CAMPUS FIRE REPORT
ENVIRONMENTAL HEALTHAND SAFETY
777 GLADES ROAD, BLDG 69, ROOM 112
BOCA RATON, FL 33431-0991
(561)297-3129, FAX (561)297-2210
Email: ehs@fau.edu Web Page: www.fau/ehs
Environmental Health and Safety would greatly appreciate notification of all fires whether or not any damage
was done to any structure or contents. This information will be used to make improvements in the Campus Fire
Safety Program and is not intended to be used for any punitive actions.
PLEASE FAX THIS FORM TO (561) 297-2210
INCIDENT DATE
AND TIME:
CAMPUS:
BUILDING NAME
AND NUMBER:
BUILDING USE:
TYPE OF
INCIDENT:
FIRE DEPARTMENT
 Y
RESPONSE:
 N
 Residence Halls
 Academic
 Support Services
 Nuisance Fire
 Electrical Fire
 Structural Fire
 Other – Please Provide a
Brief Description in the
Narrative Section
ACTION TAKEN:
 None, out on arrival
 Extinguished by campus personnel
 Extinguished by Fire Department
FIRE
INVESTIGATION:  Y
 N
INVESTIGATING
AGENCY:
INJURIES:
FIRE
SEVERITY:
 No Damage
 Damage to Item of Fire Origin
 Damage to Room/Area
 Damage to Multiple
Rooms/Areas
 Damage to Entire Structure
PLEASE INDICATE NUMBER OF EACH
MINOR
MODERATE
SEVERE
FATAL
NARRATIVE – Please Provide a Brief Description of the Incident:
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REPORT COMPLETED BY
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TITLE
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SIGNATURE
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DATE