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New Jersey Division of Fire Safety
Office of the State Fire Marshal - School Fire Report Form
Date of Incident:
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Alarm Time (24Hr):
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Municipality:
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County:
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Zip Code:
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Incident Address:
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School Name: (Indicate name and type of school)
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Incident Type: (Description)
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Cause of Fire:
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Item First Ignited:
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Number of Injuries - Civilian:
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Number of Injuries - Firefighter:
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Property Value
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Property Loss:
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Contents Value:
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Contents Loss:
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Juvenile(s) Involved:
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Yes
No
Gender:
Female
Male
Age:
Gender:
Female
Male
Age:
Gender:
Female
Male
Age:
Gender:
Female
Male
Age:
Gender:
Female
Male
Age:
Gender:
Female
Male
Age:
Was School Evacuated: (Please circle one)
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Yes
No
Was fire department notifed: (Please circle one)
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Yes
No
Fire Department Name:
FDID:
County:
Fire Official/Contact Person:
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Reporting Agency:
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Phone:
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Narrative/Remarks:
Please enter e-mail address below; a copy of this form will be sent after you have submitted the report.
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