Oregon Fire Service Conflagration Request Form

Oregon Fire Service Conflagration Request Form

PART I

Incident Information

Incident Name/Number:______Date/Time:______

Incident Location/Community/County Threatened:______

Authority Having Jurisdiction:______

Local Fire Department Contact:______

Fire Defense Board Point of Contact:______

Has Deputy SFM been contacted? Yes No Deputy SFM Point of Contact:______

Has County Emergency Manager been contacted? Yes No Co Emergency Mgr:______

Community Wildfire Protection Plan? Yes No

Type of Emergency

Structure Fire Interface Fire Act of Terror Major Disaster

Explain:______

Current Incident Size or Area Involved:______

*Situation Description:______

Current Objectives:______

GPS Location of Incident:______

Other Agencies Involved:______

Current Weather:______

Projected Weather:______

Current Incident Complexity Level: Type 1 Type 2 Type 3 Type 4

Expected Incident Complexity Level: Type 1 Type 2 Type 3 Type 4

Significant Events:______

*Evacuations Taking Place: Yes No Evacuation Plans in Place: Yes No

Describe:______

*Life Threatening Situations: Yes No

Describe:______

*Road/Highway/Freeway Closures: Yes No

Roads Affected:______

*Population Affected:______

*Number of Commercial Structures Threatened:______

*Number of Residential Structures Threatened:______

*Number of Subdivisions:______

*Significant Historical and/or Cultural Resources:______

*Natural Resources Such as Crops; Grazing; Timber; Watersheds:______

*Critical Infrastructure; Major Power Lines; Railroad:______

Incident Growth/Potential:______

Communications/Challenges Currently Established:______

*Confirmation that Local, Automatic, and Mutual aid Resources are Depleted: Yes No

Current Resources Assigned:______

Describe Contributing Factors:______

PART II

Incident Support Information

Types of Resources Being Requested:______

Public works Involvement: Yes No

What Resources:______

Disaster and Emergency Services Involvement: Yes No

What Resources:______

Law Enforcement Resources Involved: ______

Other County and Local Government Services Involved:______

Volunteer Services, (American Red Cross, Amateur Radio etc.):______

Fuel Services Including Gasoline; Diesel; oil Available:______

Certified Fire Apparatus Repair Locally Available:______

Water Supply Available:______

Location(s) Where Responding Resources are to Report to:______

PART III

Logistical Support Services

Please check the boxes next to the services that are already in place/available and provide more information as appropriate.

Food Services ______

Rehabilitation Area(s) ______

Staging Area(s) ______

Sanitary Facilities ______

Drinking Water ______

Map(s) of the Area ______

Traffic Control Plan(s) ______

GIS Support ______

Fuel Services ______

Security ______

Public Information Officer ______

Communications ______

Other Considerations:

______

OSFM Fax (503) 373-1825 OERS Phone 800-452-0311