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Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320 336-349-1024 
07907NC08/31/2004FS3200400150200
FDIDStateIncident DateExposure
NFIRS -1Basic
ABCDE
1
E
2
1 Street address
Location
1401WHARRISONSTREIDSVILLENC27320-RAMP
Number/MilepostPrefixStreet or HighwayStreet TypeSuffixCensus TractApt./Suite/RoomCityStateZip CodeCross Street or DirectionsSee Wildland Fire Module for Location
Incident Type
424 Carbon monoxide incident
Aid Given or Received
N None
Dates & TimesShifts & Alarms
08/31/200408:31:2308/31/200408:31:23: :08/31/200409:15:12D01
ArrivalControlledLast UnitClearedDateTime
Shift orDistrict
FG
1
G
2Action TakenResourcesEstimated Dollar Losses & Values
86 Investigate42 HazMat detection, monitoring, sampling, &
Primary Action Taken (1)Additional Action Taken (2)Additional Action Taken (3)
000022
SuppressionEMSOtherApparatusPersonnel
LOSSES:PRE-INCIDENT VALUE:
PropertyContents
00
PropertyContents
00
H
1
Casualties
ServiceCivilianDeathsInjuries
H
2
Detector
H
3
Hazardous Materials Release
I
Mixed Use Property
N NoneNN Not mixed use
J
Property Use
593 Office: veterinary or research
platoonIncident Type
xx
Local Option
E
3Special Studies
Local OptionSpecialStudy ID#SpecialStudy ValueCheck this box and skip this section if anApparatus or Personnel form is used.Check box if resource counts include aidreceived resources.Required for all fires if known.
$$$$
xxxx
None
Optional for non fires.
Fire
None
x
Completed Modules
Fire-2Structure-3Civilian Fire Cas.-4Fire Serv. Casualty-5EMS-6HazMat-7Wildland Fire-8Apparatus-9
x
Personnel-10
x
Arson-11
M
Authorization
530 DJohn E HarrisBATTCHC508/31/2004530 DJohn E HarrisBATTCHC508/31/2004
Officer in charge IDRankAssignmentDateMember making reportRankAssignmentDateSignatureSignatureID
x
Check box ifsame asOfficer inchargeStationIncident NumberAlarms
Dispatch
 
REIDSVILLE VETERINARY HOS
Local OptionBusiness name (if applicable)
K
1Person/Entity Involved
Check this box ifsame address asincident location.Then skip the threeduplicate addresslines.
(336) 349-3194
Phone Number
DR
Mr., Ms., Mrs.
JOSEPH
First NameMI
KINNARNEY
Last NameSuffix
1401
Number
W
Prefix
HARRISON
Street or Highway
ST
Street TypeSuffixPost Office BoxApt./Suite/Room
REIDSVILLE
City
NC
State
27320-
Zip Code
REIDSVILLE VETERINARY HOS
Local OptionBusiness name (if applicable)
K
2Owner
Check this box ifsame address asincident location.Then skip the threeduplicate addresslines.
(336) 349-3194
Phone Number
DR
Mr., Ms., Mrs.
JOSEPH
First NameMI
KINNARNEY
Last NameSuffix
1401
Number
W
Prefix
HARRISON
Street or Highway
ST
Street TypeSuffixPost Office BoxApt./Suite/Room
REIDSVILLE
City
NC
State
27320-
Zip CodeLocal Option
L
Remarks:
FM HARRIS AT REQUEST OF RCSD AND RCFMO ARRIVED AT ABOVE LOCATION TO CHECKPOTENTIAL CARBON MONOXIDE PROBLEM. UPON ARRIVAL FM HARRIS AND BATTALION CHIEFJ. WILLIAMS SPOKE WITH CAPT. BOBBY LAWSON AND ANIMAL CONTROL OFFICERS WHOREQUESTED THAT THE EUTHANASIA CHAMBER USED AT THE ABOVE LOCATION BE CHECKED FORPOSSIBLE CARBON MONOXIDE LEAKS DURING OPERATION. FM HARRIS CHECKED THE CHAMBERFINDING THAT THE DOOR SEALS TO THE CHAMBER WERE IS DIS-REPAIR AND DAMAGED INSEVERAL LOCATIONS, HARRIS ALSO OBSERVED WHERE ATTEMPTS TO REPAIR THE SEALS WEREMADE WITH WHAT APPEARED TO BE CAULKING. ALSO NOTED THAT THE INTEGRAL SAFETYSYSTEMS FOR MONITORING CARBON MONOXIDE LEVELS HAD BEEN DISABLED ( HORNACTIVATION AT 100 ppm DISABLED ). VENT PIPE FROM THE TOP PORTION OF THE CHAMBERIS POORLY FITTED AND SEALED WITH WHAT APPEARS TO BE ADHESIVE TAPE. DURINGOPERATION OF THE EUTHANASIA CHAMBER CARBON MONOXIDE MONITORS WERE USED TO TEST
x
Same as person involved?Then check this box and skipthe rest of this section.
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320 336-349-1024 
Incident: 2004001502-00
07907NC08/31/2004FS3200400150200
FDIDStateIncident DateStationIncident NumberExposure
NFIRS - 1S
K
Supplemental
DeleteChange
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320 336-349-1024 
K
Person/Entity Involved
MR
Mr., Ms., Mrs.First NameApt./Suite/RoomPost office box
ROCKINGHAM CO. SHERIFF
Business name if applicableCity
BOBBYWENTWORTHNC
MIState
(336) 634-3030
Phone NumberZip Code
27375-
3
Last Name
LAWSON
Suffix
1088
NumberPrefix
HWY 65
Street of highwayStreet TypeSuffixCheck this box ifsame address asincident location.Then skip these threeduplicate addresslines.
 
Local Option
L
Remarks:
LEVELS PRESENT ADJACENT TO THE CHAMBER, TWO SEPARATE METERS WERE USED ( MSA-MINICO RESPONDER, AIMS 350 MULTI GAS METER ) DURING OPERATION, CARBONMONOXIDE LEVELS EXCEEDED 984ppm IN THE AREA OF THE CHAMBER, INTEGRAL ALARMLIGHTS ACTIVATED AT 35ppm AND AGAIN AT 100ppm. THE AUDIBLE WARNING DID NOTACTIVATE. AFTER THE COMPLETED CYCLE DURING PURGE READINGS WERE FOUND AT 243ppmAT THE VENT PIPE ABOVE THE CHAMBER, AND AT 28 ppm IN THE ADJOINING ROOM. UPONCOMPLETION OF ALL CYCLES, AFTER THE PURGE CYCLE DURING REMOVAL OF ANIMALS AREADING OF 460ppm STILL REMAINING IN THE CHAMBER AS OFFICERS REMOVED ANIMALS.FM HARRIS AND CHIEF WILLIAMS ADVISED CAPT. LAWSON OF THE RESULTS AND ADVISEDTHAT THE CHAMBER SHOULD NOT BE USED, THAT IT WAS A CLEAR DANGER TO THOSEOPERATING IT WITH CARBON MONOXIDE LEVELS PRESENT 28 TIMES THE MAXIMUM ALLOWABLECONCENTRATION FOR CONTINUOUS EXPOSURE, CAPT. LAWSON ADVISED HE CONTACTED DR. J.KINNARNEY WHO WOULD CONTACT THE MANUFACTURER FOR REPAIRS. A COPY OF THE RFDCARBON MONOXIDE NOTICE OF FINDINGS WAS SIGNED AND LEFT WITH DEPUTY W.LeSUERALONG WITH AN MSA CO DOSEMETER TUBE LEFT AT THE SITE FOR FURTHER EVALUATION. FMHARRIS ADVISED THAT THE CHAMBER SHOULD NOT BE USED UNTIL REPAIRS WERE MADE ANDUNIT TESTED.
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