning to Station
No. 2. Captain Tonya S. Gordon, Badge No. 105, was the officer in charge. The incident was in
Census Tract 501.10, District A12.
Engine 1 Personnel
• Andrew C. Wallner, FF1, Badge No. 224, Duties: Extinguish fire and ventilation
• Karen M. Winer, FF2, Badge No. 111, Duties: Extinguish fire and ventilation
• Andrew B. Starwood, FF3, Badge No. 130, Duties: Operate apparatus
• Tonya S. Gordon, Capt., Badge No. 105, Duties: Command
Engine 2 Personnel
• Paul P. Kritz, FF2, Badge No. 222, Duties: Extinguish fire
• Andy C. Long, FF3, Badge No. 219, Duties: Extinguish fire
• Stan Baron, Capt., Badge No. 007, Duties: Command
• John Mack, FF3, Badge No. 234, Duties: Operate apparatus
Truck
• Juan M. Mills, FO2, Badge No. 317, Duties: Ventilation
• Ronald T. Harris, FF2, Badge No. 299, Duties: Operate apparatus
• Marion Fritz, Capt., Badge No. 847, Duties: Command
• Cal Heilig, FF3, Badge No. 356, Duties: Salvage and Overhaul

10-13

NFIRS 5.0 Self-Study Program
MM

Delete

Incident Date

State

Location Type

Station

Incident Number

Exposure

NFIRS–1

Number/Milepost

Prefix

Basic

No Activity

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

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

Census Tract

Street or Highway

Street Type

Suffix

Apt./Suite/Room

City

State

ZIP Code

Cross Street, Directions or National Grid, as applicable

Incident Type

YYYY

Change
FDID

Aid Given or Received

None

Dates and Times

Midnight is 0000

Month

Check boxes if
dates are the
same as Alarm
Date.

Day

Year

Hour

Min

Shifts and Alarms
Local Option

ALARM always required

Shift or
Platoon

Alarm

Alarms

District

ARRIVAL required, unless canceled or did not arrive

1
2
3
4
5

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

Their FDID

Last Unit
Cleared

Resources

Primary Action Taken (1)

Apparatus

Personnel

Suppression
Additional Action Taken (2)

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

Check box if resource counts include aid
received resources.

Casualties

None

Deaths Injuries
Fire
Service
Civilian

H2
1
2
U

Detector
Required for confined fires.

Detector alerted occupants
Detector did not alert them
Unknown

H3
1
2
3
4
5
6
7
8
0

Special
Study Value

Estimated Dollar Losses and Values

LOSSES:

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

Property

Contents

None

PRE-INCIDENT VALUE: Optional

EMS
Other
Additional Action Taken (3)

Special
Study ID#

LAST UNIT CLEARED, required except for wildland fires

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

Fire–2
Structure Fire–3

Local Option

Controlled

Actions Taken

Completed Modules

Special Studies

CONTROLLED optional, except for wildland fires

Their
State

Their Incident Number

Arrival

Property

Contents

Hazardous Materials Release

None

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.)

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

10-14

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

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

NFIRS 5.0 Self-Study Program
Person/Entity Involved

Local Option

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

Business Name (if applicable)

Mr., Ms., Mrs.

First Name

Number

Prefix

Post Office Box

State

Area Code

Phone Number

Last Name

Suffix

Street or Highway

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

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

Owner

Local Option

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

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

Mr., Ms., Mrs.

Business Name (if applicable)

First Name

Number

Prefix

Phone Number

Last Name

Suffix

Street or Highway

Street Type

Apt./Suite/Room

Post Office Box

State

Area Code

Suffix

City

ZIP Code

Remarks:

Local Option

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

ITEMS WITH A

MUST ALWAYS BE COMPLETED!

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

Authorization

Check box if
same as
Officer in
charge.

Officer in charge ID

Signature

Position or rank

Assignment

Month

Day

Year

Member making report ID

Signature

Position or rank

Assignment

Month

Day

Year

10-15

NFIRS 5.0 Self-Study Program

MM
FDID

YYYY

Incident Date

State

Station

Property Details

C
Not Residential

Incident Number

On-Site Materials
or Products

Change

Exposure

None

Enter up to three codes. Check one box for each code
entered.

On-Site Materials
Storage Use

On-site material (1)

1
2
3
4
U

Bulk storage or warehousing
Processing or manufacturing
Packaged goods for sale
Repair or service
Undetermined

On-site material (2)

1
2
3
4
U

Bulk storage or warehousing
Processing or manufacturing
Packaged goods for sale
Repair or service
Undetermined

1
2
3
4
U

Bulk storage or warehousing
Processing or manufacturing
Packaged goods for sale
Repair or service
Undetermined

Buildings not involved
Number of buildings involved

None

Less than one acre

Acres burned (outside fires)

On-site material (3)

D
D1
D2

Ignition

Area of fire origin

Heat source

D3
Item first ignited

Check box if fire spread was
confined to object of origin.

Cause of Ignition
Skip to
Section G

Check box if this is an exposure report.

Intentional
Unintentional
Failure of equipment or heat source
Act of nature
Cause under investigation
Cause undetermined after investigation

Factors Contributing to Ignition

3
4
5
None
6

Estimated age of
person involved

Required only if item first
ignited code is 00 or <70

Equipment Involved in Ignition
None

Age was a factor

Factor contributing to ignition (2)

None

Asleep
Possibly impaired by
alcohol or drugs
Unattended person
Possibly mentally disabled
Physically disabled
Multiple persons involved

1
2

Factor contributing to ignition (1)
Type of material first ignited

Human Factors
Contributing to Ignition

Check all applicable boxes

1
2
3
4
5
U

Fire

Complete if there were any significant amounts of
commercial, industrial, energy, or agricultural products or
or materials on the property, whether or not they became involved

Estimated number of residential living units in
building of origin whether or not all units
became involved

NFIRS–2

Delete

Equipment Power Source

Male

Fire Suppression Factors

Female

None

Enter up to three codes.

If equipment was not involved, skip to
Section G
Equipment Power Source

Equipment Involved

Brand
Model
Serial #

Equipment Portability
1

Portable

Stationary

Portable equipment normally can be moved by
one or two persons, is designed to be used in
multiple locations, and requires no tools to install.

Year

Mobile Property Involved

Not involved in ignition, but burned

Involved in ignition, but did not burn

Involved in ignition and burned

None

Fire suppression factor (1)

Fire suppression factor (2)

Fire suppression factor (3)

Mobile Property Type and Make

Local Use
Pre-Fire Plan Available
Some of the information presented in this report may be
based upon reports from other agencies:

Mobile property type

Mobile property make

Mobile property model

License Plate Number

Year

State

Arson report attached
Police report attached
Coroner report attached
Other reports attached

VIN

Structure fire? Please be sure to complete the Structure Fire form (NFIRS–3).
NFIRS–2 Revision 01/01/05

10-16

NFIRS 5.0 Self-Study Program
Structure Type

If fire was in an enclosed building or a
portable/mobile structure, complete the
rest of this form.

1
2
3
4
5
6
7
8
0

Enclosed building
Portable/mobile structure
Open structure
Air-supported structure
Tent
Open platform (e.g., piers)
Underground structure (work areas)
Connective structure (e.g., fences)
Other type of structure
Fire Origin

Building Status

1
2
3
4
5
6
7
0
U

Under construction
Occupied & operating
Idle, not routinely used
Under major renovation
Vacant and secured
Vacant and unsecured
Being demolished
Other
Undetermined

Number of stories w/significant damage
(25 to 49% flame damage)

None Present

Present

Undetermined

Detector Type

1
2
3
4
5
0
U

Smoke
Heat
Combination smoke and heat
Sprinkler, water flow detection
More than one type present
Other
Undetermined

Number of stories w/extreme damage
(75 to 100% flame damage)

Detector Power Supply

1
2
3
4
5
6
7
0
U

0
U

Detector Operation

Fire too small to activate

Operated

Complete
Block L5

Failed to operate

Complete
Block L6

Undetermined

Type of Automatic Extinguishing System
Required if fire was within designed range of AES

Wet-pipe sprinkler
Dry-pipe sprinkler
Other sprinkler system
Dry chemical system
Foam system
Halogen-type system
Carbon dioxide (CO2) system
Other special hazard system
Undetermined

Width in feet

Type of Material Contributing Most
to Flame Spread
Check if no flame spread OR if
same as Material First Ignited (Block D4,
Fire Module) OR if unable to determine.

Skip to
Section L

Item contributing most to flame spread

K2
Type of material contributing
most to flame spread

Battery only
Hardwire only
Plug-in
Hardwire with battery
Plug-in with battery
Mechanical
Multiple detectors & power
supplies
Other
Undetermined

1
2
3
4
5
6
7

Presence of Automatic Extinguishing System
None Present
N
Present
1
Complete rest of
Section M
2
Partial System Present
U
Undetermined

Length in feet

Number of stories w/heavy damage
(50 to 74% flame damage)

L3
Skip to
Section M

,
Total square feet

Total number of stories
below grade

Fire Spread

(In area of the fire)

NFIRS–3
Structure
Fire

Number of stories w/minor damage
(1 to 24% flame damage)

Presence of Detectors

Total number of stories at or
above grade

Story of
fire origin

Confined to room of origin
Confined to floor of origin
Confined to building of origin
Beyond building of origin

Main Floor Size

Count the roof as part of the
highest story.

Count the roof as part of the highest story.

If fire spread was confined to object of origin,
do not check a box (Ref. Block D3, Fire Module).

2
3
4
5

Building
Height

Number of Stories Damaged by Flame

Below grade

1
2
3
4
U

Detector Effectiveness
Required if detector operated.

Alerted occupants, occupants responded
Alerted occupants, occupants failed
to respond
There were no occupants
Failed to alert occupants
Undetermined
Detector Failure Reason
Required if detector failed to operate

1
2
3
4
5
6
0
U

Power failure, shutoff, or disconnect
Improper installation or placement
Defective
Lack of maintenance, includes
not cleaning
Battery missing or disconnected
Battery discharged or dead
Other
Undetermined

Operation of Automatic
Extinguishing System

Required if fire was within designed range

Operated/effective (go to M4)
Operated/not effective (go to M4)
Fire too small to activate
Failed to operate (go to M5)
Other
Undetermined

1
2
3
4
0
U

Number of Sprinkler
Heads Operating

Required if system operated

Required only if item
contributing code is 00 or <70.

Reason for Automatic
Extinguishing System Failure

Required if system failed or not effective

1
2
3
4
5
6
7
8
0
U

System shut off
Not enough agent discharged
Agent discharged but did not
reach fire
Wrong type of system
Fire not in area protected
System components damaged
Lack of maintenance
Manual intervention
Other
Undetermined

Number of sprinkler heads operating
NFIRS–3

10-17

Revision 01/01/06

NFIRS 5.0 Self-Study Program
MM

A
FDID

Apparatus or
Resources

Incident Date

State

Station

Dates and Times

ID
Type

Personnel
ID

Year

Sent
X

Hour/Min

Exposure

Number
of
People

Sent

Name

Rank or
Grade

Attend
X

Action
Taken

Sent

Dispatch
Arrival

Rank or
Grade

Attend
X

Action
Taken

Sent

Dispatch
Arrival

Rank or
Grade

Attend
X

Personnel

Apparatus Use

Actions Taken

Check ONE box for each
apparatus to indicate its main
use at the incident.

List up to 4 actions for
each apparatus and
each personnel.

Action
Taken

NFIRS–10

10-18

Action
Taken

Suppression
EMS
Other

Clear
Name

NFIRS–10

Change

Suppression
EMS
Other

Clear
Name

Delete

Suppression
EMS
Other

Clear

Personnel
ID

Midnight is 0000

Dispatch
Arrival

Personnel
ID

Incident Number

Check if same date as Alarm date on
the Basic Module (Block E1)
Month Day

YYYY

Action
Taken

Revision 01/01/04

NFIRS 5.0 Self-Study Program

Personnel Module Test
1. The Personnel Module

(a) is required when a firefighter is injured.

(b) cannot be used in place of the Apparatus or Resources Module.

(d) can be used for non-fire service personnel.

2. The Personnel Module uses the following to record the duties performed at the incident by the
individual responder:

(a) Personnel Action Taken.

(b) Apparatus Action Taken.

(d) Apparatus or Resources Type.

3. The Personnel Module uses the following to record the duties performed by specific apparatus
or resources at the incident:

(a) Personnel Action Taken.

(b) Apparatus Action Taken.

(d) Apparatus or Resources Type.

4. The Personnel Module uses the following to identify personnel on specific pieces of apparatus:

(a) Personnel Action Taken.

(b) Personnel Identification.

(d) Attend.

5. Provide basic life support and provide air supply are examples of which data element?

(a) Apparatus Use.

(b) Apparatus Action Taken.

(d) Apparatus Type.

10-19

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