Structure Fire Module: NFIRS-3

NFIRS 5.0 Self-Study Program Structure Fire Module: NFIRS-3

Objectives

After completing the Structure Fire Module the student will be able to: 1. Describe when the Structure Fire Module is to be used. 2. Demonstrate how to correctly complete various sections of the Structure Fire Module, given scenarios of hypothetical incidents.

3-1 Table of Contents

Pretest #3 - Structure Fire Module...... 3-3 Using the Structure Fire Module ...... 3-4 Section I: Structure Type, Building Status, Building Height, Main Floor Size ...... 3-4 Section J: Fire Origin, Fire Spread, Number of Stories Damaged by Flame...... 3-6 Section K: Material Contributing Most to Flame Spread...... 3-7 Section L: Presence of Detectors, Detector Type, Detector Power Supply, Detector Operation, Detector Effectiveness, Detector Failure Reason...... 3-8 Section M: Presence of Automatic Extinguishing System, Type of Automatic Extinguishing System, Operation of Automatic Extinguishing System, Number of Sprinkler Heads Operating, Reason for Automatic Extinguishing System Failure...... 3-10 SUMMARY ...... 3-11 EXAMPLE: Residential Fire...... 3-12 EXERCISE SCENARIO 3-1: Warehouse Fire...... 3-14 EXERCISE SCENARIO 3-2: Cary Street Fire...... 3-17 NFIRS 5.0 Self-Study Program

Pretest #3 - Structure Fire Module

1. All structures are buildings. (a) True. (b) False.

2. A Structure Fire Module is required to be completed for a hostile fire confined to a chimney. (a) True. (b) False.

3. The Structure Fire Module is a required NFIRS module if the fire occurs in or on a structure. (a) True. (b) False.

4. All buildings are structures. (a) True. (b) False.

5. A Structure Fire Module should be completed for all building fires that extend beyond a noncombustible container. (a) True. (b) False.

3-3 NFIRS 5.0 Self-Study Program

Using the Structure Fire Module

he Structure Fire Module furnishes information regarding the buildings involved in the fire, Thow the fire started, and detection and suppression equipment present. The Structure Fire Module (NFIRS-3) should be completed for all structure fires that extend beyond a noncombustible container. A structure is an assembly of materials forming a construction for occupancy or use to serve a specific purpose. This includes, but is not limited to, buildings, open platforms, bridges, roof assemblies over open storage or process areas, tents, air-supported structures, and grandstands. Like the other modules, the Structure Fire Module is divided into sections and further subdivided into blocks. The sections and blocks ask for information on different factors or items involved in the building fire.

Section I: Structure Type, Building Status, Building Height, Main Floor Size

Structure Type Building Status Building Main Floor Size I1 I2 I3 I4 NFIRS–3 If fire was in an enclosed building or a Height Structure portable/mobile structure, complete the Count the roof as part of the rest of this form. Fire 1 Under construction highest story. 1 Enclosed building 2 Occupied & operating 2 Portable/mobile structure , , 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open structure 4 Under major renovation above grade 4 Air-supported structure 5 Vacant and secured OR 5 Tent 6 Vacant and unsecured 6 Open platform (e.g., piers) 7 Being demolished BY 7 Underground structure (work areas) Total number of stories , , 0 Other below grade Length in feet Width in feet 8 Connective structure (e.g., fences) U Undetermined 0 Other type of structure

Block I1 records information regardingFire the Origin type of structure. If the fireNumber is in of an Stories enclosed Damaged building, by Flame Type of Material Contributing Most J1 J3 K complete this entire module. The rest of the module would not be completedCount the roof if as thepart of structure the highest story. is to Flame Spread Below grade Number of stories w/minor damage Check if no flame spread OR if Story of Skip to (1 to 24% flame damage) same as Material First Ignited (Block D4, • an open structure - such as a bridge;fire origin Fire Module) OR if unable to determine. Section L • an air-supported structure; Number of stories w/significant damage Fire Spread (25 to 49% flame damage) K1 J2 If fire spread was confined to object of origin, Item contributing most to flame spread • a tent; do not check a box (Ref. Block D3, Fire Module). Number of stories w/heavy damage (50 to 74% flame damage) 2 Confined to room of origin • an open platform - such as a pier, dock; 2 3 Confined to floor of origin K Number of stories w/extreme damage Type of material contributing Required only if item • a connective structure - such4 Confined as a fence to orbuilding pipeline; of origin and/or (75 to 100% flame damage) most to flame spread contributing code is 00 or <70. 5 Beyond building of origin • an underground structure - such as flood tunnel. Presence of Detectors Detector Power Supply Detector Effectiveness L1 L3 L5 Required if detector operated. Complete the Structure Fire Module for (Inenclosed area of the buildings.fire) Examples include residential buildings, commercial buildings, subway station, or similar structures. It also must1 be completedBattery only for portable/ 1 Alerted occupants, occupants responded N None Present Skip to mobile structures such as job-site trailers, portable offices, orSection similar M structures.2 Hardwire only 2 Alerted occupants, occupants failed 1 Present 3 Plug-in to respond Information about the status of the buildingU Undeterminedis collected in Block I2. 4 Hardwire with battery 3 There were no occupants 5 Plug-in with battery 4 Failed to alert occupants Detector Type 6 Mechanical U Undetermined L2 7 Multiple detectors & power Detector Failure Reason 3-4 supplies L6 0 Other 1 Smoke Required if detector failed to operate U Undetermined 2 Heat 3 Combination smoke and heat Detector Operation 1 Power failure, shutoff, or disconnect L4 2 Improper installation or placement 4 Sprinkler, water flow detection 3 Defective 1 Fire too small to activate 5 More than one type present 4 Lack of maintenance, includes 0 Other 2 Operated Complete not cleaning U Undetermined Block L5 5 Battery missing or disconnected 3 Failed to operate Complete 6 Battery discharged or dead Block L6 0 Other U Undetermined U Undetermined

Block IFire2 captures Origin the status of the buildingNumber involved of Stories in theDamaged fire. by Flame Type of Material Contributing Most J1 J3 K Count the roof as part of the highest story. to Flame Spread Below grade Number of stories w/minor damage Check if no flame spread OR if Story of Skip to (1 to 24% flame damage) same as Material First Ignited (Block D4, Structure Type fire origin Building Status Building Main Floor SizeFire Module) OR if unable to determine. Section L I1 I2 I3 I4 NFIRS–3 If fire was in an enclosed building or a NumberHeight of stories w/significant damage Structure portable/mobile structure, complete the Fire Spread Count(25 theto roof49% as flame part of damage) the 1 rest of this form. highest story. K Fire J2 If fire spread was1 confinedUnder to object construction of origin, Item contributing most to flame spread 1 Enclosed building do not check a2 box (Ref.Occupied Block D3, Fire & Module). operating Number of stories w/heavy damage 2 Portable/mobile structure (50 to 74% flame damage) , , 2 Confined3 to roomIdle, ofnot origin routinely used Total number of stories at or 3 Total square feet 2 Open structure 3 Confined4 to floorUnder of originmajor renovation above grade K 4 Air-supported structure Number of stories w/extreme damage Type of material contributing Required only if item 4 Confined5 to buildingVacant ofand origin secured (75 to 100% flame damage) OR most to flame spread contributing code is 00 or <70. 5 Tent 5 Beyond building6 Vacant of origin and unsecured 6 Open platform (e.g., piers) 7 Being demolished , BY , 7 Underground structure (work areas) 0 Other Total number of stories 8 Presence of Detectors belowDetector grade Power SupplyLength in feet WidthDetector in feet Effectiveness Connective structureL (e.g.,1 fences) U Undetermined L3 L5 Required if detector operated. 0 Other type of structure (In area of the fire) 1 Battery only 1 Alerted occupants, occupants responded N Skip to None Present Section M 2 Hardwire only 2 Alerted occupants, occupants failed Fire Origin In Block1 I3 enterPresentNumber the total of Stories number Damaged of stories3 by Flame atPlug-in or above Typegrade of level, Material then Contributing enter theto total Most respond number of J1 J3 K to Flame Spread stories belowUndetermined gradeCount the rooflevel. as part Do of the nothighest count story. 4 normallyHardwire inaccessible with battery attics, attics with3 lessThere than were standing no occupants Below grade U Number of stories w/minor damage5 Plug-in withCheck battery if no flame spread OR if 4 Failed to alert occupants Story of height, or the roof as a story. Both parts of I3 must be completed without regard to howSkip many to (1 to 24% flame damage) same as Material First Ignited (Block UD4, Undetermined fire origin Detector Type 6 MechanicalFire Module) OR if unable to determine. Section L floorsL2 were involved in the fire. 7 Multiple detectors & power Number of stories w/significant damagesupplies Detector Failure Reason Fire Spread (25 to 49% flame damage) 1 L6 0 Other K J2 If fire spread was confined to object 1of origin, Smoke Item contributing most to flame spread Required if detector failed to operate Structure Type do not check aBuilding box (Ref. Block Status D3, Fire Module). BuildingNumber of stories w/heavyMain damageU FloorUndetermined Size I1 I2 2 HeatI3 (50 to 74% flame damage)I4 NFIRS–3 If fire was in an enclosed building or a 2 Confined to room of origin Height 3 Combination smoke and heat Detector OperationStructure 1 Power failure, shutoff, or disconnect portable/mobile structure, complete the Count the roof as part of the K2 rest of this form. 3 Confined to floor of origin L4 FireType of material contributing 2 Improper installation or placement 4 Sprinkler,highest story. waterNumber flow of stories detection w/extreme damage Required only if item 4 Confined1 Under to building construction of origin (75 to 100% flame damage) most to flame spread contributing code is 00 or <70. 1 Enclosed building Fire too small to activate 3 Defective 5 2 Occupied & operating5 More than one type present 1 2 Portable/mobile structure Beyond building of origin , , 4 Lack of maintenance, includes 3 Idle, not routinely used Total number of stories at or 0 Other Total square feet Complete 3 above grade not cleaning Open structure 4 Under major renovation 2 Operated Block L5 Presence of DetectorsU UndeterminedDetector Power Supply Detector Effectiveness5 Battery missing or disconnected 4 Air-supported structure 5 Vacant and secured L1 L3 OR L5 Required if detector operated. 6 Battery discharged or dead 5 Tent 6(In areaVacant of the fire) and unsecured 3 Failed to operate Complete 6 1 Alerted occupants,Block L6 0occupantsOther responded Open platform (e.g., piers) 7 Being demolished Skip to 1 Battery only N None Present Section M , BY 2, Alerted occupants, UoccupantsUndetermined failed 7 Underground structure (work areas) 0 Other Total2 number of storiesHardwire only U Undetermined below grade Length in feet Width in feet to respond 8 Connective structure (e.g., fences) 1U UndeterminedPresent 3 Plug-in 0 Other type of structure U Undetermined 4 Hardwire with battery 3 There were no occupants Presence of5 AutomaticPlug-in Extinguishing with battery System 4 FailedOperation to alert of Automaticoccupants Reason for Automatic M1 M3 Extinguishing System M5 Extinguishing System Failure Detector Type N None6 PresentMechanical U Undetermined Fire Origin Number of StoriesBlock Damaged I4 offers by Flametwo options Typefor indicating of Material the Contributing main floor RequiredMost size. if Enterfire was within either designed the range number of square feet J1 L2J3 1 Present7 MultipleK detectorsComplete & power rest of Required if system failed or not effective Count the roof as part of the highest story. to Flame SpreadSection M 1 Operated/effectiveDetector Failure Reason (go to M4) on the 2structure’sPartial main Systemsupplies floor Present or its length and width in feet. 1 System shut off Below grade L6 Operated/not effective (go to M4) Number of stories w/minorU damageUndetermined0 OtherCheck if no flame spread OR if 2 Story of 1 Smoke RequiredSkip if to detector failed to operate 2 Not enough agent discharged (1 to 24% flame damage) same as Material First Ignited (Block D4, 3 Fire too small to activate fire origin U UndeterminedFire Module) OR if unable to determine. Section L 3 Agent discharged but did not 2 Heat Type of Automatic Extinguishing System 4 Failed to operate (go to M5) M2 reach fire 3 CombinationNumber of smokestories w/significant and heatRequired damage if fire was withinDetector designed range Operation of AES 10 OtherPower failure, shutoff, or disconnect (25 to 49% flame damage) L4 4 Wrong type of system Fire Spread 1 Wet-pipe sprinklerK1 2U UndeterminedImproper installation or placement J2 If fire spread was confined to object of origin, 4 Sprinkler, water flow detection Item contributing most to flame spread 5 Fire not in area protected Number of stories w/heavy2 damageDry-pipe sprinkler 3 Defective do not check a box (Ref. Block D3, Fire Module).5 More than one type present 1 Fire too small to activate 3-5 6 System components damaged (50 to 74% flame damage)3 Other sprinkler system 4 LackNumber of maintenance, of Sprinkler includes 2 Confined to room of origin M4 7 Lack of maintenance 0 Other 4 Dry chemical systemK2 Complete notHeads cleaning Operating 3 Confined to floor of origin 2 Operated Block L5 8 Manual intervention U UndeterminedNumber of stories w/extreme5 damageFoam system Type of material contributing Required5 onlyRequired if itemBattery if system missing operated or disconnected 4 Confined to building of origin (75 to 100% flame damage) most to flame spread contributing code is 00 or <70. 0 Other 6 Halogen-type3 Failed system to operate Complete 6 Battery discharged or dead 5 Beyond building of origin Block L6 0 Other U Undetermined 7 Carbon dioxide (CO2) system Number of sprinkler heads operating 0 OtherU specialUndetermined hazard system U Undetermined Presence of Detectors Detector PowerU Supply Detector Effectiveness NFIRS–3 Revision 01/01/06 L1 L3 UndeterminedL5 Required if detector operated. (In area of the fire) Presence1 of BatteryAutomatic only Extinguishing System 1 AlertedOperation occupants, of occupantsAutomatic responded Reason for Automatic N None Present SkipM1 to M3 M5 Section M N 2 NoneHardwire Present only 2 AlertedExtinguishing occupants, occupants System failed Extinguishing System Failure Required if fire was within designed range 1 Present 1 3 PresentPlug-in Complete rest of to respond Required if system failed or not effective Section M 3 1ThereOperated/effective were no occupants (go to M4) U Undetermined 2 4 PartialHardwire System with Present battery 1 System shut off 4 2FailedOperated/not to alert occupants effective (go to M4) U 5 UndeterminedPlug-in with battery 2 Not enough agent discharged U 3UndeterminedFire too small to activate Detector Type 6 Mechanical 3 Agent discharged but did not L2 Type of Automatic Extinguishing System 4 Failed to operate (go to M5) M2 7 Multiple detectors & power reach fire Required if fire was within designed range of AES Detector0 Other Failure Reason supplies L6 4 Wrong type of system 1 0Wet-pipeOther sprinkler U Undetermined 1 Smoke Required if detector failed to operate 5 Fire not in area protected 2 Dry-pipe sprinkler U Undetermined 6 System components damaged 2 Heat 3 Other sprinkler system Number of Sprinkler M4 7 Lack of maintenance 3 Combination smoke and heat4 Dry chemicalDetector system Operation 1 Power failure,Heads shutoff,Operating or disconnect L4 2 Improper installation or placement 8 Manual intervention 4 Sprinkler, water flow detection5 Foam system Required if system operated 3 Defective 0 Other 6 1Halogen-typeFire too systemsmall to activate 5 More than one type present 4 Lack of maintenance, includes U Undetermined 7 Carbon dioxide (CO2) system 0 Other Complete notNumber cleaning of sprinkler heads operating 0 2Other Operatedspecial hazard system U Undetermined Block L5 5 Battery missing or disconnected U Undetermined NFIRS–3 Revision 01/01/06 3 Failed to operate Complete 6 Battery discharged or dead Block L6 0 Other U Undetermined U Undetermined

Presence of Automatic Extinguishing System Operation of Automatic Reason for Automatic M1 M3 M5 N None Present Extinguishing System Extinguishing System Failure Required if fire was within designed range 1 Present Complete rest of Required if system failed or not effective Section M 1 Operated/effective (go to M4) 2 Partial System Present 1 System shut off 2 Operated/not effective (go to M4) U Undetermined 2 Not enough agent discharged 3 Fire too small to activate 3 Agent discharged but did not Type of Automatic Extinguishing System 4 Failed to operate (go to M5) M2 reach fire Required if fire was within designed range of AES 0 Other 4 Wrong type of system 1 Wet-pipe sprinkler U Undetermined 5 Fire not in area protected 2 Dry-pipe sprinkler 6 System components damaged 3 Other sprinkler system Number of Sprinkler M4 7 Lack of maintenance 4 Dry chemical system Heads Operating 8 Manual intervention 5 Foam system Required if system operated 0 Other 6 Halogen-type system U Undetermined 7 Carbon dioxide (CO2) system 0 Other special hazard system Number of sprinkler heads operating U Undetermined NFIRS–3 Revision 01/01/06 Structure Type Building Status Building Main Floor Size I1 I2 I3 I4 NFIRS–3 NFIRSIf fire was 5.0 in Self-Studyan enclosed buildingProgram or a Height Structure portable/mobile structure, complete the Count the roof as part of the rest of this form. Fire 1 Under construction highest story. 1 Enclosed building 2 Occupied & operating Section 2J: FirePortable/mobile Origin, structure Fire Spread, , , 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open structure 4 Under major renovation above grade Number of4 StoriesAir-supported Damaged structure by 5FlameVacant and secured OR 5 Tent 6 Vacant and unsecured Structure Type Building Status Building Main Floor Size NFIRS–3 6I1 Open platform (e.g., piers) 7I2 Being demolished I3 I4 If fire was in an enclosed building or a Height BY In Section J you will record data 7that will help describe where(work areas)the fire started, whether or not itTotal number of stories , , Structure Undergroundportable/mobile structure, structure complete the 0 Other Countbelow the grade roof as part of the Length in feet Width in feet 8 Connectiverest of this form. structure (e.g., fences) Fire spread, and the percentage of the structure that was damaged by flame.U1 UndeterminedUnder construction highest story. 0 Other type of structure 1 Enclosed building 2 Occupied & operating 2 Portable/mobile structure , , 3 Idle, not routinely used Total number of stories at or 3 Total square feet OpenFire structureOrigin 4 NumberUnder of major Stories renovation Damaged byabove Flame grade Type of Material Contributing Most 4 J1 Air-supported structure J3 5 Vacant and secured K to Flame Spread OR 5 Count the roof as part of the highest story. Tent Below grade 6 Vacant and unsecured Check if no flame spread OR if 6 (e.g., piers) Number of stories w/minor damage OpenStory of platform 7 Being demolished same as Material First Ignited (Block D4, Skip to fire origin (1 to 24% flame damage) , BY , 7 Underground structure (work areas) 0 Other Total number of stories Fire Module) OR if unable to determine. Section L 8 below grade Length in feet Width in feet Connective structure (e.g., fences) U UndeterminedNumber of stories w/significant damage 0 OtherFire typeSpread of structure (25 to 49% flame damage) K1 Enter the story on which the fire Joriginated2 If fire spread wasin Blockconfined to Jobject1. This of origin, story number is assumed to be at or Item contributing most to flame spread do not check a box (Ref. Block D3, Fire Module). Number of stories w/heavy damage above grade unless the Below Grade boxFire is marked.Origin Count the groundNumber level(50 toas of74% story Stories flame 1.damage) DamagedIn case of by Flame Type of Material Contributing Most 2J1 Confined to room of origin J3 K most residential basements, you would enter “1” for the Story of fire originCount the and roof as then part of thecheck highest thestory. box K2 to Flame Spread 3 Confined to floor of origin Type of material contributing Below grade Number of stories w/extreme damage Required only if item to indicate it was below grade. 4 Confined to building of origin (75Number to 100% of stories flame damage)w/minor damage Checkmost if no to flameflame spreadspread OR if contributing code is 00 or <70. Story of Skip to (1 to 24% flame damage) same as Material First Ignited (Block D4, 5 Beyondfire origin building of origin Fire Module) OR if unable to determine. Section L

Number of stories w/significant damage PresenceFire Spread of Detectors (25 toDetector 49% flame Power damage) Supply K1 Detector Effectiveness L21 L3 L5 Required if detector operated. J If fire spread(In area was of confined the fire) to object of origin, Item contributing most to flame spread do not check a box (Ref. Block D3, Fire Module). Number of stories w/heavy damage Skip to 1 (50 to Battery74% flame only damage) 1 Alerted occupants, occupants responded Structure Type 2 BuildingConfinedN StatusNone to room Present of origin Building Main Floor Size 1 2 3Section M 2 Hardwire4 only NFIRS–32 Alerted occupants, occupants failed I If fire was in an enclosed building or a I I Height I K2 3 Confined to floor of origin Structure Typeto respond of material contributing portable/mobile structure, complete the 1 Present 3 NumberPlug-in of stories w/extreme damage Required only if item Count the roof as part of the most to flame spread rest of this form. 4 Confined to building of origin 4 (75 to Hardwire100% flame withdamage) battery Fire 3 There were no occupantscontributing code is 00 or <70. 1 UnderU constructionUndetermined highest story. 5 Beyond building of origin 5 Plug-in with battery 4 Failed to alert occupants 1 Enclosed building 2 Occupied & operating 2 Portable/mobile structure Detector Type 6 Mechanical, , U Undetermined 3 Idle, not routinely used Total number of stories at or Total square feet 3 2 L2 Presence of Detectors 7 DetectorMultiple Power detectors Supply & power Detector Effectiveness BlockOpen J structure captures the extent of fire4 spread1Under in majorterms renovation of how far theabove flame grade damage3 extended. The extent 5 L L supplies L RequiredDetector if detector Failure operated. Reason 4 ofAir-supported flame damage structure is the area actually5 burnedVacant(In areaorand charred of secured the fire) and does not include the area receivingOR only L6 5 0 OtherBattery only 1 Alerted occupants, occupants responded heat,Tent smoke, or water damage. Mark6 1 Vacant theSmoke box and best unsecured describing theSkip toextent1 of fire spread. If the fire Required if detector failed to operate 6 N None Present Section M U Undetermined 2 Alerted occupants, occupants failed Open platform (e.g., piers) 7 2 BeingHeat demolished 2 Hardwire only 3 BY 7 spreadUnderground was confined structure to (work the areas) object of origin1 Present(1) and the boxTotal in number Block of stories 3D on thePlug-in Fire, Module was , to respond 0 3 OtherCombination smoke andbelow heat grade DetectorLength in Operation feet Width in feet 1 Power failure, shutoff, or disconnect 8 marked,Connective do not structure mark the(e.g., fences)box here. Undetermined L44 Hardwire with battery 23 ImproperThere were installation no occupants or placement U 4 UndeterminedUSprinkler, water flow detection 0 Other type of structure 5 Plug-in with battery 34 DefectiveFailed to alert occupants 1 Fire too small to activate 5 DetectorMore than Type one type present 6 Mechanical 4U LackUndetermined of maintenance, includes L02 Other 7 Multiple detectors & power Fire Origin Number of Stories Damaged by Flame Type of Material ContributingComplete Most not cleaning 2 Operatedsupplies Block L5 Detector Failure Reason J1 J3 U Undetermined K to Flame Spread L56 Battery missing or disconnected Count the roof as part of the highest story. 0 Other Below grade 1 Smoke 3 Failed to operate Complete 6 BatteryRequired if detectordischarged failed to operate or dead Number of stories w/minor damage U CheckUndetermined if no flame spread OR if Block L6 Story of 0Skip to Other 2 (1 to Heat24% flame damage) same as Material First Ignited (Block D4, fire origin Fire Module) OR if unable to determine. USection LUndetermined 3 Combination smoke and heat U DetectorUndetermined Operation 1 Power failure, shutoff, or disconnect Number of stories w/significant damage L4 2 Improper installation or placement 4 Sprinkler, water flow detection Fire Spread (25 to 49% flame damage) K1 3 Defective 1 Fire too small to activate J2 If fire spread was confined to object of origin, 5 PresenceMore than of Automatic one type present Extinguishing SystemItem contributing most to flameOperation spread of Automatic Reason for Automatic do not check a box (Ref. Block D3, Fire Module). Number of stories w/heavy damage 4 Lack of maintenance, includes M0 1 Other M3 Extinguishing System M5 Extinguishing System Failure (50N to 74% flameNone damage) Present 2 Operated Complete not cleaning 2 Confined to room of origin Required if fire was Blockwithin designedL5 range U 1UndeterminedPresent CompleteK2 rest of 5 Battery missingRequired if system or disconnected failed or not effective 3 Confined to floor of origin Number2 of Partialstories w/extreme System damage Present Section MType of material1 contributingOperated/effective (go to M4) 3 Failed to operate RequiredComplete only if item6 Battery1 dischargedSystem shutor dead off 4 Confined to building of origin (75 to 100% flame damage) most to flame 2spread Operated/notcontributingBlock L6 effective code is 00 or (go <70. to M4) U Undetermined 0 Other2 Not enough agent discharged 5 Beyond building of origin 3 Fire too small to activate U Undetermined U Undetermined3 Agent discharged but did not Type of Automatic Extinguishing System 4 Failed to operate (go to M5) M2 reach fire Presence of Detectors DetectorRequired if fire Power was within Supply designed range of AES Detector 0EffectivenessOther Block J3 captures the number of stories damaged by flame spread. Flame damage is the area actually 4 Wrong type of system L1 L31 Wet-pipe sprinkler L5 Required if detectorU operated.Undetermined burned(In area or of charred the fire) and does not includePresence areas receiving of Automatic only Extinguishing heat, smoke, Systemor water damage. Operation of Automatic 5 ReasonFire not for in areaAutomatic protected M12 Dry-pipe sprinkler 1 Alerted occupants,M3 occupants responded M5 Skip to 1 N BatteryNone only Present Extinguishing System 6 ExtinguishingSystem components System damaged Failure N None Present 3 Other sprinkler system Number of Sprinkler Section M 2 1 HardwirePresent only 2 Alerted occupants,Required4 if fire occupants was within designed failed range Required if system failed or not effective Complete rest of M Heads Operating 7 Lack of maintenance 4 Dry chemical system Section Mto respond1 Operated/effective (go to M4) 1 Present 3 2 Plug-inPartial System Present 81 ManualSystem interventionshut off 5 Foam system RequiredOperated/not if system operated effective (go to M4) Undetermined 4 U HardwireUndetermined with battery 3 There were2 no occupants 0 Other U 6 Halogen-type system 2 Not enough agent discharged 5 Plug-in3-6 with battery 4 Failed to3 alert Fireoccupants too small to activate U Undetermined 7 Type of Automatic Extinguishing System 3 Agent discharged but did not 6 MechanicalCarbon dioxide (CO2) system U Undetermined4 Failed to operate (go to M5) Detector Type M2 Required if fire was within designed range of AES Number of sprinkler heads operating reach fire L2 7 0 MultipleOther specialdetectors hazard & power system 0 Other 4 Wrong type ofNFIRS–3 system Revision 01/01/06 U1 UndeterminedWet-pipe sprinkler Detector FailureU Undetermined Reason supplies L6 5 Fire not in area protected 0 2 OtherDry-pipe sprinkler 1 Smoke Required if detector failed to operate 6 System components damaged 3 Other sprinkler system Number of Sprinkler U Undetermined M4 7 Lack of maintenance 2 Heat 4 Dry chemical system Heads Operating 8 Manual intervention 3 Combination smoke and heat 5 DetectorFoam systemOperation 1 Power failure,Required shutoff, if system or operated disconnect L4 2 Improper installation or placement 0 Other 4 Sprinkler, water flow detection 6 Halogen-type system 3 Defective U Undetermined 5 More than one type present 1 7 FireCarbon too small dioxide to activate (CO2) system 4 Lack of maintenance,Number of sprinkler includes heads operating 0 Other special hazard system 0 Other Complete not cleaning 2 U OperatedUndetermined NFIRS–3 Revision 01/01/06 U Undetermined Block L5 5 Battery missing or disconnected 3 Failed to operate Complete 6 Battery discharged or dead Block L6 0 Other U Undetermined U Undetermined

Fire Origin Number of Stories Damaged by Flame Type of Material Contributing Most J1 J3 K Count the roof as part of the highest story. to Flame Spread Below grade Number of stories w/minor damage Check if no flame spread OR if Story of Skip to (1 to 24% flame damage) same as Material First Ignited (Block D4, fire origin Fire Module) OR if unable to determine. Section L Structure Type Building Status Building Main Floor Size I1 I2 Number of stories w/significant damageI3 I4 NFIRS–3 If fireFire was Spread in an enclosed building or a (25 to 49% flame damage) Height 1 Structure portable/mobile structure, complete the K J2 If fire spread was confined to object of origin, Section K is completedCount the roof onlyas part of if: the Item contributing most to flame spread rest of this form. Fire do not check a box (Ref. Block D3, Fire Module). 1 UnderNumber construction of stories w/heavy damagehighest story. 1 Enclosed building (50 to 74% flame damage) 2 Confined to room of origin 2 Occupied1. & operating The flame spread is beyond the object of origin. 2 Portable/mobile structure 2 , , 3 Idle, not routinely used Total number of storiesK at or 3 Confined to floor of origin Number of stories w/extreme damage Type ofTotal material square contributing feet 3 Open structure 2. The materialabove contributing grade most to the flame spreadRequired is only different if item from the Item First Ignited 4 Confined to building of origin 4 Under(75 to 100% major flame renovation damage) most to flame spread contributing code is 00 or <70. 4 Air-supported structure 5 Beyond building of origin 5 Vacant and secured(recorded in D3 of NFIRS-2 - Fire Module). OR 5 StructureTent Type Building Status Building Main Floor Size I1 6I2 Vacant and unsecured I3 I4 NFIRS–3 6 OpenIf fire was platform in an enclosed (e.g., building piers) or a If either one of theseHeight conditions does not apply, mark the box and skip the rest of the section. Presence of Detectors 7 BeingDetector demolished Power Supply Detector, EffectivenessBY Structure 7 Undergroundportable/mobile structure, structure complete (work the areas) CountTotal the number roof as of partstories of the , 1 0 3Other 5 Required if detector operated. L rest of this form. L highestbelow story. grade L Length in feet Width in feetFire 8 Connective(In area of the structure fire) (e.g., fences) U1 UndeterminedUnder constructionIn Block K1 you will enter the code for the Item Contributing Most to Flame Spread. Fill in this item 01 EnclosedOther type building of structure 2 1 OccupiedBattery & operatingonly 1 Alerted occupants, occupants responded N Skip to only if: 2 Portable/mobileNone Present structureSection M 2 Hardwire only 2 Alerted, occupants, occupants, failed 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open1 structurePresent 4 3 UnderPlug-in major renovation above grade to respond Fire Origin Number of Stories1. The Damaged flame spread by Flame beyond theType object of Material of origin. Contributing Most 4 Air-supported structure 5 4 VacantHardwire and secured with battery 3 There were no occupants J1 U Undetermined J3 K to Flame Spread OR 5 Tent 6 Count5 Vacant the roofPlug-in as and part2. of unsecured thewith The highest batteryitem story. contributing most4 toFailed flame to spread alert occupants is different from the Item First Ignited. 6 Below grade Open platform (e.g., piers) 7 6 BeingNumberMechanical demolished of stories w/minor damage U CheckUndetermined if no flame spread OR if StoryDetector of Type BY Skip to 7 2 Underground structure (work areas) (1 to 24% flame damage) Total number of stories same as Material, First Ignited (Block D4, , L fire origin 0 7 OtherMultiple detectors & power Section L below grade FireDetector Module)Length OR ifin Failureunable feet to determine. ReasonWidth in feet 8 Connective structure (e.g., fences) U Undeterminedsupplies Number of stories w/significant damage L6 0 Other type of structure 0 Other 1 FireSmoke Spread (25 to 49% flame damage) K1 Required if detector failed to operate 2 U Undetermined J2 If fire Heatspread was confined to object of origin, Item contributing most to flame spread do not check a box (Ref. Block D3, Fire Module). Number of stories w/heavy damage 3 FireCombination Origin smoke and heat Number(50 toDetector of74% Stories flame Operationdamage) Damaged by Flame 1 TypePower of Material failure, Contributingshutoff, or disconnect Most J1 Confined to room of origin J3 4 K 2 CountL the roof as part of the highest story. 2 to ImproperFlame Spread installation or placement 4 Sprinkler, water flow detection K2 3 Confined to floor ofBelow origin grade The codes used in this section areType the of materialsame contributing as those for the Item First Ignited and are found in the NumberFire of toostories small w/extremew/minor to activatedamage damage 3 CheckDefective if no flame spread OR if Required only if item 5 StoryMore of than one type present 1 most to flame spread Skip to 4 Confined to building of origin (1(75 to to 24% 100% flame flame damage) damage) 4 sameLack as Material of maintenance,First Ignited (Block D4,contributing includes code is 00 or <70. fire origin CRG. Fire Module) OR if unable to determine. Section L 50 BeyondOther building of origin Complete not cleaning 2 Operated Block L5 U Undetermined Number ofYou stories will w/significant use Block damage K2 to record5 theBattery Type missingof Material or disconnected Contributing Most to the Flame Spread. (25 to 49% flame damage) PresenceFire Spread of Detectors Detector Power Supply K6 1 DetectorBattery discharged Effectiveness or dead J2 3 Failed to operate Complete Item contributing most to flame spread L1 If fire spread was confined to object of origin, L3 Block L6 L5 Required if detector operated. do not(In check area a box of the(Ref. fire) Block D3, Fire Module). Number of stories w/heavy damage 0 Other U1 (50 to Battery74% flame only damage) U1 UndeterminedAlerted occupants, occupants responded 2 ConfinedN to room of origin Skip to Undetermined None Present Section M 2 Hardwire only K22 Alerted occupants, occupants failed 3 Confined to floor of origin Type of material contributing Present Number of stories w/extreme damage to respond Required only if item 4 Confined1 to building of origin 3 (75 to Plug-in100% flame damage) most to flame spread contributing code is 00 or <70. Presence of Automatic Extinguishing4 SystemHardwire with batteryOperation of Automatic3 There wereReason no occupants for Automatic 5M1BeyondU buildingUndetermined of origin M3 M5 N None Present 5 Plug-in with batteryExtinguishing System4 Failed to alertExtinguishing occupants System Failure Required if fire was within designed range 1 Present Complete6 restMechanical of Complete this Block when theU codeUndetermined for TypeRequired of if Materialsystem failed or is not between effective 00 and 70. It is not necessary to PresenceDetector Typeof Detectors Detector Power Supply Detector Effectiveness 2 2 Partial System Present Section M 1 Operated/effective (go to M4) L1 L73 Multiplesupply detectors this information & power whenL5 theRequired type if1of detector materialSystem operated. code shut offis 70 or greater. U (In areaUndetermined of the fire) supplies2 Operated/not effective (go toDetector M4) Failure Reason L16 Alerted2 occupants,Not enough occupants agent discharged responded Skip to 01 OtherBattery only3 Fire too small to activate 1 NSmokeNone Present Required3 if detectorAgent failed to dischargedoperate but did not Type of Automatic ExtinguishingSection M System2 Hardwire4 onlyFailed to operate (go to2 M5) Alerted occupants, occupants failed M2 U Undetermined reach fire 2 1HeatRequiredPresent if fire was within designed range of AES 3 Plug-in 0 Other to respond 4 Wrong type of system 3 1 CombinationWet-pipe sprinkler smoke and heat 4 DetectorHardwire UOperation withUndetermined battery 13 PowerThere werefailure, no shutoff,occupants or disconnect U Undetermined L4 5 Fire not in area protected 2 Dry-pipe sprinkler 5 Plug-in with battery 24 ImproperFailed to alertinstallation occupants or placement 4 Sprinkler, water flow detection 6 System components damaged 3 Other sprinkler system 6 FireMechanical too small to Numberactivate of Sprinkler3U DefectiveUndetermined 5 DetectorMore than Type one type present 1 M4 7 Lack of maintenance L2 4 Dry chemical system 7 Multiple detectorsHeads & power Operating 4 Lack of maintenance, includes 0 Other Detector8 FailureManual Reason intervention 5 Foam system 2 Operatedsupplies Required if systemComplete operated not cleaning Block L5 L6 0 Other U 6 UndeterminedHalogen-type system 0 Other 5 Battery missing or disconnected 1 Smoke RequiredU if detectorUndetermined failed to operate 7 Carbon dioxide (CO ) system 3U FailedUndetermined to operate Complete 6 Battery discharged or dead 2 Heat 2 Block L6 0 Other special hazard system Number of sprinkler heads operating 0 Other 3-7 Detector Operation 1 Power failure, shutoff, or disconnect 3 U Combination smoke and heat U U Undetermined NFIRS–3 Revision 01/01/06 Undetermined L4 Undetermined 2 Improper installation or placement 4 Sprinkler, water flow detection 3 Defective 5 More than one type present 1 Fire too small to activate Presence of Automatic Extinguishing System Operation of Automatic4 Lack of maintenance,Reason for includesAutomatic M0 1 Other M3 Complete not cleaningM5 N None Present 2 Operated ExtinguishingBlock L5 System Extinguishing System Failure U Undetermined Required if fire was within designed range5 Battery missing or disconnected 1 Present Complete rest of Required if system failed or not effective 2 Partial System Present 3Section MFailed to 1operateOperated/effectiveComplete (go6 to M4)Battery discharged or dead Block L6 1 System shut off 2 Operated/not effective0 (go toOther M4) U Undetermined 2 Not enough agent discharged U 3 Fire too small to activateU Undetermined Undetermined 3 Agent discharged but did not Type of Automatic Extinguishing System 4 Failed to operate (go to M5) M2 reach fire Required if fire was within designed range of AES 0 Other 4 Wrong type of system 1PresenceWet-pipe of Automatic sprinkler Extinguishing System U UndeterminedOperation of Automatic Reason for Automatic M1 M3 M5 5 Fire not in area protected 2 N Dry-pipeNone Present sprinkler Extinguishing System Extinguishing System Failure Required if fire was within designed range 6 System components damaged 3 1 OtherPresent sprinkler system Complete rest of Number of Sprinkler Required if system failed or not effective M4 7 Lack of maintenance 4 2 DryPartial chemical System system Present Section M 1 Operated/effectiveHeads Operating (go to M4) 81 ManualSystem interventionshut off 5 U FoamUndetermined system 2 RequiredOperated/not if system operated effective (go to M4) 02 OtherNot enough agent discharged 6 Halogen-type system 3 Fire too small to activate Type of Automatic Extinguishing System U3 UndeterminedAgent discharged but did not 7 4 Failed to operate (go to M5) M2 RequiredCarbon if fire was dioxide within designed (CO 2range) system of AES reach fire 0 NumberOther of sprinkler heads operating 0 Other special hazard system 4 Wrong type of system 1 Wet-pipe sprinkler U Undetermined NFIRS–3 Revision 01/01/06 U Undetermined 5 Fire not in area protected 2 Dry-pipe sprinkler 6 System components damaged 3 Other sprinkler system Number of Sprinkler M4 7 Lack of maintenance 4 Dry chemical system Heads Operating 8 Manual intervention 5 Foam system Required if system operated 0 Other 6 Halogen-type system U Undetermined 7 Carbon dioxide (CO2) system 0 Other special hazard system Number of sprinkler heads operating U Undetermined NFIRS–3 Revision 01/01/06 Structure Type Building Status Building Main Floor Size I1 I2 I3 I4 NFIRS–3 If fire was in an enclosed building or a Height Structure portable/mobile structure, complete the Count the roof as part of the rest of this form. Fire 1 Under construction highest story. 1 Enclosed building 2 Occupied & operating 2 Portable/mobile structure , , 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open structure above grade Structure Type 4 UnderBuilding major Status renovation Building Main Floor Size NFIRS–3 I41 Air-supported structure I2 I3 I4 If fire was in an enclosed building or a 5 Vacant and secured Height OR Structure 5 Tentportable/mobile structure, complete the 6 Vacant and unsecured Count the roof as part of the rest of this form. highest story. Fire 6 Open platform (e.g., piers) 17 UnderBeing constructiondemolished 1 Enclosed building , BY , 7 Underground structure (work areas) 20 OccupiedOther & operating Total number of stories below grade Length in feet , Width in feet 28 Portable/mobileConnective structure structure (e.g., fences) , 3U Idle,Undetermined not routinely used Total number of stories at or Total square feet 30 OpenOther structuretype of structure 4 Under major renovation above grade 4 Air-supported structure 5 Vacant and secured OR 5 Tent 6 Vacant and unsecured Fire Origin Number of Stories Damaged by Flame Type of Material Contributing Most 6 Open platform (e.g., piers) 7 Being demolished J1 J3 K to Flame Spread, BY , 7 Underground structure (work areas) 0 CountOther the roof as part of the highest story. Total number of stories Below grade below grade Length in feet Width in feet 8 Connective structure (e.g., fences) Number of stories w/minor damage Check if no flame spread OR if Story of U Undetermined Skip to 0 Other type of structure (1 to 24% flame damage) same as Material First Ignited (Block D4, NFIRSfire origin 5.0 Self-Study Program Fire Module) OR if unable to determine. Section L

Number of stories w/significant damage FireFire OriginSpread Number(25 to of49% Stories flame damage) Damaged by Flame K1 Type of Material Contributing Most J12 If fire spread was confined to object of origin, J3 K Item contributing most to flame spread Count the roof as part of the highest story. to Flame Spread Section L: Presencedo not check aof box (Ref.Detectors, Block D3, Fire Module). DetectorNumber of storiesType, w/heavy damage Below grade (50 to 74% flame damage) Number of stories w/minor damage Check if no flame spread OR if 2 ConfinedStory of to room of origin same as Material First Ignited (Block D4, Skip to Detector Powerfire Supply,origin Detector Operation,(1 to 24% flame damage) 2 3 Confined to floor of origin K Fire Module) OR if unable to determine. Section L Number of stories w/extreme damage Type of material contributing Required only if item Detector Effectiveness,4 Confined to building Detector of origin FailureNumber(75 to 100%Reason of stories flame damage)w/significant damage most to flame spread contributing code is 00 or <70. 5 BeyondFire Spread building of origin (25 to 49% flame damage) K1 J2 If fire spread was confined to object of origin, Item contributing most to flame spread do not check a box (Ref. Block D3, Fire Module). Number of stories w/heavy damage Presence of Detectors (50 toDetector 74% flame Power damage) Supply Detector Effectiveness 2L1 Confined to room of origin L3 L5 Required if detector operated. 2 3 Confined(In area to of thefloor fire) of origin K 1 NumberBattery of stories only w/extreme damage 1 TypeAlerted of material occupants, contributing occupantsRequired only ifresponded item 4 Confined to building of originSkip to (75 to 100% flame damage) most to flame spread contributing code is 00 or <70. N None Present Section M 2 Alerted occupants, occupants failed Structure Type 5 BeyondBuilding building Status of origin Building2 HardwireMain only Floor Size NFIRS–3 I1 I2 I3 I4 to respond If fire was in an enclosed building or a 1 Present Height3 Plug-in Structure portable/mobile structure, complete the Count the roof as part4 of the Hardwire with battery 3 There were no occupants rest of this form. PresenceU Undetermined of Detectors Detector Power Supply Fire Detector Effectiveness highest story. 4 Failed to alert occupants 1L1 Under construction L53 Plug-in with battery L5 Required if detector operated. 1 Enclosed building 2 OccupiedDetector(In area of & the Typeoperating fire) 6 Mechanical U Undetermined 2 Portable/mobile structure , , 1 Alerted occupants, occupants responded 3L2 Idle, not routinely used TotalSkip numberto of stories17 at or BatteryMultiple only detectors & power In Block L1 you should indicate the existenceN None of detectorsPresent within their designed rangeTotal square of feet the fire. If 3 Open structure Sectionabove grade M 2 Hardwire only 2 DetectorAlerted occupants, Failure Reason occupants failed no detectors were present, mark4 NoneUnder Present major and renovation skip to Section M. supplies L6 4 Air-supported structure 5 Vacant1 andPresent secured 30 Plug-inOther OR to respond 5 1 Smoke Required if detector failed to operate Tent 6 VacantU andUndetermined unsecured 4U HardwireUndetermined with battery 3 There were no occupants 2 Heat 6 Open platform (e.g., piers) 7 Being demolished 5 Plug-in with battery 4 Failed to alert occupants Detector ,Operation BY , 1 Power failure, shutoff, or disconnect 7 Underground structure (work areas) 03 OtherDetectorCombination Type smoke andTotal heat number of stories6 Mechanical U Undetermined below grade L4 Length in feet Width in feet 2 Improper installation or placement 8 Connective structure (e.g., fences) UL42 UndeterminedSprinkler, water flow detection 7 Multiple detectors & power 0 3 DetectorDefective Failure Reason Other type of structure 5 More than one type present 1 Firesupplies too small to activate L6 0 Other 4 Lack of maintenance, includes 10 SmokeOther Required if detector failed to operate 2U OperatedUndetermined Complete not cleaning Fire Origin 2UNumberHeatUndetermined of Stories Damaged by Flame Type of Material ContributingBlock L5 Most 5 Battery missing or disconnected 1 3 J J K toDetector Flame SpreadOperation 1 Power failure, shutoff, or disconnect 3Count theCombination roof as part of the highest smoke story. and heat 3 Failed to operate Complete 6 Battery discharged or dead Below grade L4 Block L6 2 Improper installation or placement 4 NumberSprinkler, of stories water w/minor flow damage detection Check if no flame spread OR if 0 Other Story of Skip to (1 to 24% flame damage) same as Material First Ignited (Block D4, 3U DefectiveUndetermined fire origin 1U FireFireUndetermined Module) too OR small if unable to to determine.activate Section L 5 More than one type present 4 Lack of maintenance, includes 0 NumberOther of stories w/significant damage 2 Operated Complete not cleaning Fire Spread U (25Undetermined to 49% flame damage) K1 Block L5 5 Battery missing or disconnected J2 Presence of Automatic Extinguishing SystemItem contributing most toOperation flame spread of Automatic Reason for Automatic If fire spread was confined to object of origin, M1 M3 M5 do not check a box (Ref. Block D3, Fire Module). NumberN ofNone stories Present w/heavy damage 3 Failed to operateExtinguishingComplete System6 Battery dischargedExtinguishing or dead System Failure (50 to 74% flame damage) Block L6 Required if fire was within designed range0 Other 2 Confined to room of origin 1 Present Complete rest of Required if system failed or not effective Use Block L2 Detector Type to identify2 the typePartial of detector System Present present in theUSectionK area2 M Undeterminedof fire origin.1 Operated/effective This field (goU to M4)Undetermined 3 Confined to floor of origin Number of stories w/extreme damage Type of material contributing 1 System shut off is required if the fire was within the Uarea coveredUndetermined by the detector. 2 Operated/notRequired effective only if item (go to M4) 4 Confined to building of origin (75 to 100% flame damage) most to flame spread contributing code is 00 or <70. 2 Not enough agent discharged 3 Fire too small to activate 5 Beyond building of origin 3 Agent discharged but did not PresenceType of of Automatic Automatic Extinguishing Extinguishing System System 4 FailedOperation to operate of Automatic (go to M5) Reason for Automatic M12 Required if fire was within designed range of AES M3 M5 reach fire N None Present 0 OtherExtinguishing System Extinguishing System Failure Presence of Detectors Detector Power Supply Detector Effectiveness 4 Wrong type of system 1 1 Wet-pipePresent sprinkler U RequiredUndetermined if fire was within designed range Required if system failed or not effective L1 L3 CompleteL5 restRequired of if detector operated. 5 (In area of the fire) Section M 1 Operated/effective (go to M4) Fire not in area protected 2 2 Dry-pipePartial Systemsprinkler Present 1 System shut off 1 Alerted occupants, occupants responded(go to M4) 6 System components damaged Skip to 13 U BatteryOtherUndetermined sprinkler only system 2 Operated/notNumber of effectiveSprinkler N None Present M4 27 NotLack enough of maintenance agent discharged Section M 24 HardwireDry chemical only system 2 Alerted3 occupants,FireHeads too occupants small Operating to activate failed Type of Automatic Extinguishing System 38 AgentManual discharged intervention but did not 1 Present 35 Plug-inFoam system to respond4 RequiredFailed if system to operateoperated (go to M5) M2 Required if fire was within designed range of AES 0 reachOther fire 46 HardwireHalogen-type with batterysystem 3 There were0 noOther occupants U Undetermined 4U WrongUndetermined type of system 517 Plug-inWet-pipe with sprinkler battery 4 Failed toU alertUndetermined occupants Carbon dioxide (CO2) system 5 Fire not in area protected 62 MechanicalDry-pipe sprinkler U UndeterminedNumber of sprinkler heads operating Detector Type 0 Other special hazard system 6 System components damaged L2 73 MultipleOther sprinkler detectors system & power Number of Sprinkler NFIRS–3 Revision 01/01/06 U Undetermined M4 7 Lack of maintenance 4 suppliesDry chemical system Detector FailureHeads Reason Operating L6 8 Manual intervention 05 OtherFoam system Required if system operated 1 Smoke Required if detector failed to operate 0 Other U6 UndeterminedHalogen-type system 2 Heat U Undetermined 7 Carbon dioxide (CO ) system Detector Operation 2 1 Power failure, shutoff, or disconnect 3 Combination smoke and heat 0 Other special hazard system Number of sprinkler heads operating L4 2 Improper installation or placement 4 Sprinkler, water flow detection U Undetermined NFIRS–3 Revision 01/01/06 3 Defective 5 More than one type present 1 Fire too small to activate Use Block L3 to describe the power supply for the detector that was found.4 ThisLack field of maintenance, is required includesif 0 Other the fire was within the designed 2range Operatedof the detector. Complete not cleaning U Undetermined Block L5 5 Battery missing or disconnected 3 Failed to operate Complete 6 Battery discharged or dead Block L6 0 Other U Undetermined U Undetermined 3-8 Presence of Automatic Extinguishing System Operation of Automatic Reason for Automatic M1 M3 M5 N None Present Extinguishing System Extinguishing System Failure Required if fire was within designed range 1 Present Complete rest of Required if system failed or not effective Section M 1 Operated/effective (go to M4) 2 Partial System Present 1 System shut off 2 Operated/not effective (go to M4) U Undetermined 2 Not enough agent discharged 3 Fire too small to activate 3 Agent discharged but did not Type of Automatic Extinguishing System 4 Failed to operate (go to M5) M2 reach fire Required if fire was within designed range of AES 0 Other 4 Wrong type of system 1 Wet-pipe sprinkler U Undetermined 5 Fire not in area protected 2 Dry-pipe sprinkler 6 System components damaged 3 Other sprinkler system Number of Sprinkler M4 7 Lack of maintenance 4 Dry chemical system Heads Operating 8 Manual intervention 5 Foam system Required if system operated 0 Other 6 Halogen-type system U Undetermined 7 Carbon dioxide (CO2) system 0 Other special hazard system Number of sprinkler heads operating U Undetermined NFIRS–3 Revision 01/01/06 Structure Type Building Status Building Main Floor Size I1 I2 I3 I4 NFIRS–3 If fire was in an enclosed building or a Height Structure portable/mobile structure, complete the Count the roof as part of the rest of this form. Fire 1 Under construction highest story. 1 Enclosed building 2 Occupied & operating 2 Portable/mobile structure , , 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open structure 4 Under major renovation above grade 4 Air-supported structure 5 Vacant and secured OR 5 Tent 6 Vacant and unsecured 6 Open platform (e.g., piers) 7 Being demolished BY 7 Underground structure (work areas) Total number of stories , , 0 Other below grade Length in feet Width in feet 8 Connective structure (e.g., fences) U Undetermined 0 Other type of structure

Presence of Detectors Detector Power Supply Detector Effectiveness L1 L3 L5 Required if detector operated. (In area of the fire) 1 Battery only 1 Alerted occupants, occupants responded N Skip to None Present Section M 2 Hardwire only 2 Alerted occupants, occupants failed 1 Present 3 Plug-in to respond U Undetermined 4 Hardwire with battery 3 There were no occupants 5 Plug-in with battery 4 Failed to alert occupants Detector Type 6 Mechanical U Undetermined Structure Type BuildingL2 Status Building 7 MultipleMain Floor detectors Size & powerNFIRS–3 I1 I2 I3 Height I4 Detector Failure Reason If fire was in an enclosed building or a NFIRSsupplies 5.0 Self-Study Program StructureL6 portable/mobile structure, complete the Count the roof as part of the 0 Other rest of this form. 1 Smoke highest story. Fire Required if detector failed to operate 1 Under construction U Undetermined 1 Enclosed building 2 Occupied2 Heat & operating 2 Portable/mobile structure 3 Combination smoke and heat Detector, Operation, 1 Power failure, shutoff, or disconnect 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open structure above grade L4 2 Improper installation or placement Structure Type 4 UnderBuilding4 majorSprinkler, Status renovation water flow detectionBuilding Main Floor Size NFIRS–3 4 I1 Air-supported structure I2 I3 Height I4 3 Defective If fire was in an enclosed building or a 5 Vacant5 andMore secured than one type present 1 Fire too smallOR to activate Structure 5 Tentportable/mobile structure, complete the Count the roof as part of the 4 Lack of maintenance, includes rest of this form. 6 Vacant and unsecured Fire 6 0 Other highest story. Complete Open platform (e.g., piers) 7 1 BeingUnder demolished construction 2 Operated not cleaning 1 Enclosed building , BY , Block L5 7 Underground structure (work areas) 0 2 OtherOccupiedU Undetermined & operating Total number of stories 5 Battery missing or disconnected 2 below grade Length in, feet , Width in feet 8 ConnectivePortable/mobile structure structure (e.g., fences) Complete 6 Battery discharged or dead U3 UndeterminedIdle, not routinely used Total number of stories 3at or FailedTotal square to feet operate 0 3 OtherOpen type structure of structure 4 Under major renovation above grade Block L6 0 Other 4 Air-supported structure 5 Vacant and secured U UndeterminedOR U Undetermined 5 Tent 6 Vacant and unsecured Fire Origin Number of Stories Damaged by Flame Type of Material Contributing Most 6 Open platform (e.g., piers) 7 Being demolished J1 J3 K to Flame Spread, BY , 7 Underground structure (work areas) Count0 theOther roof asPresence Blockpart of the highestL 4of identifies Automatic story. Total Extinguishingwhether number of storiesor not System the detection equipmentOperation worked. of Automatic This field isrequired Reason if the for fireAutomatic Below grade 1 below grade Length in feetM3 Width in feet 5 8 Connective structure (e.g., fences) U NumberUndeterminedM of stories w/minor damage Check if no flame spread OR if Extinguishing System M Extinguishing System Failure Story of Nwas withinNone Presentthe designed range ofsame the as Material detector. First Ignited (Block D4, Skip to 0 fireOther origin type of structure (1 to 24% flame damage) Required if fire was within designed range 1 Present CompleteFire Module) rest OR of if unable to determine. Section L Required if system failed or not effective 2 Partial System Present Section M 1 Operated/effective (go to M4) Number ofIf stories the fire w/significant was too damage small to activate the detection equipment or the detector operation1 System was undeter shut off- 2 Operated/not effective (go to M4) FireFire Spread Origin Number(25 to 49% ofUmined flame Stories damage)Undetermined then Damaged skip to by Section Flame M.K1 Type of Material Contributing Most 2 Not enough agent discharged J2J1If fire spread was confined to object of origin, J3 K Item contributing most 3to flame Firespread too small to activate Count the roof as part of the highest story. to Flame Spread 3 Agent discharged but did not do not check a box (Ref. Block D3, Fire Module). Number of storiesType ofw/heavy Automatic damage Extinguishing System 4 Failed to operate (go to M5) Below grade (50M to2 74%When flame damage) the Operated box (2) is marked, then a box in L5 is marked to indicate the detector’sreach effective fire - Number ofRequired stories if w/minorfire was within damage designed range of AES Check if no flame spread OR if Other 2 ConfinedStory of to room of origin 0 Skip to (1 to 24%ness, flame and damage) Block L6 can be skipped.2 same If theas Material Failed First Ignitedto operate (Block D4, box (3) is marked, then 4skip toWrong Block type L6 toof system 3 Confinedfire origin to floor of origin 1 Wet-pipe sprinkler K Fire Module) OR if unableU to determine.Undetermined Section L Number of stories w/extreme damage Type of material contributing Required only if item 5 Fire not in area protected 2 showDry-pipe the reason sprinkler for detector failure.most to flame spread 4 Confined to building of origin (75Number to 100% of flame stories damage) w/significant damage contributing code is 00 or <70. 6 System components damaged 3 Other sprinkler system Number of Sprinkler 5 BeyondFire building Spread of origin (25 to 49% flame damage) K1 M4 7 Lack of maintenance J2 If fire spread was confined to object of origin, 4 Dry chemical system Item contributing most to flame spreadHeads Operating Number of stories w/heavy damage 8 Manual intervention do not check a box (Ref. Block D3, Fire Module). 5 Foam system Required if system operated Presence of Detectors (50Detector to 74% flame Power damage) Supply Detector Effectiveness 0 Other L21 Confined to room of origin L3 6 Halogen-type system L5 Required if detector operated. 2 U Undetermined 3 Confined(In area of tothe floor fire) of origin 7 K Number of storiesCarbon w/extreme dioxide damage (CO2) system Type of material contributing Required only if item 1 Battery only 1 Alerted occupants,Number occupants of sprinkler heads responded operating 4 ConfinedN to building of originSkip to (75 to0 100% flameOther damage) special hazard system most to flame spread contributing code is 00 or <70. None Present Section M 2 Hardwire only 2 Alerted occupants, occupants failed 5 Beyond building of origin U Undetermined NFIRS–3 Revision 01/01/06 1 Present 3 Plug-in to respond 4 Hardwire with battery 3 There were no occupants UPresenceUndetermined of Detectors Detector Power Supply Detector Effectiveness 4 Failed to alert occupants L1 5L3 Plug-in with battery L5 Required if detector operated. Detector(In area ofType the fire) 6 Mechanical U Undetermined L2 Skip to 1 Battery only 1 Alerted occupants, occupants responded N 7 Multiple detectors & power None Present Section M 2 Hardwire only 2 DetectorAlerted Failure occupants, Reason occupants failed supplies L6 1 Present 0 3 OtherPlug-inIn Block L5 mark the box best describingto respond the effectiveness of the detector. This field is required if 1 Smoke Required if detector failed to operate U Undetermined U4 UndeterminedHardwireyou checked with battery box (2) in L4 (Operated).3 There were no occupants 2 Heat 5 Plug-in with battery 4 Failed to alert occupants Detector Operation 1 Power failure, shutoff, or disconnect 3 CombinationDetector Type smoke and heat 6 Mechanical U Undetermined L4 2 Improper installation or placement 4L2 Sprinkler, water flow detection 7 Multiple detectors & power 3 DefectiveDetector Failure Reason 5 More than one type present 1 Firesupplies too small to activate L6 0 Other 4 Lack of maintenance, includes 0 1 OtherSmoke Required if detector failed to operate 2 U OperatedUndetermined Complete not cleaning U2 UndeterminedHeat Block L5 5 Battery missing or disconnected Detector Operation 1 Power failure, shutoff, or disconnect 3 Combination smoke and heat 3 Failed to operate Complete 6 Battery discharged or dead L4 Block L6 2 Improper installation or placement 4 Sprinkler, water flow detection 0 Other 3 Defective U1 UndeterminedFire too small to activate U Undetermined 5 More than one type present 4 Lack of maintenance, includes 0 Other Complete not cleaning 2 Operated Block L5 U PresenceUndetermined of Automatic Extinguishing System Operation of Automatic5 Battery missingReason orfor disconnected Automatic M1 M3 M5 N None Present 3 Failed to operateExtinguishingComplete System6 Battery dischargedExtinguishing or dead System Failure Block L6 Required if fire was within designed range0 Other 1 Present Complete rest of Required if system failed or not effective SectionU M 1 Operated/effective (go Uto M4) Undetermined 2 Partial System Present Undetermined 1 System shut off 2 Operated/not effective (go to M4) U Undetermined 2 Not enough agent discharged 3 Fire too small to activate 3 Agent discharged but did not PresenceType of Automatic of Automatic Extinguishing Extinguishing System SystemIn Block4 LFailed6 markOperation to theoperate box of Automatic (go that to M5)best describes Reasonwhy the for detector Automatic failed to operate or did not operate MM2 1 Required if fire was within designed range of AES M3 M5 reach fire N None Present 0 OtherExtinguishing System Extinguishing System Failure properly. This field isrequired if you checked4 Wrong box type(3) inof systemBlock L4 (Failed to operate). 1 1 Wet-pipePresent sprinkler U RequiredUndetermined if fire was within designed range Required if system failed or not effective Complete rest of 5 Fire not in area protected 2 2 Dry-pipePartia sprinklerl System Present Section M 1 Operated/effective (go to M4) 6 1 SystemSystem components shut off damaged 3 U OtherUndetermined sprinkler system 2 Operated/notNumber of Sprinkler effective (go to M4) M4 7 2 LackNot ofenough maintenance agent discharged 4 Dry chemical system 3 FireHeads too Operating small to activate Type of Automatic Extinguishing System 8 3 ManualAgent interventiondischarged but did not 5 Foam system 4RequiredFailed if system to operated operate (go to M5) M2 Required if fire was within designed range of AES 0 Otherreach fire 6 Halogen-type system 0 Other U4 UndeterminedWrong type of system 7 1 Wet-pipe sprinkler U Undetermined 3-9 Carbon dioxide (CO2) system 5 Fire not in area protected 2 Dry-pipe sprinkler Number of sprinkler heads operating 0 Other special hazard system 6 System components damaged 3 Other sprinkler system Number of Sprinkler NFIRS–3 Revision 01/01/06 U Undetermined M4 7 Lack of maintenance 4 Dry chemical system Heads Operating 8 Manual intervention 5 Foam system Required if system operated 0 Other 6 Halogen-type system U Undetermined 7 Carbon dioxide (CO2) system 0 Other special hazard system Number of sprinkler heads operating U Undetermined NFIRS–3 Revision 01/01/06 Structure Type Building Status Building Main Floor Size I1 I2 I3 I4 NFIRS–3 If fire was in an enclosed building or a Height Structure portable/mobile structure, complete the Count the roof as part of the rest of this form. Fire 1 Under construction highest story. 1 Enclosed building 2 Occupied & operating 2 Portable/mobile structure , , 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open structure 4 Under major renovation above grade 4 Air-supportedStructure Type structure Building Status Building Main Floor Size I1 5I2 Vacant and secured I3 I4 OR NFIRS–3 5 TentIf fire was in an enclosed building or a 6 Vacant and unsecured Height Structure portable/mobile structure, complete the 6 Open platform (e.g., piers) 7 Being demolished Count the roof as part of the Fire rest of this form. highest story. , BY , 7 Underground structure (work areas) 01 OtherUnder construction Total number of stories 1 Enclosed building below grade Length in feet Width in feet 8 Connective structure (e.g., fences) 2 Occupied & operating 2 Portable/mobile structure U Undetermined , , 0 Other type of structure 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open structure 4 Under major renovation above grade 4 Air-supported structure 5 Vacant and secured OR 5 TentFire Origin Number of Stories Damaged by Flame Type of Material Contributing Most J1 J3 6 Vacant and unsecured K 6 Open platform (e.g., piers) Count the roof as part of the highest story. to Flame Spread 7 Being demolished BY 7 Underground structureBelow grade (work areas) Total number of stories , , 0 OtherNumber of stories w/minor damage Check if noLength flame spreadin feet OR if Width in feet Story of below grade Skip to 8 Connective structure (e.g., fences) (1 to 24% flame damage) same as Material First Ignited (Block D4, fire origin U Undetermined Fire Module) OR if unable to determine. Section L 0 Other type of structure Number of stories w/significant damage Fire Spread (25 to 49% flame damage) K1 J2 If fire Firespread Originwas confined to object of origin, Number of Stories Damaged by Flame TypeItem contributing of Material most to Contributing flame spread Most J1 do not check a box (Ref. Block D3, Fire Module). J3 Number of stories w/heavy damage K Count(50 the toroof 74% as partflame of the damage) highest story. to Flame Spread 2 Confined to room ofBelow origin grade Number of stories w/minor damage 2 Check if no flame spread OR if Story of K Skip to 3 Confined to floor of origin Number(1 to 24% of flamestories damage) w/extreme damage sameType as ofMaterial material First contributing Ignited (Block D4, fire origin Fire Module) OR if unable to determine.Required only if item Section L 4 Confined to building of origin (75 to 100% flame damage) most to flame spread contributing code is 00 or <70. 5 Beyond building of origin Number of stories w/significant damage Fire Spread (25 to 49% flame damage) K1 J2 If fire spread was confined to object of origin, Item contributing most to flame spread do notPresence check a box of(Ref. Detectors Block D3, Fire Module). NumberDetector of stories Power w/heavy Supply damage Detector Effectiveness L1 L3 (50 to 74% flame damage) L5 Required if detector operated. 2 Confined(In area ofto the room fire) of origin 1 Battery only K1 2 Alerted occupants, occupants responded Structure Type Building3 Confined Status to floor of originBuildingSkip to NumberMain of stories Floor w/extreme Size damage Type of material contributing N None Present Section M NFIRS–3 Required only if item 1 2 3 2 4 Hardwire only 2 Alertedmost to flame occupants, spread occupantscontributing code failed is 00 or <70. I If fire was in an enclosed building or a I 4 Confined to buildingI ofHeight origin I (75 to 100% flame damage) 1 Present 3 Plug-in Structure to respond portable/mobile structure, complete the 5 Beyond building Countof origin the roof as part of the rest of this form. Fire 3 There were no occupants 1 Under constructionU Undeterminedhighest story. 4 Hardwire with battery 4 Failed to alert occupants 1 Enclosed building 2 Occupied &Presence operating of Detectors 5 DetectorPlug-in withPower battery Supply Detector Effectiveness 2 Portable/mobile structure L1 Detector Type L6 3 Mechanical, , LU5 RequiredUndetermined if detector operated. 3 Idle, not routinely(In area ofused the fire) Total number of stories at or Total square feet 3 Open structure L2 above grade 7 Multiple detectors & power 4 Under major renovation 1 Battery only 1 DetectorAlerted occupants,Failure Reason occupants responded 4 Air-supported structure N Skip to supplies 5 Vacant and securedNoneNFIRS Present 5.0 Self-StudySection Program M 2 HardwireOR only L62 Alerted occupants, occupants failed 5 Tent 0 Other 6 Vacant1 andSmoke1 unsecuredPresent 3 Plug-in Requiredto respond if detector failed to operate 6 Open platform (e.g., piers) 7 Being demolished U Undetermined 2 HeatU Undetermined 4 ,Hardwire withBY battery, 3 There were no occupants 7 Underground structure (work areas) 0 Other Total number of stories 3 Combination smokebelow grade and heat 5 LengthDetector Plug-inin feet Operationwith batteryWidth in feet 14 PowerFailed failure,to alert shutoff,occupants or disconnect 8 Connective structureSection (e.g., fences) M: Presence of Automatic Extinguishing4 System, U Undetermined L6 Mechanical 2U ImproperUndetermined installation or placement 0 Other type of structure 4 Sprinkler,Detector Type water flow detection 2 3 Defective Type ofL Automatic Extinguishing17 Fire MultipleSystem, too small detectors to activate & power 5 More than one type present 4 LackDetector of maintenance, Failure Reason includes supplies L6 Fire Origin Number0 of StoriesOther Damaged by Flame Type0 of MaterialOther Contributing MostComplete not cleaning Operation1 ofSmoke Automatic Extinguishing2 Operated System, Block L5 Required if detector failed to operate J1 J3 U Undetermined K to FlameU SpreadUndetermined 5 Battery missing or disconnected Count the roof2 as part ofHeat the highest story. Below grade Complete 6 Battery discharged or dead NumberNumber of stories of w/minor Sprinkler damage HeadsCheck3 Operating,if no flameFailed spread toOR operateif 1 Power failure, shutoff, or disconnect Story of 3 Combination smoke and heat Detector Operation Block L6 Skip to (1 to 24% flame damage) same as4 Material First Ignited (Block D4, 0 Other fire origin Fire LModule) OR if unable to determine. Section L 2 Improper installation or placement 4 Sprinkler, water flow detection U U Undetermined Reason for Automatic Extinguishing SystemUndetermined Failure 3 Defective Number5 of storiesMore w/significant than one damage type present 1 Fire too small to activate Fire Spread (25 to 49% flame damage) K1 4 Lack of maintenance, includes 2 0 Other Complete J If fire spread was confined to object of origin, Presence of Automatic ExtinguishingItem2 System contributingOperated most to flame spreadOperation of Automatic not cleaningReason for Automatic do not check a box (Ref. Block D3, Fire Module). NumberMU1 of storiesUndetermined w/heavy damage M3 Block L5 5 BatteryM5 missing or disconnected (50 to 74% flameN damage)None Present Extinguishing System Extinguishing System Failure 6 Battery discharged or dead 2 Confined to room of origin 3 Required if fire was withinComplete designed range 1 Present 2 Complete restFailed of to operate Required if system failed or not effective 3 Confined to floor of origin K Block L6 0 Other Number of 2stories w/extremePartial System damage Present TypeSection of material M contributing1 Operated/effectiveRequired only if item (go to M4) most to flame spread 1 System shut off 4 Confined to building of origin (75 to 100% flame damage) U Undetermined2 Operated/notcontributing code is 00effective or <70. U (go toUndetermined M4) U Undetermined 2 Not enough agent discharged 5 Beyond building of origin 3 Fire too small to activate 3 Agent discharged but did not Type of Automatic Extinguishing System Failed to operate (go to M5) 2 4 You must mark one of theM boxesPresenceRequired in Blockif fireof wasAutomatic withinM1 .designed If no Extinguishing range automatic of AES Systemextinguishing systemOperation was present, of Automatic Reasonreach fire for Automatic Presence of Detectors Detector1 Power Supply Detector Effectiveness0 3 Other 5 L1 L3 M L5 Required if detector operated.M Extinguishing System 4M ExtinguishingWrong type of Systemsystem Failure (In area of the fire)check the None Present box1 andN skipWet-pipeNone the Present restsprinkler of Section M. Complete the otherU partsUndetermined of Section M Required if fire was within designed range 5 Fire not in area protected 2 1 Dry-pipePresent sprinkler 1 CompleteAlerted rest occupants, of occupants responded Required if system failed or not effective only if an extinguishingSkip to 1 systemBattery was only present. N None Present 2 Partial System Present Section M 1 Operated/effectiveNumber of Sprinkler (go to M4) 6 System components damaged Section M 2 Hardwire3 Other only sprinkler system 2 Alerted occupants,4 occupants failed 1 System shut off U Undetermined M2 Operated/notHeads Operating effective (go to M4) 7 Lack of maintenance 1 Present 3 Plug-in4 Dry chemical system to respond 2 Not enough agent discharged 3 Fire too small to activate 8 Manual intervention 4 Hardwire5 Foam with batterysystem 3 There were no occupantsRequired if system operated 3 Agent discharged but did not U Undetermined Type of Automatic Extinguishing System 4 Failed to operate (go to M5) 0 Other 5 MPlug-in26 Required withHalogen-type batteryif fire was within system designed range of4 AES Failed to alert occupants reach fire 0 Other U Undetermined 6 Mechanical7 Carbon dioxide (CO2) systemU Undetermined 4 Wrong type of system Detector Type 1 Wet-pipe sprinkler U NumberUndetermined of sprinkler heads operating L2 Multiple0 Otherdetectors special & power hazard system 5 Fire not in area protected 7 2 Dry-pipe sprinkler suppliesU Undetermined Detector Failure Reason 6 System componentsNFIRS–3 Revision damaged 01/01/06 3 Other sprinkler system L6 Number of Sprinkler 0 Other M4 7 Lack of maintenance 1 Smoke 4 Dry chemical system Required if detector failed to operate Heads Operating U Undetermined 8 Manual intervention 5 Foam system Required if system operated 2 Heat 0 Other 6 Halogen-type system 1 Power failure, shutoff, or disconnect 3 Combination smoke and heat Detector Operation U Undetermined L4 7 Carbon dioxide (CO ) system2 Improper installation or placement 4 Sprinkler, water flow detection 2 0 Other special hazard system3 Defective Number of sprinkler heads operating 5 More than one type present 1 Fire too small to activate U Undetermined 4 Lack of maintenance, includes NFIRS–3 Revision 01/01/06 0 Other 2 Operated Complete not cleaning U Undetermined Block L5 5 Battery missing or disconnected In Block M2 mark the box indicating the type of Automatic Extinguishment System (AES) present. If 3 Failed to operate Complete 6 Battery discharged or dead multiple systems are present, indicate the systemBlock designed L6 0 to protectOther the area where the fire started. The field is requiredU if theUndetermined fire was within the designatedU rangeUndetermined for the AES.

3-10 Structure Type Building Status Building Main Floor Size I1 I2 I3 I4 NFIRS–3 If fire was in an enclosed building or a Height Structure portable/mobile structure, complete the Count the roof as part of the rest of this form. Fire 1 Under construction highest story. 1 Enclosed building 2 Occupied & operating 2 Portable/mobile structure , , 3 Idle, not routinely used Total number of stories at or Total square feet 3 Open structure 4 Under major renovation above grade 4 Air-supported structure 5 Vacant and secured OR 5 Tent 6 Vacant and unsecured 6 Open platform (e.g., piers) 7 Being demolished BY 7 Underground structure (work areas) Total number of stories , , 0 Other below grade Length in feet Width in feet 8 Connective structure (e.g., fences) U Undetermined 0 Other type of structure

Number of stories w/significant damage Fire Spread (25 to 49% flame damage) K1 J2 If fire spread was confined to object of origin, Item contributing most to flame spread do not check a box (Ref. Block D3, Fire Module). Number of stories w/heavy damage (50 to 74% flame damage) 2 Confined to room of origin Structure Type Building Status Building Main Floor Size NFIRS–32 I1 3 I2 Confined to floor of origin I3 I4 K If fire was in an enclosed building or a Height Number of stories w/extreme damage StructureType of material contributing Required only if item most to flame spread portable/mobile structure, complete the 4 Confined to building of originCount the roof as part(75 of the to 100% flame damage) contributing code is 00 or <70. rest of this form. Fire 5 1 BeyondUnder buildingconstruction of origin highest story. 1 Enclosed building 2 Occupied & operating 2 Portable/mobile structure , , 3 Idle,Presence not routinely of Detectors used Total number of stories atDetector or Total Power square feet Supply Detector Effectiveness 3 Open structure L41 Under major renovation above grade L3 L5 Required if detector operated. 4 Air-supported structure (In area of the fire) 5 Vacant and secured 1 Battery only OR 1 Alerted occupants, occupants responded 5 Tent N Skip to 6 Vacant Noneand unsecured Present Section M 2 Hardwire only 2 Alerted occupants, occupants failed 6 Open platform (e.g., piers) 7 Being1 demolishedPresent 3 Plug-in , BY , to respond 7 Underground structure (work areas) 0 Other Total number of stories below grade 4 HardwireLength with in feet battery Width in feet 3 There were no occupants 8 Connective structure (e.g., fences) U Undetermined U Undetermined 4 Failed to alert occupants 0 Other type of structure 5 Plug-in with battery Detector Type 6 Mechanical U Undetermined L2 7 Multiple detectors & power Fire Origin Number of Stories Damaged by Flame Typesupplies of Material Contributing Most Detector Failure Reason 1 3 L6 J J 0 K toOther Flame Spread 1 Count theSmoke roof as part of the highest story. Required if detector failed to operate Below grade Number of stories w/minor damage U CheckUndetermined if no flame spread OR if Story of 2 Heat Skip to (1 to 24% flame damage) same as Material First Ignited (Block D4, fire origin 3 Combination smoke and heat DetectorFire Module) OR Operation if unable to determine. 1 SectionPower L failure, shutoff, or disconnect L4 2 Improper installation or placement 4 NumberSprinkler, of stories water w/significant flow detection damage (25 to 49% flame damage) 3 Defective Fire Spread 5 More than one type present 1 K1 Fire too small to activate J2 If fire spread was confined to object of origin, Item contributing most to flame spread 4 Lack of maintenance, includes Number of stories w/heavy damage do not check a box (Ref. Block D3, Fire Module). 0 Other Complete (50 to 74% flame damage) 2 Operated not cleaning 2 Confined to room of origin U Undetermined Block L5 5 Battery missing or disconnected K2 3 Confined to floor of origin Complete 6 Battery discharged or dead Number of stories w/extreme damage 3 FailedType ofto material operate contributing Required only if item Block L6 4 Confined to building of origin (75 to 100% flame damage) most to flame spread contributing code0 is 00 or <70.Other 5 Beyond building of origin U Undetermined U Undetermined

Presence of Detectors Detector Power Supply Detector Effectiveness L1 LPresence3 of Automatic Extinguishing SystemL5 Required if detector operated.Operation of Automatic Reason for Automatic (In area of the fire) M1 M3 M5 N None Present Extinguishing System Extinguishing System Failure Skip to 1 Battery only 1 Alerted occupants, occupants responded N Required if fire was within designed range None Present Section M 2 1 HardwirePresent only Complete2 rest ofAlerted occupants, occupants failed Required if system failed or not effective Section M 1 Operated/effective (go to M4) 1 Present 3 2 Plug-inPartial System Present to respond 1 System shut off 2 Operated/not effective (go to M4) 4 U HardwireUndetermined with battery 3 There were no occupants 2 Not enough agent discharged U Undetermined 3 Fire too small to activate 5 Plug-in with battery 4 Failed to alert occupants 3 Agent discharged but did not Type of Automatic Extinguishing System 4 Failed to operate (go to M5) M26 RequiredMechanical if fire was within designed range of AES U UndeterminedNFIRS 5.0 Self-Study Program reach fire Detector Type 0 Other L2 7 Multiple detectors & power 4 Wrong type of system 1 Wet-pipe sprinkler U Undetermined supplies Detector Failure Reason 5 Fire not in area protected 2 Dry-pipe sprinkler L6 0 Other 6 System components damaged 1 Smoke 3 Other sprinkler system Required if detector failedNumber to operate of Sprinkler U Undetermined M4 7 Lack of maintenance 2 Heat 4 Dry chemical system Heads Operating 8 Manual intervention 5 DetectorFoam system Operation 1 Power failure,Required shutoff,if system operated or disconnect 3 Combination smoke and heat 0 Other L64 Halogen-type system 2 Improper installation or placement 4 Sprinkler, water flow detection U Undetermined 7 Carbon dioxide (CO ) system 3 Defective 5 More than one type present 1 Fire too small to activate2 0 Other special hazard system 4 Lack of maintenance,Number of sprinkler heads includes operating 0 Other NFIRS–3 Revision 01/01/06 2U OperatedUndetermined Complete not cleaning U Undetermined Block L5 5 Battery missing or disconnected 3 Failed to operateIn Block MComplete4 fill in the6 totalBattery number discharged of sprinkler or dead heads that operated during the fire. This field is Block L6 required if the sprinkler0 systemOther activated. U Undetermined U Undetermined

SUMMARY

The Structure Fire Module is used along with the Fire Module to gather detailed information about larger fire incidents that involve building or portable/mobile structures. Given the information presented, you should know how to document an incident that requires the completion of the Structure Fire Module.

3-11 NFIRS 5.0 Self-Study Program

EXAMPLE: Residential Fire

Directions: Read the call information in the example below. Then look at the completed Structure Fire Module form. Look at each section and follow along with the proper use of the information as applicable to the Structure Fire Module. A smoke detector in the first-floor hallway alerted the residents of a single-family dwelling of a possible problem. They quickly exited out the front door and reported seeing smoke coming from the basement. Children playing with matches started a fire in a small stack of newspapers that were in the basement of a ranch-style home, 30 feet by 50 feet. Luckily they were uninjured. There was fire damage in the basement and smoke damage on the first floor. The detector was hardwired with a battery backup. There was a residential wet-pipe sprinkler system installed throughout the home. One sprinkler head activated and extinguished the fire.

3-12 NFIRS 5.0 Self-Study Program

3-13 NFIRS 5.0 Self-Study Program

EXERCISE SCENARIO 3-1: Warehouse Fire

Directions: Read the call information in the exercise below. Use the information provided to complete the Structure Fire Module form. Compare your work to the answers provided on the completed Structure Fire Module form. If your answers are different from the ones provided, read over the Structure Fire Module again. A fire occurred on the fifth floor of an eight-story, vacant and secured warehouse. The 200- foot by 100-foot fifth floor was damaged by the fire. The sixth story was damaged by smoke. The warehouse was protected by a wet-pipe sprinkler system. Smoke detectors were hardwired through the main power box on the building’s north end. Power to the warehouse was knocked out by an electrical storm moving through the area. Because it was after eight in the evening, no one was in the building to notice that the power was off or that a fire had started near where weld- ers had been working on storage racks. Fortunately, two sprinkler heads activated and quickly extinguished the fire.

3-14 NFIRS 5.0 Self-Study Program

3-15 NFIRS 5.0 Self-Study Program

3-16 NFIRS 5.0 Self-Study Program

EXERCISE SCENARIO 3-2: Cary Street Fire

Directions: Read the call information in the exercise below. Use the information provided to complete the entire Structure Fire Module form and the other required forms. Compare your work to the answers provided in Appendix A. If your answers are different from the ones provided, read over the Structure Fire Module again. The Alberta Fire Department (FDID #92188) received a call for a reported house fire at 5 East Cary Street, Brunswick, Virginia 23351, on May 1, 2005. The dispatcher assigned the incident (#5433) to Engine 1, Engine 2, and Truck 1 from Shift A. The units received the alarm at 12:53 p.m. and arrived at the scene at 1:05 p.m. Each unit was staffed with four firefighters. The owner of the single-family dwelling, Mrs. Christy Gordon, said that she was warming her lunch on the stove when the grease from the pan began to burn. The gas stove was a Whirlpool, Model RF330PXVN, Serial Number F925888840, Year 2000. The fire spread from the pan to the curtains. She had fallen asleep upstairs and was alerted when the hardwired smoke detector activated. The flame damage was confined to the kitchen. The 2,000-square-foot, two-story home was filled with smoke in the other rooms. She called 911. The firefighters extinguished the fire and removed smoke from the other rooms. The fire was brought under control at 1:25 p.m. There was $24,000 fire loss to property and $9,600 content loss. The value of the property was $161,000 and the content value was $80,400. The last unit cleared the scene at 2:40 p.m. FF1 Adam C. Wallner, Badge No. 224, completed the report after returning to Station No. 2. Captain Tonya S. Gordon, Badge No. 105, was the officer in charge. The incident was in Census Tract 5011-12, District A12.

3-17 NFIRS 5.0 Self-Study Program

A MM DD YYYY Delete NFIRS–1 Change FDID Incident Date Station Incident Number Basic State Exposure No Activity

Location Type Check this box to indicate that the address for this incident is provided on the Wildland Fire Census Tract - B Module in Section B, “Alternative Location Specification." Use only for wildland fires. Street address Intersection In front of Number/Milepost Prefix Street or Highway Street Type Suffix Rear of - Adjacent to Apt./Suite/Room City State ZIP Code Directions

US National Grid Cross Street, Directions or National Grid, as applicable

Incident Type Dates and Times Midnight is 0000 Shifts and Alarms C E1 E2 Month Day Year Hour Min Local Option Incident Type Check boxes if ALARM always required dates are the Shift or Alarms District Aid Given or Received None same as Alarm Alarm D Date. Platoon ARRIVAL required, unless canceled or did not arrive Special Studies 1 Mutual aid received Arrival E3 2 Auto. aid received Local Option Their FDID Their CONTROLLED optional, except for wildland fires 3 Mutual aid given State 4 Auto. aid given Controlled Special Special 5 Other aid given Last Unit LAST UNIT CLEARED, required except for wildland fires Study ID# Study Value Their Incident Number Cleared

Resources Estimated Dollar Losses and Values F Actions Taken G1 G2 Check this box and skip this block if an Required for all fires if known. Apparatus or Personnel Module is used. LOSSES: Optional for non-fires. None Primary Action Taken (1) Property $ , , Apparatus Personnel Suppression Contents $ , , Additional Action Taken (2) EMS PRE-INCIDENT VALUE: Optional Other Property $ , , Additional Action Taken (3) Check box if resource counts include aid Contents $ , , received resources.

Completed Modules Casualties None Hazardous Materials Release None Mixed Use H1 H3 I Not mixed Fire–2 Property Deaths Injuries Structure Fire–3 10 Assembly use Fire 1 Natural gas: slow leak, no evacuation or HazMat actions Civilian Fire Cas.–4 20 Education use Service 2 Propane gas: <21-lb tank (as in home BBQ grill) 33 Medical use Fire Service Cas.–5 3 Gasoline: vehicle fuel tank or portable container 40 Residential use Civilian EMS–6 4 Kerosene: fuel burning equipment or portable storage 51 Row of stores 53 Enclosed mall 5 Diesel fuel/fuel oil: vehicle fuel tank or portable storage HazMat–7 Detector 58 H2 6 Business & residential Wildland Fire–8 Required for confined fires. Household solvents: home/office spill, cleanup only 59 Office use 7 Motor oil: from engine or portable container 60 Industrial use Apparatus–9 1 Detector alerted occupants 8 Paint: from paint cans totaling <55 gallons 63 Military use Personnel–10 2 Detector did not alert them 0 Other: special HazMat actions required or spill > 55 gal 65 Farm use U Unknown Arson–11 (Please complete the HazMat form.) 00 Other mixed use

J Property Use None 341 Clinic, clinic-type infirmary 539 Household goods, sales, repairs Structures 342 Doctor/dentist office 571 Gas or service station 131 Church, place of worship 361 Prison or jail, not juvenile 579 Motor vehicle/boat sales/repairs 161 Restaurant or cafeteria 419 1- or 2-family dwelling 599 Business office 162 Bar/tavern or nightclub 429 Multifamily dwelling 615 Electric-generating plant 213 Elementary school, kindergarten 439 Rooming/boarding house 629 Laboratory/science laboratory 215 High school, junior high 449 Commercial hotel or motel 700 Manufacturing plant 241 College, adult education 459 Residential, board and care 819 Livestock/poultry storage (barn) 311 Nursing home 464 Dormitory/barracks 882 Non-residential parking garage 331 Hospital 519 Food and beverage sales 891 Warehouse Outside 936 Vacant lot 981 Construction site 124 Playground or park 938 Graded/cared for plot of land 984 Industrial plant yard 655 Crops or orchard 946 Lake, river, stream Look up and enter a 669 Forest (timberland) 951 Railroad right-of-way Property Use code and Property Use 807 Outdoor storage area 960 Other street description only if you Code have NOT checked a 919 Dump or sanitary landfill 961 Highway/divided highway Property Use box. 931 Open land or field 962 Residential street/driveway Property Use Description NFIRS–1 Revision 01/01/05

3-18 NFIRS 5.0 Self-Study Program

K1 Person/Entity Involved Local Option Business Name (if applicable) Area Code Phone Number

Check this box if same address as incident Mr., Ms., Mrs. First Name MI Last Name Suffix Location (Section B). Then skip the three duplicate address lines. Number Prefix Street or Highway Street Type Suffix

Post Office Box Apt./Suite/Room City

State ZIP Code More people involved? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

Owner Same as person involved? K2 Then check this box and skip the rest of this block. Local Option Business Name (if applicable) Area Code Phone Number

Check this box if same address as incident Location (Section B). Mr., Ms., Mrs. First Name MI Last Name Suffix Then skip the three duplicate address lines. Number Prefix Street or Highway Street Type Suffix

Post Office Box Apt./Suite/Room City

State ZIP Code

L Remarks: Local Option

Fire Module Required? Check the box that applies and then complete the Fire Module based on Incident Type, as follows:

Buildings 111 Complete Fire & Structure Modules Special structure 112 Complete Fire Module & Section I, Structure Module Confined 113–118 Basic Module Only Mobile property 120–123 Complete Fire Module Vehicle 130–138 Complete Fire Module Vegetation 140–143 Complete Fire or Wildland Module Outside rubbish fire 150–155 Basic Module Only Special outside fire 160 Complete Fire or Wildland Module Special outside fire 161–163 Complete Fire Module Crop fire 170–173 Complete Fire or Wildland Module ITEMS WITH A MUST ALWAYS BE COMPLETED!

More remarks? Check this box and attach Supplemental Forms (NFIRS–1S) as necessary.

M Authorization

Check box if Officer in charge ID Signature Position or rank Assignment Month Day Year same as Officer in charge. Member making report ID Signature Position or rank Assignment Month Day Year

3-19 NFIRS 5.0 Self-Study Program

MM DD YYYY Delete NFIRS–2 A Fire Change FDID State Incident Date Station Incident Number Exposure

Property Details On-Site Materials Complete if there were any significant amounts of commercial, industrial, energy, or agricultural products or B C or Products None or materials on the property, whether or not they became involved Enter up to three codes. Check one box for each code On-Site Materials Not Residential entered. Storage Use B1 Estimated number of residential living units in 1 Bulk storage or warehousing 2 Processing or manufacturing building of origin whether or not all units 3 Packaged goods for sale became involved 4 Repair or service On-site material (1) U Undetermined

Buildings not involved 1 Bulk storage or warehousing B2 2 Processing or manufacturing Number of buildings involved 3 Packaged goods for sale 4 Repair or service On-site material (2) U Undetermined

None B3 , 1 Bulk storage or warehousing Acres burned (outside fires) Less than one acre 2 Processing or manufacturing 3 Packaged goods for sale 4 Repair or service On-site material (3) U Undetermined

Ignition Cause of Ignition Human Factors D E1 E3 Check box if this is an exposure report. Skip to Contributing to Ignition Section G Check all applicable boxes D1 1 Intentional None Area of fire origin 2 Unintentional 1 Asleep 3 Failure of equipment or heat source 2 Possibly impaired by 4 Act of nature alcohol or drugs D2 Heat source 5 Cause under investigation 3 Unattended person U Cause undetermined after investigation 4 Possibly mentally disabled 5 Physically disabled 3 Factors Contributing to Ignition None D E2 6 Multiple persons involved Item first ignited 1 Check box if fire spread was confined to object of origin. 7 Age was a factor D4 Factor contributing to ignition (1) Estimated age of Type of material first ignited Required only if item first person involved ignited code is 00 or <70 Factor contributing to ignition (2) 1 Male 2 Female

Equipment Involved in Ignition Equipment Power Source Fire Suppression Factors None F1 F2 G Enter up to three codes. None If equipment was not involved, skip to Section G Equipment Power Source

Fire suppression factor (1) Equipment Involved Equipment Portability F3 Brand 1 Portable Model Fire suppression factor (2) 2 Stationary Serial # Portable equipment normally can be moved by one or two persons, is designed to be used in Year multiple locations, and requires no tools to install. Fire suppression factor (3)

Mobile Property Involved None Mobile Property Type and Make Local Use H1 H2 Pre-Fire Plan Available 1 Not involved in ignition, but burned Some of the information presented in this report may be based upon reports from other agencies: Mobile property type 2 Involved in ignition, but did not burn 3 Involved in ignition and burned Arson report attached Mobile property make Police report attached Coroner report attached

Mobile property model Year Other reports attached

License Plate Number State VIN

Structure fire? Please be sure to complete the Structure Fire form (NFIRS–3). NFIRS–2 Revision 01/01/05

3-20 NFIRS 5.0 Self-Study Program

3-21