Report an On Duty Death

Submitted by dclewis1 on Wed, 08/12/2020 - 08:49

In the event of a fatality in your department or squad, immediately complete the form below. In the event you cannot complete this form, please call the State Fire Marshal's Office at 800-634-7854. You will be greeted by a voice menu, press "0" for the operator and ask to speak to someone about reporting an On Duty Death.

Indicates required field

Fatality Information

Date of Incident

Rank

First

Last

Comment

To assist with data collection, please provide a brief description of the incident and the probable cause, if known.

Report second fatality

Rank

First

Last

Comment

To assist with data collection, please provide a brief description of the incident and the probable cause, if known.

Report third fatality

Rank

First

Last

Comment

To assist with data collection, please provide a brief description of the incident and the probable cause, if known.

Fire Department - Rescue Squad Information

Fire Dept - Rescue Squad

Address

City/Town

State/Province

ZIP/Postal Code

County

Phone

Reporting Person's Contact Information

Rank

First

Last

Phone

You will be contacted for additional information about this event.

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