Notification of Fatality Report

Notification of Fatality Report

Date of Fire*

Time of Fire*

Incident Address*

County*

Select

Victim Age*

Victim Gender*

Working Smoke Detectors?*

Yes

No

Type

Coroner Name*

Coroner Contact Phone Number*

Coroner Case Number*

Fire Department*

Fire Department Contact Phone Number*

Investigator Name*

Investigator Contact Phone Number*

Cause of Fire*

Fire Department Case Number*

Comments*

Did the State Fire Marshal's Investigations Section also investigate this incident?*

Yes

No

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