Incident Zip Code:
Incident Alarm Time:
Were you asleep at alarm time?
How long were you at the incident?
Fire Stage at Arrival:
Smoke Density at Arrival:
Smoke Color at Arrival:
Was rehabilitation performed?
Was ALL your gear separated from you during rehabilitation?
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?
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?
No symptoms listed