Review PER #169 for Submission


Incident Information

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 Incident Type: 

Incident Information

Update

Incident #

Incident Type:

Fire

Incident Date:

Incident Zip Code:

Incident Alarm Time:

Were you asleep at alarm time?

How long were you at the incident?

Unit #:

Incident Detail

Update

Fire Type:

Brush/Wildland Fire

Fire Stage at Arrival:

Smoke Density at Arrival:

Smoke Color at Arrival:

Activities Performed:

Fire Scale:

Extinguishment Means:

Rehabilitation

Update

Was rehabilitation performed?

Yes

Pulse:

Blood Pressure:

Temperature:

SaO2%:

Was ALL your gear separated from you during rehabilitation?

Personal Protective Equipment

Update

Where was your gear stored between shifts?

What type of personal protective equipment did you wear at this incident?

Did you wear full personal protective equipment (skin and respiratory protection) for all overhaul activities?

Decontamination

Update

Was your gear decontaminated prior to incident response?

Decontamination on Scene, Rinsed:

Decontamination on Scene, Replaced:

Was your contaminated gear separated from you during Post Incident Analysis?

Was your contaminated gear separated from you on returning to the station (not in the cab)?

Decontamination at Station, Rinsed:

Decontamination at Station, Replaced:

How long after clearing the incident did you shower?

Medical Symptoms

Update

No symptoms listed