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Home My WebLink About19-04519_RedactedNFIRS-1 Basic 40060 CA 09 10 2019 Fire Station 2 (FS2) 19-04519 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 1239 FOOTHILL # 102 Number Prefix Street or Highway Street Type Suffix San Luis Obispo CA 93401 Apt./Suite/Room City State Zip Code Cross Street Incident Type 113-Cooking fire, confined to container 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 09 10 2019 19:51 Arrival 09 10 2019 19:55 Controlled 09 10 2019 19:56 Last Unit Cleared 09 10 2019 20:29 Shifts and Alarms C 1 FZ2 Shift or Platoon Alarms District Special Studies ID#Value A B C D E1 E2 E3 Page 1 of 11 Actions Taken 12-Salvage & overhaul Primary Action Taken Resources Apparatus or Personnel Module is used. Apparatus Personnel Suppression 3 7 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:$ 0 Contents:$ 500.00 Pre-Incident Values: Optional None Property:$ 0 Contents:$ 500.00 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. Person/Entity Involved Occupant 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 K1 Page 2 of 11 Owner Owner Local Option Person/Entity Type Business Name (if applicable)Phone Number MR-Mr. 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 Remarks: T2 arrived on scene to find occupant out front of a two-story multi family dwelling with light smoke coming from doorway of apt 102, and light smoke throughout first floor of apt. Upon further investigation the smoke was coming from oven in kitchen, no visible flame, nothing in main compartment of oven, trays and burnt unidentifiable material in the bottom broiler drawer of oven, Trays and burnt unidentifiable material were removed and overhauled, oven was disconnected and removed from apartment, T2 personnel used thermal imaging camera to check for extension in area near oven. E3 personnel removed smoke from 1st and 2nd floor of apartment. Occupants stated they were preheating oven when they noticed smoke coming from oven, occupants used fire extinguisher and called 911, then exited apartment. Property was released back to occupants, and notifications were made to property management and property owner. Through phone conversation with property owner, owner stated one of the occupants admitted to placing trays and liners in bottom drawer of oven sometime prior to incident. sms Authorization 80947 Skove, Shayne Fire Captain 09/12/2019 Officer In Charge ID Signature Position or Rank Assignment Date 80947 Skove, Shayne Fire Captain 09/12/2019 Member Making Report ID Signature Position or Rank Assignment Date K2 L M Page 3 of 11 NFIRS-2 Fire 40060 CA 09 10 2019 Fire Station 2 (FS2) 19-04519 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 Area of Fire Origin D2 Heat Source D3 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 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 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 Number of Stories At/Above Grade Number of Stories Below Grade Main Floor Size Total Square Feet OR BY Length (ft) X Width (ft) Fire Origin 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 09 10 2019 Fire Station 2 (FS2) 19-04519 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:09/10/2019 19:51 Arrival:09/10/2019 19:55 Clear:09/10/2019 20:09 Sent 1 Suppression EMS Other 81-Incident command ID:E3 Type:11-Engine Dispatch:09/10/2019 19:51 Arrival:09/10/2019 19:55 Clear:09/10/2019 20:27 Sent 3 Suppression EMS Other 12-Salvage & overhaul ID:T2 Type:12-Truck or aerial Dispatch:09/10/2019 19:51 Arrival:09/10/2019 19:55 Clear:09/10/2019 20:29 Sent 3 Suppression EMS Other 12-Salvage & overhaul A Page 8 of 11 NFIRS-10 Personnel 40060 CA 09 10 2019 Fire Station 2 (FS2) 19-04519 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:09/10/2019 19:51 Arrival:09/10/2019 19:55 Clear:09/10/2019 20:09 Sent 1 Suppression EMS Other 81-Incident command Personnel ID Name Rank Role Attend Actions Taken 16750 Berryman, Neal Battalion Chief ID:E3 Type:11-Engine Dispatch:09/10/2019 19:51 Arrival:09/10/2019 19:55 Clear:09/10/2019 20:27 Sent 3 Suppression EMS Other 12-Salvage & overhaul Personnel ID Name Rank Role Attend Actions Taken 25944 Child, Robert Engineer 61000 Marshall, David Captain 90841 Weis, Trevor Firefighter ID:T2 Type:12-Truck or aerial Dispatch:09/10/2019 19:51 Arrival:09/10/2019 19:55 Clear:09/10/2019 20:29 Sent 3 Suppression EMS Other 12-Salvage & overhaul Personnel ID Name Rank Role Attend Actions Taken 70995 Pratt, Jason Engineer 80947 Skove, Shayne Captain 30791 Doolin, Luke Firefighter A Page 9 of 11 NFIRS-1S Supplemental 40060 CA 09 10 2019 Fire Station 2 (FS2) 19-04519 0 FDID State Month Day Year Station Number Exposure Primary Narrative: T2 arrived on scene to find occupant out front of a two-story multi family dwelling with light smoke coming from doorway of apt 102, and light smoke throughout first floor of apt. Upon further investigation the smoke was coming from oven in kitchen, no visible flame, nothing in main compartment of oven, trays and burnt unidentifiable material in the bottom broiler drawer of oven, Trays and burnt unidentifiable material were removed and overhauled, oven was disconnected and removed from apartment, T2 personnel used thermal imaging camera to check for extension in area near oven. E3 personnel removed smoke from 1st and 2nd floor of apartment. Occupants stated they were preheating oven when they noticed smoke coming from oven, occupants used fire extinguisher and called 911, then exited apartment. Property was released back to occupants, and notifications were made to property management and property owner. Through phone conversation with property owner, owner stated one of the occupants admitted to placing trays and liners in bottom drawer of oven sometime prior to incident. sms Person/Entity Involved Occupant 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 Person/Entity Involved Occupant 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 A Page 10 of 11 Person/Entity Involved Property Manager 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 Page 11 of 11