SOP_NUMBER: 511.09-att-2
TITLE: Institutional Fire Incident Report
REFERENCE_CODE: IVN06-0001
DIVISION: Facilities
TOPIC_AREA: 511 Policy-Fire Services
EFFECTIVE_DATE: 2020-09-23
WORD_COUNT: 153
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105858
URL: https://gps.press/sop-data/511.09-att-2/

SUMMARY:
This form is used to report all fires occurring at GDC facilities to the GDC Fire Services office within 24 hours of the incident, as required by Georgia Safety Fire Commissioner regulations. The report collects critical information about the fire including location, extent of damage, injuries or deaths, known and probable causes, and responding fire department details. Suspected incendiary fires must be reported immediately.

KEY_TOPICS: fire incident report, fire reporting, institutional fire, fire damage, fire investigation, incendiary fire, fire safety, life safety, facility fires, fire documentation

ATTACHMENTS:
  1. Emergency Response Plan Fire Safety Checklist
     URL: https://gps.press/sop-data/511.09-att-1/
  2. Institutional Fire Incident Report
     URL: https://gps.press/sop-data/511.09-att-2/

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FULL TEXT:
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SOP 511.09
Attachment 2

9/23/20

**GDC Fire Services and Life Safety**

**300 Patrol Rd.**
**P. O. Box 1529**
**Forsyth, GA 31029**

**INSTITUTIONAL FIRE INCIDENT REPORT**

**In accordance with the Rules and Regulations of the Georgia Safety Fire Commissioner**
**Chapter 120-3-6, Paragraph 120-3-6-.03 every fire must be reported to the GDC Fire Services**
**office within twenty-four (24) hours of the incident. This form shall enable you to report and**
**to provide the necessary details of the incident.** **Report suspected incendiary fires**
**immediately.**

**Name of Facility:**

**Address:** **City: ________________**

**Number of Stories:        Number of Patients: ________**

**Date of Fire:** **Time of Fire: _______**

**Location** **of** **Fire** **in** **Building:** **_____________________________________**

**Extent of Damage to affected area:**

|Name|Sex|DOB|Extent of Injury|
|---|---|---|---|
|**1.**||||
|**2.**||||
|**3.**||||
|**4.**||||
|**5.**||||



**Injuries and/or Deaths**
**Known Cause of Fire:**

**Probable Cause of Fire:**

**Name of Fire Department Responding:**

**Signature of Administrator: _______________________  Date: __________________**


Retention Schedule: Upon completion, this form shall be retained by the Chief of Security for two (2) years **.**