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Home My WebLink AboutKerry Incident Report_RedactedNFIRS-1 Basic 40060 CA 08 29 2023 Fire Station 4 (FS4) 23-05168 0 FDID State Month Day Year Station Number Exposure Location Type Census tract: Street Address Intersection In Front Of Rear Of Adjacent To Directions US National Grid 1036 KERRY Number Prefix Street or Highway Street Type Suffix San Luis Obispo CA 93401 Apt./Suite/Room City State Zip Code Cross Street Incident Type 111-Structure Fire Aid Given Or Received 1 Mutual Aid Received 2 Auto. Aid Received 3 Mutual Aid Given 4 Auto. Aid Given 5 Other Aid Given None Their FDID Their State Their Incident Number Dates and Times Alarm 08 29 2023 23:46 Arrival 08 29 2023 23:50 Controlled 08 29 2023 23:52 Last Unit Cleared 08 30 2023 00:24 Shifts and Alarms A 1 FZ4 Shift or Platoon Alarms District Special Studies 9244 3 - No, COVID 19 was not a factor ID#Value A B C D E1 E2 E3 Page 1 of 11 Actions Taken 81-Incident command Primary Action Taken 11-Extinguishment by fire service personnel Additional Action Taken Resources Apparatus or Personnel Module is used. Apparatus Personnel Suppression 5 14 EMS 0 0 Other 0 0 Resource counts include aid received resources. Estimated Dollar Losses and Values Losses:Required for all fires if known. Optional for all non-fires. None Property:$ 1,636.00 Contents:$ Pre-Incident Values: Optional None Property:$ 163,638.00 Contents:$ 19,852.00 Completed Modules 2 - Fire 3 - Structure Fire 4 - Civilian Fire Cas. 5 - Fire Service Cas. 6 - EMS 7 - HazMat 8 - Wildland Fire 9 - Apparatus 10 - Personnel 11 - Arson Casualties None Deaths Injuries Fire Service 0 0 Civilian 0 0 Detector Required for Confined Fires 1 - Detector Alerted Occupants 2 - Detector Did Not Alert Them 3 - Unknown Hazardous Materials Release 1 - Natural Gas 2 - Propane Gas 3 - Gasoline 4 - Kerosene 5 - Diesel Fuel / Fuel Oil 6 - Household Solvents 7 - Motor Oil 8 - Paint 0 - Other None Mixed Use Property Not Mixed 10 - Assembly Use 20 - Education Use 33 - Medical Use 40 - Residential Use 51 - Row Of Stores 53 - Enclosed Mall 58 - Business and Residential 59 - Office Use 60 - Industrial Use 63 - Military Use 65 - Farm Use 00 - Other Mixed Use Property Use None Structures 131 Church, Place of Worship 161 Restaurant or Cafeteria 162 Bar/Tavern or Nightclub 213 Elementary School, Kindegarten 215 High School, Junior High 241 College, Adult Education 311 Nursing Home 331 Hospital 341 Clinic, Clinic-Type Infirmary 342 Doctor/Dentist Office 361 Prison or Jail, Not Juvenile 419 1- or 2-Family Dwelling 429 MultiFamily Dwelling 439 Rooming/Boarding House 449 Commerical Hotel or Motel 459 Residential, Board and Care 464 Dormitory/Barracks 519 Food and Beverage Sales 539 Household Goods, Sales, Repairs 571 Gas or Service Station 579 Motor Vehicle/Boat Sales/Repairs 599 Business Office 615 Electric-Generating Plant 629 Laboratory/Science Laboratory 700 Manufacturing Plant 819 Livestock/Poultry Storage (Barn) 882 Non-Residential Parking Garage 891 Warehouse Outside 124 Playground or Park 655 Crops or Orchard 669 Forest (Timberland) 807 Outdoor Storage Area 919 Dump or Sanitary Landfill 931 Open Land or Field 936 Vacant Lot 938 Graded/Cared for Plot of Land 946 Lake, River, Stream 951 Railroad Right-of-Way 960 Other Street 961 Highway/Divided Highway 962 Residential Street/Driveway 981 Construction Site 984 Industrial Plant Yard Property Use: Description Look up and enter a Property Use code and description only if you have NOT checked a Property Use box. Owner Local Option Person/Entity Type Business Name (if applicable)Phone Number Mr., Ms., Mrs.First Name MI Last Name Suffix Number Prefix Street or Highway Street Type Suffix Post Office Box Apt./Suite/Room City State Zip Code F G1 G2 H1 H2 H3 I J K2 Page 2 of 11 Remarks: A first alarm was dispatched to given address for a report of structure fire with report of smoke and flames seen. E4 arrived at scene established command and found one patient standing outside residents with no fire or smoke seen. E4 made contact with resident and found all occupants were out of structure. E4 completed a 360 with negative findings then made entry into structure to find light smoke in bathroom and back room. One ceiling was smoldering and already been extinguished by resident. IC canceled the first alarm and remained on scene for overhaul. E4 applied water to smoldering bathroom fan then removed extinguished fan from ceiling and moved outside. Resident claimed she was lying in bed when she heard the smoke detector activation. She got out of bed, opened bathroom door to find smoke in bathroom and small flames on floor of bathroom. Resident then threw water on fames from bathroom sink then exited structure. Electrical panel was inspected to find one 15-amp breaker popped to the off position. On inspection of ceiling found it was found to have had a melted motor which was determined the area of origin. Electrical wires were melted and fire was contained to the ceiling fan structure. The immediate area around the ceiling fan was inspected for extension with negative finds. E4 removed smoke in structure utilizing an electric fan. Once smoke was removed a gas detector was used to ensure structure was safe for resident to re- enter. Water used by E4 was cleaned using... Full primary narrative can be found in NFIRS 1S - Supplemental Authorization 73250 Renner, David Fire Captain 08/30/2023 Officer In Charge ID Signature Position or Rank Assignment Date 73250 Renner, David Fire Captain 08/30/2023 Member Making Report ID Signature Position or Rank Assignment Date L M Page 3 of 11 NFIRS-2 Fire 40060 CA 08 29 2023 Fire Station 4 (FS4) 23-05168 0 FDID State Month Day Year Station Number Exposure Property Details B1 1 Not Residential Estimated number of residential living units in the building of origin whether or not all units became involved B2 Buildings Not Involved Number of buildings involved B3 None Less than 1 acre Acres burned (outside fires) On-Site Materials Or Products On-Site Materials Storage Use Ignition D1 25-Bathroom, checkroom, lavatory, locker room Area of Fire Origin D2 10-Heat from powered equipment, other Heat Source D3 25-Appliance housing or casing Item First Ignited D4 99-Multiple types of material Type of Material First Ignited Cause of Ignition 1 - Intentional 2 - Unintentional 3 - Failure of Equipment or Heat Source 4 - Act of Nature 5 - Cause Under Investigation U - Cause Undetermined After Investigation Factors Contributing to Ignition 30-Electrical failure, malfunction, other Factor Contributing to Ignition Human Factors Contributing to Ignition Check all applicable boxes None 1 - Asleep 2 - Possibly impaired by alcohol or drugs 3 - Unattended person 4 - Possibly Mentally Disabled 5 - Physically Disabled 6 - Multiple Persons Involved 7 - Age Was A Factor Estimated Age of Person Involved Male Female Equipment Involved In Ignition Equipment Involved Brand Model Serial # Year Equipment Power Source Equipment Power Source Equipment Portability 1 - Portable 2 - Stationary Portable equipment normally can be moved by one or two persons. Fire Suppression Factors A B C D E1 E2 E3 F1 F2 F3 G Page 4 of 11 Mobile Property Involved 1 - Not involved in ignition, but burned 2 - Involved in ignition, but did not burn 3 - Involved in ignition and burned None Mobile Property Type and Make Mobile Property Type Mobile Property Make Local Use Pre-Fire Plan Available Arson Report Attached Police Report Attached Coroner Report Attached Other Reports Attached Mobile Property Model Year State License Plate Number VIN _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ H1 H2 Page 5 of 11 NFIRS-3 Structure Fire Structure Type 1 - Enclosed Building 2 - Portable/Mobile Structure 3 - Open Structure 4 - Air-Supported Structure 5 - Tent 6 - Open Platform 7 - Underground Structure 8 - Connective Structure 0 - Other Building Status 1 - Under Construction 2 - In Normal Use 3 - Idle, Not Routinely Used 4 - Under Major Renovation 5 - Vacant and Secured 6 - Vacant and Unsecured 7 - Being Demolished 0 - Other U - Undetermined Building Height 1 Number of Stories At/Above Grade 0 Number of Stories Below Grade Main Floor Size 1536 Total Square Feet OR BY Length (ft) X Width (ft) Fire Origin 1 Below Grade Story of Fire Origin Fire Spread Confined to Object of Origin 2 - Confined to Room of Origin 3 - Confined to Floor of Origin 4 - Confined to Building of Origin 5 - Beyond Building of Origin Number of Stories Damaged By Flame Number of Stories w/Minor Damage (1-24%) Number of Stories w/Significant Damage (25-49%) Number of Stories w/Heavy Damage (50-74%) Number of Stories w/Extreme Damage (75-100%) *Count the roof as part of the highest story Type of Material Contributing Most to Flame Spread K1 Item Contributing Most to Flame Spread K2 Type of Material Contributing Most To Flame Spread Presence of Detectors N - None Present 1 - Present U - Undetermined Detector Type 1 - Smoke 2 - Heat 3 - Combination of Smoke and Heat 4 - Sprinkler, Water Flow Detection 5 - More Than One Type Present 0 - Other U - Undetermined Detector Power Supply 1 - Battery Only 2 - Hardwire Only 3 - Plug-In 4 - Hardwire With Battery 5 - Plug-In With Battery 6 - Mechanical 7 - Multiple Detectors & Power Supplies 0 - Other U - Undetermined Detector Operation 1 - Fire Too Small To Activate 2 - Operated 3 - Failed To Operate U - Undetermined Detector Effectiveness 1 - Alerted Occupants, Occupants Responded 2 - Alerted Occupants, Occupants Failed to Respond 3 - There Were No Occupants 4 - Failed to Alert Occupants U - Undetermined Detector Failure Reason 1 - Power Failure, Shutoff, or Disconnect 2 - Improper Installation or Placement 3 - Defective 4 - Lack of Maintenance, Dirty 5 - Battery Missing or Disconnected 6 - Battery Discharged or Dead 0 - Other U - Undetermined I1 I2 I3 I4 J1 J2 J3 K L1 L2 L3 L4 L5 L6 Page 6 of 11 Presence of Automatic Extinguishing System N - None Present 1 - Present 2 - Partial System Present U - Undetermined Type of Automatic Extinguishing System 1 - Wet-Pipe Sprinkler 2 - Dry-Pipe Sprinkler 3 - Other Sprinkler System 4 - Dry Chemical System 5 - Foam System 6 - Halogen-Type System 7 - Carbon Dioxide System 0 - Other U - Undetermined Required if fire was within designed range of AES Operation of Automatic Extinguishing System 1 - Operated/Effective 2 - Operated/Not Effective 3 - Fire Too Small To Activate 4 - Failed To Operate 0 - Other U - Undetermined Required if fire was within designed range Number of Sprinkler Heads Operating Required if system operated Reason for Automatic Extinguishing System Failure 1 - System Shut Off 2 - Not Enough Agent Discharged 3 - Agent Discharged But Did Not Reach Fire 4 - Wrong Type of System 5 - Fire Not In Area Protected 6 - System Components Damaged 7 - Lack of Maintenance 8 - Manual Intervention 0 - Other U - Undetermined Required if system failed or not effective M1 M2 M3 M4 M5 Page 7 of 11 NFIRS-9 Apparatus or Resources 40060 CA 08 29 2023 Fire Station 4 (FS4) 23-05168 0 FDID State Month Day Year Station Number Exposure B Apparatus/Resource Dates/Times Sent Number of People Apparatus Use Actions Taken ID:BC1 Type: 92-Chief officer car Dispatch:08/29/2023 23:46 Arrival: Clear: Sent 1 Suppression EMS Other 93-Cancelled en route ID:E3 Type:11-Engine Dispatch:08/29/2023 23:46 Arrival: Clear:08/29/2023 23:52 Sent 3 Suppression EMS Other 93-Cancelled en route ID:E4 Type:11-Engine Dispatch:08/29/2023 23:46 Arrival:08/29/2023 23:50 Clear:08/30/2023 00:24 Sent 3 Suppression EMS Other 81-Incident command 11-Extinguishment by fire service personnel ID:T1 Type:12-Truck or aerial Dispatch:08/29/2023 23:46 Arrival: Clear: Sent 4 Suppression EMS Other 93-Cancelled en route ID:T2 Type:12-Truck or aerial Dispatch:08/29/2023 23:46 Arrival: Clear:08/29/2023 23:53 Sent 3 Suppression EMS Other 93-Cancelled en route A Page 8 of 11 NFIRS-10 Personnel 40060 CA 08 29 2023 Fire Station 4 (FS4) 23-05168 0 FDID State Month Day Year Station Number Exposure A Page 9 of 11 B Apparatus/Resource Dates/Times Sent Number of People Apparatus Use Actions Taken ID:BC1 Type: 92-Chief officer car Dispatch:08/29/2023 23:46 Arrival: Clear: Sent 1 Suppression EMS Other 93-Cancelled en route Personnel ID Name Rank Role Attend Actions Taken 41550 Hais, Ray Battalion Chief ID:E3 Type:11-Engine Dispatch:08/29/2023 23:46 Arrival: Clear:08/29/2023 23:52 Sent 3 Suppression EMS Other 93-Cancelled en route Personnel ID Name Rank Role Attend Actions Taken 14845 Barrett, Richard Captain 74579 Robertson, Travis Engineer 99163 Martin, Ted Firefighter ID:E4 Type:11-Engine Dispatch:08/29/2023 23:46 Arrival:08/29/2023 23:50 Clear:08/30/2023 00:24 Sent 3 Suppression EMS Other 81-Incident command 11-Extinguishment by fire service personnel Personnel ID Name Rank Role Attend Actions Taken 100080 Davis, Jaden Firefighter 66265 Nason, William Engineer 73250 Renner, David Captain ID:T1 Type:12-Truck or aerial Dispatch:08/29/2023 23:46 Arrival: Clear: Sent 4 Suppression EMS Other 93-Cancelled en route Personnel ID Name Rank Role Attend Actions Taken 57382 Larsen, Patrick Engineer 70995 Pratt, Jason Captain 99186 McAninch, Scott Engineer 99552 Morrison, Keanu Firefighter ID:T2 Type:12-Truck or aerial Dispatch:08/29/2023 23:46 Arrival: Clear:08/29/2023 23:53 Sent 3 Suppression EMS Other 93-Cancelled en route Personnel ID Name Rank Role Attend Actions Taken 100070 Kaperonis, George Firefighter 52001 Joy, Cullen Engineer 70100 Polkow, Matthew Captain Page 10 of 11 NFIRS-1S Supplemental 40060 CA 08 29 2023 Fire Station 4 (FS4) 23-05168 0 FDID State Month Day Year Station Number Exposure Primary Narrative: A first alarm was dispatched to given address for a report of structure fire with report of smoke and flames seen. E4 arrived at scene established command and found one patient standing outside residents with no fire or smoke seen. E4 made contact with resident and found all occupants were out of structure. E4 completed a 360 with negative findings then made entry into structure to find light smoke in bathroom and back room. One ceiling was smoldering and already been extinguished by resident. IC canceled the first alarm and remained on scene for overhaul. E4 applied water to smoldering bathroom fan then removed extinguished fan from ceiling and moved outside. Resident claimed she was lying in bed when she heard the smoke detector activation. She got out of bed, opened bathroom door to find smoke in bathroom and small flames on floor of bathroom. Resident then threw water on fames from bathroom sink then exited structure. Electrical panel was inspected to find one 15-amp breaker popped to the off position. On inspection of ceiling found it was found to have had a melted motor which was determined the area of origin. Electrical wires were melted and fire was contained to the ceiling fan structure. The immediate area around the ceiling fan was inspected for extension with negative finds. E4 removed smoke in structure utilizing an electric fan. Once smoke was removed a gas detector was used to ensure structure was safe for resident to re- enter. Water used by E4 was cleaned using towels and all materials that had been damaged by fire was removed from structure. Resident claimed that she would be staying at hotel for the rest of the night. Resident informed to leave breaker off and contact repair company. E4 cleared scene and terminated command. E4 returned to station. Resident: A Page 11 of 11