Ahca Fire Incident Report
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1
2RICK SCOTT
ELIZABETH DUDEK
GOVERNOR
SECRETARY
OFFICE OF PLANS AND CONSTRUCTION
TEL: 850/412-4477
FAX: 850/922-6483
FIRE INCIDENT REPORT
(Complete and return one copy to the Office of Plans and Construction and one copy to
the appropriate Agency Field Office within 10 to 15 days of the incident)
Name of Facility:
Address of Facility:
Date and time of fire or explosion:
Location of fire within facility:
Name and title of person reporting fire:
Alarm/Signal device used:
Pull Alarm
Detector
Phone
Was evacuation of facility necessary: Yes
No
If yes, how many were
evacuated:
Was smoke compartmentation utilized for evacuation? If so, describe.
Were there any deaths?
Yes
No
Were there any injuries?
Yes
No
If yes, how many and describe
injuries.
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V i s i t A H C A o n l i n e a t
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