GENERAL FIRE INFORMATION
Fire Date (YYYY-MM-DD) / Incident Number / Fire Centre / Fire Zone
Geographic Location
Legal Description of Area of Ignition
Latitude[e.g.: 50 47.201] / Longitude[e.g.: 119 33.301] / Approx. Fire Ignition Time (24 hr) / Fire Report Time (24 hr) / Fire Attack Time (24 hr)
I/C Responding / Aspect / Elevation / Date (YYYY-MM-DD) / Time (24 hr)
OWNER / OCCUPANT
Tenure Holder / Owner/ Occupant
Name / Contact / Contact Office # / Contact Cell #
Address and e-mail
ORIGIN AND CAUSE REPORT DETAILS
O&C Report Completed name(s) / Fire Investigator Certification / Assigned Date (YYYY-MM-DD) / Time (24 hr) / Field Work Completion Date (YYYY-MM-DD)
Type I / Type II
Other Certification Explain:
REPRESENTATIVE WEATHER STATION
Weather Station Name / Weather Station Elevation / Aspect
Precipitation (24 hr) / Temperature (C°) / Relative Humidity % / Wind Speed km/ph / Wind Direction (deg.)
Fine Fuel Moisture Code / Duff Moisture Code / Drought Code
Initial Spread Index / Build Up Index / Fire Weather Index / Danger Class
Description of Weather at Time of Ignition
ONSITE WEATHER
Precipitation (mm) / Temperature (C°) / Relative Humidity % / Wind Speed (km\ph) / Wind Direction(deg.)
Comments:
Information obtained from source:
WITNESSES
Surname / Given Name(s) / Statement Taken (Y/N) / Mailing Address / e-mail address / Contact Number
Other Agencies Involved / Statement Taken (Y/N) / Address / Contact Number

FS1348 HPR 2013/05

FIRE CAUSE ELIMINATION AND EXPLANATION
Natural / LIGHTNING
Open Burning / CAMPFIRE
CATEGORY 2, 3, or RESOURCE MANAGEMENT OPEN FIRE
Incendiary / ARSON/SUSPICIOUS (Include RCMP or other Agency File No.)
JUVENILE FIRE SETTER / FIRE USE
Mechanical / EQUIPMENT USE (Explain)
RAILROADS (Explain)
VEHICLE
ELECTRICAL TRANSMISSION/UTILITY LINE/POLE
Smoking / DISCARDED MATCH OR SMOKING SUBSTANCE
Miscellaneous / SPECIFY CAUSE
CAUSE UNDERTERMINED (Explain)

FS1348 HPR 2013/05

FIRE ORIGIN AND CAUSE INFORMATION
Photos taken
Y N / Site Map/Sketches
Y N / Evidence Collected
Y N
SUMMARY OF FINDINGS
IGNITION AREA DESCRIPTION
IGNITING OBJECT (if known)
FORM OF HEAT OF IGNITION
MATERIAL FIRST IGNITED
DETERMINED CAUSE
REFERENCE PHOTOS

FS1348 HPR 2013/05

FIRE ORIGIN AND CAUSE INFORMATION
CONCLUSION / COMPLETE APPLICABLE BOXES
Based on the field examination, evidence gathered and a complete review of the facts, I offer the following comments: / Suspected / Confirmed
Y / N / N/A / Y / N / N/A
Completed by (Print name) / Title / Signature (Handwritten or Electronic Only) / Date (YYYY-MM-DD)

This report may contain both personal and sensitive information and must be securely stored at all times, and may only be disclosed in accordance with the Freedom of Information and Protection of Privacy Act.

FS1348 HPR 2013/05