Northwest Fire District Near-MissReporting System

Reporter Information
Rank:
Civilian Employee
Firefighter
Engineer
Paramedic
x Captain
Incident Safety Officer
Chief Officer / Total years job experience at time of event
0-1 year
2-4
5-10
10-20
x > 20
Event Information
Event Type (select one)
Fire Event
EMS Event
Special Ops Event
On Duty Activity
x Training Activity
Vehicle Driving Event
Other Click here to enter text.
What was your participation?
x Involved
Witnessed event but not directly involved
Told of event, but neitherinvolved nor witnessed event
Requested to or submitted by ISO
Approximate time of event (24 hr clock) enter four digits
0930 / Loss Potential
Environmental
Life Threatening Injury
x Lost Time Injury
Minor Injury
Property Damage
Unknown/other Click here to enter text.
Contributing Factors (up to 5)
Accountability
Command
Communications
Decision Making
x Equipment
Fatigue
Horseplay
Human Error
Individual Action
In a Hurry
Lack of SOP/Policy
Situational Awareness
Deviation from SOP/Policy
Staffing
Task Allocation
Teamwork
Training Issue
Weather
Other Click here to enter text.
Do you think this can happen again without further action to prevent it?
x Yes
No
Unsure
Event Description
Describe the event
Describe the event in the space below. Keep in mind the following when preparing your narrative:
Chain of event Equipment Sleep patterns Staffing Training
Communication Incident command Situational awareness Task allocation Weather
Decision making Role SOP Teamwork
EN331 went to the training center for pumping drills. EN331 hooked up to a hydrant for the drill. FF then noticed a “hissing” sound from the hydrant. FF noticed the sound was coming from the 5” Stortz adaptor at the hydrant. He shut down the hydrant then checked to make sure the connection was seated properly.Everything looking normal. FF then re-opened the hydrant and noticed the 5” Storz adaptor was separating. Frank shut down the hydrant immediately.
Lessons Learned
What lessons were learned? Keep in mind the following when preparing your narrative:
Chain of event Equipment Sleep patterns Staffing Training
Communication Incident command Situational awareness Task allocation Weather
Decision making Role SOP Teamwork
FFpayed attention to a sound that was not familiar. Noticed the 5” Stortz adaptor was coming apart and promptly shut down the hydrant. FF was standing behind the hydrant and wearing proper PPE for the drill.
Follow up (to be filed out by HSO only)
Immediate action required
Yes
No
State of investigation report
Not started (default)
In progress
Completed
Health/Safety Work Group review status
Yes
No (default)
Status of recommended actions
Not begun (default)
In progress
Completed
Status of report
Open (default)
Closed
Follow up investigation/recommendation report (filled out by HSO only)
Click here to enter text.