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National Association of Fire Equipment Distributors
Portable/Wheeled Fire Extinguisher Incident Report

Distributor
Location

Date of Report

Date of Incident

Indicate quantity and type of extinguisher(s) used.

Classification(s) of Fire:

Class A

Class B

Class C

Class D

Class K

Types of Occupancy:

Did extinguisher(s) extinguish fire?

YES

If NO, how was fire extinguished?

	Sprinkler System			Fire Department			Self-Extinguished
	Other Suppression System			Occupant Use Hose			Other

If extinguisher failed to extinguish fire, why?

Fire Too Large	Extinguisher Not Full	Extinguisher Malfunction (see below)
Operator Error	Extinguisher Not Pressurized	Unkown
Operator Not Trained	Wrong Type of Extinguisher	Other

Reason for malfunction:

	No Maintenance			Valve Failed to Open			Other
	Improper Recharge			Unknown

Was Fire Department Called?		YES		NO		If YES, was Fire Department needed?		YES		NO
Was fire area sprinklered?		YES		NO		If YES, did sprinklers operate?		YES		NO

Additional Information:

FAQ