HomeMy WebLinkAbout1 Grand_RedactedNFIRS-1 Basic
40060 CA 06 14 2019 Fire Station
2 (FS2)
19-03025 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
CP BLDG 170 A CERRO VISTA CERRO MORRO
Number Prefix Street or Highway Street Type Suffix
Cal Poly CA 93407
Apt./Suite/Room City State Zip Code
Cross Street
Incident Type
131-Passenger vehicle 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
California
Their FDID Their
State
Their Incident Number
Dates and Times
Alarm 06 14 2019 17:20
Arrival 06 14 2019 17:26
Controlled 06 14 2019 17:30
Last Unit
Cleared
06 14 2019 18:17
Shifts and Alarms
A NA
Shift or
Platoon
Alarms District
Special Studies
ID#Value
A
B
C
D
E1 E2
E3
Page 1 of 8
Actions Taken
10-Fire control or extinguishment, other
Primary Action Taken
Resources
Apparatus or Personnel Module is used.
Apparatus Personnel
Suppression 2 4
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:$ 15,000.00
Contents:$ 100.00
Pre-Incident Values: Optional None
Property:$ 15,000.00
Contents:$ 100.00
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 8
Remarks:
Truck 2 arrived at reported location to find a fully involved midsize SUV perpendicular to the roadway. Truck 2 pulled 100'
preconnect and fully extinguished fire. Truck 2 assisted in full cleanup and debris removal of the area. Cal Poly PD called for
tow. Per , vehicle driver and owner, the vehicle began smoking from the engine compartment as he was making
the turn. He parked the vehicle and turned off the engine. The vehicle then became fully involved. Scene turned over to Cal
Poly PD without incident.
Driver's Contact Info:
Authorization
40667 Gutierrez, Armando Fire Captain 06/15/2019
Officer In Charge ID Signature Position or Rank Assignment Date
40667 Gutierrez, Armando Fire Captain 06/15/2019
Member Making Report
ID
Signature Position or Rank Assignment Date
L
M
Page 3 of 8
NFIRS-2 Fire
40060 CA 06 14 2019 Fire Station
2 (FS2)
19-03025 0
FDID State Month Day Year Station Number Exposure
Property Details
B1 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
83-Engine area, running gear,
wheel area
Area of Fire Origin
D2 Undetermined
Heat Source
D3 Undetermined
Item First Ignited
D4
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
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
None
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 8
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
10-Passenger or road vehicles, other
Mobile Property Type
HY-Hyundai
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 8
NFIRS-9 Apparatus or Resources
40060 CA 06 14 2019 Fire Station
2 (FS2)
19-03025 0
FDID State Month Day Year Station Number Exposure
B
Apparatus/Resource Dates/Times Sent
Number
of People Apparatus Use Actions Taken
ID:BC3
Type:92-Chief officer car
Dispatch:
Arrival:06/14/2019 17:53
Clear:
Sent 1 Suppression
EMS
Other
ID:T2
Type:12-Truck or aerial
Dispatch:06/14/2019 17:20
Arrival:06/14/2019 17:26
Clear:06/14/2019 18:17
Sent 3 Suppression
EMS
Other
A
Page 6 of 8
NFIRS-10 Personnel
40060 CA 06 14 2019 Fire Station
2 (FS2)
19-03025 0
FDID State Month Day Year Station Number Exposure
B
Apparatus/Resource Dates/Times Sent
Number
of People Apparatus Use Actions Taken
ID:BC3
Type:92-Chief officer car
Dispatch:
Arrival:06/14/2019 17:53
Clear:
Sent 1 Suppression
EMS
Other
Personnel ID Name Rank Role Attend Actions Taken
Bisson, Bob Battalion
Chief
ID:T2
Type:12-Truck or aerial
Dispatch:06/14/2019 17:20
Arrival:06/14/2019 17:26
Clear:06/14/2019 18:17
Sent 3 Suppression
EMS
Other
Personnel ID Name Rank Role Attend Actions Taken
40667 Gutierrez, Armando Captain
52001 Joy, Cullen Firefighter
60045 Lokkart, Eric Engineer
A
Page 7 of 8
NFIRS-1S Supplemental
40060 CA 06 14 2019 Fire Station
2 (FS2)
19-03025 0
FDID State Month Day Year Station Number Exposure
Primary Narrative:
Truck 2 arrived at reported location to find a fully involved midsize SUV perpendicular to the roadway. Truck 2 pulled 100'
preconnect and fully extinguished fire. Truck 2 assisted in full cleanup and debris removal of the area. Cal Poly PD called for
tow. Per , vehicle driver and owner, the vehicle began smoking from the engine compartment as he was making
the turn. He parked the vehicle and turned off the engine. The vehicle then became fully involved. Scene turned over to Cal
Poly PD without incident.
Driver's Contact Info:
A
Page 8 of 8