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Fire Report Request Form

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Columbia Fire Department

BUREAU OF FIRE INVESTIGATION

1800 Laurel Street,

Columbia,

29201

Phone: (803)-545-4276 Fax:

(803) 733-8311

FIRE REPORT REQUEST FORM

Type of Fire Report(s) Requested

FIRE INCIDENT

REPORT

(NFIRS): Report

generated

the

Incident Commander under

the rules and

guidelines

the National Fire Incident

Reporting

System.

Please indicate how

you would like

to receive the report:

U.S. Mail

Pick-up

(Please call to confirm if report

is ready)

FIRE INVESTIGATION REPORT (FIR)

: Report generated

when

CFD Fire Investigators are dispatched to

perform

origin

and

cause

investigation.

determ

ine

the ava ilab

ility

FIR,

please call

(803)-545-3701.

Please note: Depending

the complexity and other factors of an

incident,

FIR

may

not

completed for

weeks

months.

If applicable, a FIR may be

withheld

from

disclosure

pursuant

Government

Code Title-30

and

SC CHAPTER

-Public Records -SECTION 30-4-40

Please indicate how

you

would

to receive the

report:

U.S.

Mail

Pick-up

(Please call to confirm if

report

ready)

SUBPOENAING

MEDICAL

RECORDS

I understand that I have the

right

to inspect

and

copy

the information

that

to be

used

disclosed as part

of this authorization.

hereby

authorize

the disclosure of the following information pertaining

the incident date

below:

Please indicate

how you would

like to

receive

the report:

My entire

MEDICAL

Record

and any accompanying

documents

entire

BILLING

Record

MEDICAL

Record Limited to:

MY BILLING Record limited to:

Incident

Information

Type

of Incident:

CFD Incident# (if known):

(Buildinq,

Vehicle, etc.)

Incident Date:

Approximate

Time:

Address

Intersection:

Requester Information

Name:

Phone#:

Company:

Email:

Mai

ling Address:

City:

State:

Zip Code:

Interest in

incident/Reason

for Request:

(

Victim~

Insurance Co, Media,

etc.)

Signature:

Date:

INTERNAL USE ONLY

Mail

request

to:

Columbia

Fire

Department

Attn:

Fire

Analysis Specialist

Incident#:

1800

Laurel Street

Columbia, SC 29201

Date

request

received:

Or emai

to:

Date

provided/

mailed:

Initials:

Revise

d 10/30/16

Submit Form

Fire Report Request Form

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