FIRE ORIGIN TYPE	COUNTY/CITY	MUTUAL AID
Virginia – Non-Federal	FALSE ALARM
Virginia – Federal Assist	Federal Agency:	LATITUDE (N)	Deg	Min	Sec
Other State	Neighbor State:	LONGITUDE (W)	Deg	Min	Sec
LOCATION
INCIDENT COMMANDER	INCIDENT NAME
TIME DOCUMENTATION	Time	Date	REPORTED BY
Fire Start Estimated Known	Dispatch	(name)
Fire Reported	Phone	(name)
Control Work Started	Aircraft	(name)
Fire Under Control	Other	(name)
Fire Out	Callback Ph. Number
ACRES BURNED	Total	FIRE WEATHER	Observation Date/Time
Forested Acres	Class Day	Temperature
Artificial Regen. Acres	Wind Direction	Relative Humidity
Non-Forested Acres	Wind Speed	CSI (optional)
Area Measured By
DAMAGED ESTIMATE	DESTROYED ESTIMATE	PROTECTED ESTIMATE
Timber	#	$	Homes	#	$	Homes	#	$
Homes	#	$	Buildings	#	$	Buildings	#	$
Buildings	#	$	Other	#	$	Other	#	$
Other	#	$
INVESTIGATION DETAILS	Supplement Sheet?
Incident Investigated By	Investigation Date
Investigation Results
FIRE CAUSE	Juveniles	Equipment Use	Miscellaneous
Lightning	Under age 12	Exhaust	Power Lines	Other
Campfires	Ages 12-17	Friction/Dragging	Fireworks
Smoking	Railroad	Fuel	Cutting/Welding/Grinding
Incendiary	Exhaust Carbon	Fluid Leaks	Firearms/Ammunition
Debris Burning	Brake Failure	Equip Malfunction	Spontaneous Heating
Prescribed Burn	Track Maintenance	Direct Heat Transfer	Electric Fences
Trash Burn	Flares	Other	Blasting
Other Burn	Warming Fires	Structure Fires
Debris Burning	Vehicle Fires
Other Malfunction	Woodstove Ashes
RESPONSIBLE PARTIES	Summons Issued?	Yes No
Name	Address	Phone	Driver License
INVESTIGATED PARTIES	K = Knowledgeable, L = Landowner
K / L	Name	Address
/
/
/
RAILROAD FIRE INFORMATION (if RR = Cause)	RR Company	Train Number
Milepost (Location)	Side of Track Fire Started	Direction Train Traveling
Person Notified at RR	Date/Time	By Whom
VDOF FULL-TIME PERSONNEL WAGES & MILEAGE EXPENSES:
Name	Date:	Date:	Date:	Date:
Hours	VDOF Miles	Personal Miles	Hours	VDOF Miles	Personal Miles	Hours	VDOF Miles	Personal Miles	Hours	VDOF Miles	Personal Miles
VDOF TRACTOR EXPENSES: (Note: where minimum applies, only enter minimum dollar amount, do not enter hours)
Hours DOF Tractor Use (min. chg.2hr)
Miles for DOF Tractor Transport Vehicle
PART-TIME PERSONNEL WAGES & MILEAGE EXPENSE:
Total Personal Miles (From Form 12 Part-time Fire Control Personnel Time & Mileage Report)
Total VDOF Miles (From Form 12 Part-time Fire Control Personnel Time & Mileage Report)
Total Hours (From Form 12 Part-time Fire Control Personnel Time & Mileage Report)
TOTAL AERIAL SUPPRESSION EXPENSES:
Hours Aerial Suppression	Heli Type 2	Heli Type 3	SEAT	Contractor:
TOTAL DOF SMALL EQUIPMENT EXPENSES: (Note: where minimum applies, only enter minimum dollar amount, do not enter hours)
Hours Small Equipment Use: Chainsaws, Fireline Blowers, Brushcutters (min. chg.1 hr)
VDOF ALL-TERRAIN VEHICLE / ENGINE EXPENSES: (Note: where minimum applies, only enter minimum dollar amount, do not enter hours)
Hours ATV Use (min. chg. 1hr)
Hours Engine Use (min. chg. 2 hr)
Miles for Engine Vehicle
OTHER EXPENSES:
Meals	Comments:	$
Lodging	Comments:	$
Supplies	Comments:	$
Cooperators (i.e. VDOT, USFS, etc.)	Comments:	$
Other (specify)	$
Other (specify)	$
PAYMENT:	Received	Send Bill	No Collectible Costs	No Cost (mutual aid/false alarm)
Deposit Certificate No.:	Receipt No.	Date of Deposit	Amount of Deposit
VOLUNTEER FIRE DEPARTMENTS RESPONDING:
Volunteer Fire Department Name	Number of Volunteers	Number of Hours