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EMERGENCY RESPONSE RECORD

Call # Date (yy-mm-dd) Day of Week Response Type Property Type Page Of Supplemental
Fire Department Response Information
(Optional)
Address of Incident:  
Call Reported As (Specifics):  
Time Call Received by 9-1-1:   Name of Fire Department:
Time Dispatcher Notified:   Name of FD Official:                                                                                            Signature of FD Official:
Vehicle  & Staff Responding #FFs on Apparatus Time Dispatched Time Acknowledged Time Apparatus/ Personnel Enroute Time Apparatus/ Personnel on Scene Response Time Accumulated total # FFs on Scene Response Impact Factors
(Positive or Negative)
       
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
Notes   Total # Responding Personnel of Local FD The four columns above have been added for fire department use. Such use is not a required part of the optimization process, but may be useful in recording information such as: 
  • incident command established
  • entry control established
  • application of extinguishing agent
  • time leaving scene
  • time back at station
  • etc.
  Time Taken for 4 FFs to Arrive on Scene
  Time Taken for 10 FFs to Arrive on Scene
  # FFs on Scene from Automatic Aid
  # FFs on Scene from Mutual Aid
  Response Time of 1st FD Apparatus on Scene
  Total Time Taken to Dispatch
PFSG-04-08A-03: 1A  2005-02-02