East Bank Fire Dept.

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East Bank Fire Dept.

Please add your full name, rank and unit number under My Account before submitting reports.

New Incident Report

Reporting Member

Incident Details

Incident / Run #

Incident Type

Incident Date

Dispatch Time

Clear Time

Incident Location (physical address)

Owner Information

Owner Name

Owner Phone

Owner Address

Vehicle

Required for auto accidents and vehicle fires.

Year

Make

Model

VIN

Plate / Other Vehicle Details (optional)

Commercial Vehicle Commercial vehicle involved (tractor trailer, box truck, tanker, bus, etc.)

Insurance

Insurance Company

Policy Number

Agent Name (helpful)

Agent Phone (helpful)

Additional People / Vehicles / Insurance

The owner, vehicle and insurance above are the first party. If more people, vehicles or insurance companies were involved (another driver, a second vehicle, a property owner), add each one here.

Apparatus on Scene

Select every unit that responded.

Mutual Aid (departments / units, if any)

Specialty Equipment Used (optional)

Services Provided

Other Services

Supplies Used

Other Supplies / Quantities

Damaged Equipment

Insurance companies will sometimes reimburse for equipment damaged on scene. List the name, type and cost to fix or replace each item.

Narrative of the Incident

Billing Decision

How should the billing company bill this incident? (first party; additional parties have their own choice)

Notes for the Billing Company (optional)

Scene Photos

Up to 12 photos per report. Large photos are resized automatically.

Fields marked * are required by the billing company. Press Validate to check what's missing.

Finished? Submit Report checks that everything the billing company needs is filled in. Not done yet? Save Draft and come back to it from Saved Reports.

Date	Incident	Owner / Insurance	Bill To	Status
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