Form Center

2. Fire Report Request
4. Once submitted, reports will be emailed within two business days.

   If there are additional questions or comments, or if the request cannot be completed you will be contacted at the contact information provided. 

6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Date of Request
    Date of Request

    Date of Request
18. E-Mail Address*
19. Preferred Method of Contact
    -- Select One --PhoneE-Mail
23. Address of Incident:*
25. City*
26. State*
27. Zip*
29. Date and Time of Incident*
    Date and Time of Incident

    Date and Time of Incident

    Please include the exact date and estimated time of the incident. 

31. Relationship to Incident:*

    Fire Reports will only be issued to authorized individuals.

    1. Homeowner
    2. Resident
    3. Property Manager/Landlord
    4. Business Owner
    5. Authorized Insurance Company Representative
32. Type of Incident:*

    1. Structure Fire (Residential)
    2. Structure Fire (Commercial
    3. Fire Alarm
    4. Fire, Other (Vehicle Fire, Outside Fire, etc.)
    5. Other Response Report (Not including EMS reports)
34. EMS Report Request

    Federal and State law provide privacy protection for patients. EMS reports will not be provided unless the proper documentation (E.g., court order or subpoena) is submitted. 

36. Additional Comments/Information
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field