Introduction to NFIRS Distance Learning (Training)

National Fire Incident Reporting System (NFIRS) Version 5.0

NFIRS Module 7 - Hazmat

Introduction to NFIRS Distance Learning (Training)

OMB: 1660-0069

Document [pdf]

Download: pdf | pdf

NFIRS 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

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

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

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

Released Into

Released into

Enter Code

HazMat Actions Taken

NFIRS 5.0 Self-Study Program
MM

A
FDID

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

Units: Capacity

Check one box

Units: Released

Check one box

Gas

U
Undetermined
• UN Number (United
Nations Standards
for the Identification
of Hazardous
Materials);
VOLUME
WEIGHT
VOLUME
WEIGHT
More hazardous
materials? Use
additional sheets.

Ounces

Barrels: 42 gal. 23

Cubic feet
Cubic meters

Ounces

Grams

Barrels: 42 gal. 23

Ounces

• DOT Hazard Classification
(Department
of Transportation
12
Gallons
22
Pounds
Gallons Classification);
Pounds
12
22

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.

Released From

Area Affected

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

Division 1.1 Explosives with mass explosion hazard

Division 5.1 Oxidizers

Division 1.2 Explosives with projectile hazard

Division 5.2 Organic peroxides

Division 1.3 Explosives with predominant fire hazard

Class 6 – Toxic material and Infectious Substances

Division 1.4 Explosives with no significant blast

Division 6.1 Toxic materials

Division 1.5 Very insensitive explosives; blasting

Division 6.2 Infectious substances

Division 1.6 Extremely insensitive detonating articles

Class 2 – Gases
21

Division 2.1 Flammable gases

Division 2.2 Non-flammable

Division 2.3 Gases toxic by inhalation

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

Division 4.2 Spontaneously combustible materials

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)

Division 9.2 Environmentally hazardous substances
(Canada)

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

Container
Type

None

Estimated Container Capacity

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

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

Classification

Released From

Container
Type

None

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.

C3
11
12
13
14
15
16

F2
1
2
3

Released From
Check all applicable boxes

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

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

None

Incident Number

Estimated Container Capacity

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

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

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

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

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

CAS Registration Number

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

Undetermined

Section E: Physical State
Factors Contributing to Release
Factors Affecting Mitigation
When ReleasedL and Released Into

Enter measurement
Incident Number

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

3. Ground

FDID

4. Water and ground

YYYY

Incident Date

State

Station

Incident Number

HazMat ID

DOT Hazard
Classification

UN Number

5. Air and ground
Container
Type

6. Water and air

None

Chemical
Name

CAS Registration Number

Estimated Container Capacity

7. Air, water, and ground

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

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

YYYY

Complete the remainder
of thisDate
form only for the
Incident
first hazardous material
involved in this incident.

Population Density

Area Evacuated

1
Urban
Section F: Released From and Population
Density
1
2
Suburban
FDID

State

Station

HazMat ID
UN Number

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

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

Area Affected

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?

Released From
Check all applicable boxes

M1
G

Equipment
Involved
Area Affected
in Release

Mobile Property
Involved
in (2)
Additional
action taken
Estimated
Number of
None
N
People Evacuated
Release

None

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

Outside of structure

Cause of Release

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

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

Name

CAS Registration Number

C2 Estimated Container Capacity
NFIRS 5.0 Self-Study, Program ,

None

Units: Capacity

Capacity: by volume or weight
Container Type

Estimated Amount Released

Amount released: by volume or weight

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

Cubic meters

Physical S
E1 When
Rele
1
2
3
U

Solid
Liquid
Gas
Undeterm

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

HazMat ID

Released From

DOT Hazard
CAS Registration Number
Check all applicable boxes
Classification

UN Number

Rural

Below grade
1
Estimated Container Capacity 2
1
Inside/on structure
3

Area

Chemical
Name
Affected

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

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

Revision 01/01/06

w/fire service present
Released to local agency

Injuries

NFIRS
Revisio

Units: Released

Check one box

Solid
Liquid
Gas
Undetermined

Section H: HazMat Actions Taken

DOT Hazard
CAS Registration Number
Classification
Population Density

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

Check one box

None

HazMat Actions Taken

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

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

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)

Units: Capacity

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

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

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

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

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

Additional action taken

Estimated Number of
Buildings Evacuated
None

Factors Contributing to Release

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

HazMat

Comple
Comple
Release
Release
Release
Release
Release
Release
manage
HazMat C

Deaths

2
Incident Date

State

Station

Released From

None

der
he
al
nt.

1
Inside/on structure
Estimated Container
Capacity

2
Capacity: by volume or weight

Units: Capacity

ase

Population Density

Blocks
2
Square
miles
Estimated
Amount
Released
3

Urban
Suburban
Rural

Additional action taken (3)

None

measurement
AmountEnter
released:
by volume or weight

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?

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

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

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

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)

Inside/on structure

Story of release
Factor or impediment (3)

Factor contributing to release (3)

Area Affected

1
2
3

Enter up to three action

1
2
3

Deaths
Square feet

Blocks

NFIRS–7

Revision 01/01/06
Enter
Primary action taken (1)
measurement

Estimated Number of
People Evacuated

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

Deaths

Equipment Involved
in Release

Equipment involved in release

Brand

Factor or impediment (3)

Injuries
NFIRS–7
Revision 01/01/06

None

Mobile Property Involved in

None

Release

1
2
3
4
5
6
7
8

Mobile property type

Mobile property make

Model
Model

Year

Serial #
License plate number
Year
DOT number/ ICC number

7-12

State

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

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

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)

Equipment Involved
in Release

Equipment involved in release

Brand

None

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

Year

Serial #
License plate number

State

Year

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

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)

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

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

I 23

Square miles

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

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

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

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

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

Blocks
Square miles

Blocks

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

Equipment Involved
in Release

Equipment involved in release

Brand

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

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

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)

Factors Affecting Mitigation

Factor contributing to release (1)

None

1
Released into

HazMat Actions Taken

Other part
failure/Leak

Released Into

Additional action taken (2)

Enter up to three contributing factors

Enter Code

None

Factors Contributing to Release

Solid
Liquid
Gas
Undetermined

Primary action taken (1)

Estimated Number of
Buildings Evacuated

0 , 002

Enter measurement

0 , 003
Enter
measurement

1
2
3
U

WEIGHT
Ounces
Pounds
Grams
Kilograms
MICRO UNITS

21
22
23
24

000 , 550

Square feet

None

Estimated Number of
People Evacuated

Area Affected

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

NFIRS–7

Chlorine

000 , 000 , 100

VOLUME
Ounces
Gallons
Barrels: 42 gal.
Liters
Cubic feet
Cubic meters

Change

Estimated Amount Released

Check one box

Delete

Haz No.

Capacity: by volume or weight

Units: Capacity

Exposure

Chemical
Name

Estimated Container Capacity

000

Incident Number

CAS Registration Number

Released From

001

YYYY

2002

Station

DOT Hazard
Classification

UN Number

Incident Date

State

HazMat ID

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

YYYY

Delete

Incident Date

State

Station

Incident Number

HazMat ID

DOT Hazard
Classification

UN Number

Container
Type

None

Estimated Container Capacity

More hazardous
materials? Use
additional sheets.

Complete the remainder
of this form only for the
first hazardous material
involved in this incident.

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

Inside/on structure
Story of release

Outside of structure

Area Affected

1
2
3

WEIGHT
Ounces
Pounds
Grams
Kilograms

Area Evacuated

Blocks

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

None

Enter measurement

Factors Contributing to Release

Enter up to three contributing factors

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

Factors Affecting Mitigation

Factor contributing to release (2)

Model

Released into

HazMat Actions Taken

Factor or impediment (1)

Released Into

Enter Code

Factor contributing to release (1)

None

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

Check one box

1
2
3
U

Square feet

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

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

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

Inside/on structure
Story of release

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

Urban
Suburban
Rural

G1
1
2
3

WEIGHT
Ounces
Pounds
Grams
Kilograms

Blocks

X Square miles

Blocks

1
2
3
4
5
U

Intentional
Unintentional release
Container/containment failure
Act of nature
Cause under investigation
Cause undetermined after
investigation

200

Equipment Involved
in Release

Collision

Model

Isolate & establish

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

Release on major Hwy

Water table

Factor contributing to release (3)

Factor or impediment (3)

Undetermined

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

Factor contributing to release (1)

Released Into

Additional action taken (2)

Enter up to three contributing factors

Solid
Liquid
Gas
Undetermined

Primary action taken (1)

None

Factors Contributing to Release

Enter Code

Estimated Number of
Buildings Evacuated

Enter measurement

0 , 009
Enter
measurement

1
2
3
U

WEIGHT
Ounces
Pounds
Grams
Kilograms
MICRO UNITS

21
22
23
24

000 , 096

X Square miles
0 , 001

Cause of Release

None

Estimated Number of
People Evacuated

Square feet

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

11
12
13
14
MICRO UNITS 15
Enter Code 16

Population Density

Acrolein

000 , 006 , 000
Check one box

HazMat

Change

Estimated Amount Released

NFIRS–7

Delete

Haz No.

Capacity: by volume or weight

Units: Capacity

Exposure

Chemical
Name

Estimated Container Capacity

000

Incident Number

CAS Registration Number

Released From

001
Station

DOT Hazard
Classification

42
Container Type

YYYY

1998

1 0 9 2

Container
Type

Incident Date

UN Number

State

HazMat ID

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

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

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

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

Local Option

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

Business Name (if applicable)

Mr., Ms., Mrs.

First Name

Number

Prefix

Post Office Box

State

Area Code

Phone Number

Last Name

Suffix

Street or Highway

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

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

Owner

Local Option

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

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

Mr., Ms., Mrs.

Business Name (if applicable)

First Name

Number

Prefix

Post Office Box

State

Area Code

Phone Number

Last Name

Suffix

Street or Highway

Street Type

Apt./Suite/Room

Suffix

City

ZIP Code

Remarks:

Local Option

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

7-23

NFIRS 5.0 Self-Study Program
MM

A
FDID

YYYY

Delete

Incident Date

State

Station

Incident Number

HazMat ID

DOT Hazard
Classification

UN Number

Container
Type

None

Estimated Container Capacity

More hazardous
materials? Use
additional sheets.

Complete the remainder
of this form only for the
first hazardous material
involved in this incident.

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

Inside/on structure
Story of release

Outside of structure

Area Affected

1
2
3

WEIGHT
Ounces
Pounds
Grams
Kilograms

Area Evacuated

Blocks

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

Estimated Number of
Buildings Evacuated
None

Factors Contributing to Release

Enter up to three contributing factors

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

Factors Affecting Mitigation

Factor contributing to release (2)

Model

Released into

HazMat Actions Taken

Factor or impediment (1)

Released Into

Enter Code

Factor contributing to release (1)

None

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

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

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

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