1994, 01-17 Incident: 930217 Fire Dept ReportSPOKANE COUNTY FIRE PROTECTION DISTRICT NO.1
SPOKANE VALLEY FIRE DEPARTMENT
INCIDENT REPORT
EMS E]
ADDITIONAL ❑
REPORT
DATE
PAGE _OF
�,�'�1
TIME
ZONE
DISPATCHED
ADDRESS /LOC TION
�1- 1 NJ, V"")
INCIDENT NUMBER
93.0.1,1
.ALL
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IN SERVICE \VO I
FIRST CO
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SIi TION ND
MUTUAL AID
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SPEC STUDIES
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CODE
ADDRESS
NAME' LAST, FIRST, M.1.
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D.O.B.
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VFIIRRS
WORK/\
PHONE: HOME R 4
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CODE
ADDRESS:
NAME: LAST, ''
, M. I. `� 1
�Y
D.O.B.
COMPLETE FOR ALL FIRES
PHONE: HOME; WORK;
AREA 0 ORIGIN
PROBABLE USSEEj ESTIMATE OF LOSS DE N SYS EM
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EXTINGUU II S1HIN YSTEM
I
INSURILD14 E C PANY:
I AGEN, T:
PHONE:
MORTGAGE COMPANY / LIEN HOLDER
VEHICLE INVOLVED -
PHONE:
YEAR MAKE:
MODEL: LICENSE NUMBER:
STATE:
PATIENT
NUMBER OF -
BLS EMS
__EXAM CPR
PROCEDURES: WOUND CARE
_02 SPLINTING - "C" COLLAR _OTHER
MECHANISM TYPE PATIENT
-__ __ TRANSPORT: TO: - BY:
NARRATIVE
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PERSONNEL AT ENE:
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MEMB MAKING REPORTS
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