Fire Incident Report

Demographics and Contact Information
This fire tracking report is intended for cold (not active) fires only. If you are experiencing an active fire, call 911.
I am a*
Name*
First Last
Date of Birth*
Month
Day
Year
Race*
Ethnicity*
Gender*
Phone*
CSU ID#
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Incident Details
Where did the fire occur?*
Type in name or physical address. If fire occurred off-campus, you must contact the agency responsible for the jurisdiction in which the fire occurred.
Choose One: This fire was*
- Accidental
- Intentional
- Unknown
Date Fire Occurred*
MM slash DD slash YYYY
Time Fire Occurred*

: Hours

Minutes

AM/PM
Date Fire Reported to CSU Fire & Life Safety
MM slash DD slash YYYY
Property Information
Was there any property damage?*
- Yes
- No
Describe damage and estimated cost to property
Additional Information
Add any additional information here.
Follow-Up
Officer may use this to contact you for any further information needed.
When is the best time to contact you?*
Preferred method of contact
- Email
- Phone
Signature*
First Last
By signing above, you agree that any form of electronic signature may substitute for the original signature and shall have the same legal effects as the original signature and that the report and information is true to the best of your knowledge.

Demographics and Contact Information