Fillable Wildland Fire Fatality and Entrapment INITIAL REPORT (National Wildfire Coordinating Group)

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Wildland Fire Fatality and Entrapment INITIAL REPORT (National Wildfire Coordinating Group)

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PMS 405-1 (01/2016) Page 1 of 2
Wildland Fire Fatality and Entrapment
INITIAL REPORT
Complete this report for fire-related entrapment and/or fatalities. Timely reporting of wildland-related
entrapments or fatalities is necessary for the rapid dissemination of accurate information to the fire
management community. It will also allow fire safety and equipment specialists to quickly respond to
these events as appropriate. This initial report does not replace agency reporting or investigative
responsibilities, policies, or procedures. Immediately notify the National Interagency Coordination Center
(NICC) Coordinator on Duty (COD) by phone, and then submit this written report to NICC within 24
hours—even if some data are missing—to the address given below.
NICC—National Interagency Fire Center Phone: 208–387–5400
3833 South Development Ave. Fax: 208–387–5414
Boise, ID 83705 Coordinator on Duty email: COD@blm.gov
Submitted by: Position:
Agency: Location:
Phone: E-mail:
1. General Information
Date of event: Time:
Number of personnel involved:
Number of Injuries: Fatalities:
Fire name, location, agency, etc.:
2. Fatalities
Type of accident:
Aircraft Vehicle Natural (lightning, drowning, etc.) Smoke
Medical (heart, stroke, heat, etc.) Entrapment Struck by falling object
Where fatality/entrapment occurred:
Fire site In transit Incident base Other
Note: In the event of fatality(s), do not release name(s) until next of kin are notified.
Employing agency:
Unit name:
Address:
For further information, contact:
Phone:
Page 2 of 2 PMS 405-1 (01/2016)
3. Fire-Related Information
Fuel Model:
Incident management type at time of the incident/accident: (check one)
1 2 3 4 5
Temperature: RH: Wind: Mph
Topography: Urban/wildland intermix?: Yes No
Slope: %
Fire size at the time of the incident/accident: acres
Cause of fire: Natural Incendiary Accidental Unknown
4. Entrapment Information
A situation where personnel are unexpectedly caught in a fire-behavior-related, life-threatening
position where escape routes or safety zones are absent, inadequate, or have been compromised.
An entrapment may or may not include deployment of a fire shelter. Note: Engine and dozer
burnovers also constitute entrapments.
Brief description of the accident:
Entrapment Description
Person trapped: With shelter Without shelter
Burns/smoke injuries while in shelter Yes No
Burns/smoke injuries while escaping entrapment Yes No
Burns/smoke injuries incurred while fighting fire Yes No
Fire shelter performed satisfactorily Yes No
Fire shelter was available, but not used Yes No
Personal Protective Equipment Used
Fire shelter Yes No
Gloves Yes No
Protective pants Yes No
Boots Yes No
Protective shirt Yes No
Goggles Yes No
Face/neck protection Yes No
Hardhat Yes No
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Wildland Fire Fatality and Entrapment INITIAL REPORT (National Wildfire Coordinating Group)

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Completed 10 August 2020

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