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Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320 336-349-1024 
07907NC10/06/2004FS3200400169200
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
10/06/200411:00:4710/06/200411:00:47: :10/06/200411:39:45D01
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)
000011
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 HarrisBATTCHC510/06/2004530 DJohn E HarrisBATTCHC510/06/2004
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.
( ) -
Phone Number
MRS
Mr., Ms., Mrs.
CINDY
First NameMI
PARROTT
Last NameSuffix
1401
Number
W
Prefix
HARRISON
Street or Highway
ST
Street TypeSuffixPost Office BoxApt./Suite/Room
REIDSVILLE
City
NC
State
27320-
Zip CodeLocal OptionBusiness name (if applicable)
K
2Owner
Check this box ifsame address asincident location.Then skip the threeduplicate addresslines.
( ) -
Phone NumberMr., Ms., Mrs.First NameMILast NameSuffixNumberPrefixStreet or HighwayStreet TypeSuffixPost Office BoxApt./Suite/RoomCityState
-
Zip CodeLocal Option
L
Remarks:
FM HARRIS REQUESTED TO CHECK CARBON MONOXIDE LEVELS IN AREA OF EUTHANASIACHAMBER AT ABOVE LOCATION. UPON ARRIVAL FM HARRIS SPOKE TO CINDY PARROTT WHOADVISED THAT ALL REPAIRS HAD BEEN MADE TO PURGE VALVE SYSTEM AND ALL SAFETYSYSTEMS WERE IN PLACE AND FUNCTIONING. (SEE INCIDENTS # 04-1502, 04-1549 &04-1659) MRS. PARROTT ADVISED THAT AN AIR PURGE VALVE HAD BEEN MISTAKENLYINSTALLED BACKWARDS AND HAD BEEN CORRECTED. FM HARRIS COLLECTED CARBON MONOXIDEREADINGS USING AN MSA MINICORESPONDER CARBON MONOXIDE METER. ( CALIBRATION DATE10-06-04) DURING INITIAL OPERATION OF THE CHAMBER A PEAK READING OF 41ppm WASOBTAINED AND DISSIPATED TO MINIMAL LEVELS IN UNDER 5 SECONDS. NO ELEVATION INCARBON MONOXIDE LEVELS WERE DETECTED DURING OPERATION. ALL CYCLES OF THEOPERATION APPEARED TO FUNCTIONED PROPERLY. UPON COMPLETION OF OPERATION, AREADING OF 135 ppm WAS OBTAINED AT THE DOOR TO THE CHAMBER THAT DISSIPATED TO
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: 2004001692-00
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320 336-349-1024 
Local Option
L
Remarks:
MINIMAL LEVELS IN LESS THAN 10 SECONDS OF THE CHAMBER DOOR BEING OPENED. UNITHAS BEEN REPAIRED AND APPEARS TO BE IN SAFE WORKING CONDITION.
2
 
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320 336-349-1024 
07907NC10/06/2004FS3200400169200
FDIDStateIncident DateExposure
NFIRS - 9
AB
Apparatus orResourcesApparatus or
DeleteChangeUse codes listed below
ResourceDates and TimesSentNumberofPeopleUseActions Taken
Check ONE box for eachapparatus to indicate its mainuse at the incident.Check if same date as alarm date
X
StationIncident Number
DispatchXArrivalXClearX
1
IDType
C592
10/06/200410/06/200410/06/2004110011001139
18642
Other
X
Type of Apparatus or Resource
More apparatus?Use additionalsheets.Ground Fire Suppression11 Engine12 Truck or aerial13 Quint14 Tanker & pumper combination16 Brush truck17 ARF (Aircraft Rescue and Firefighting)10 Ground fire suppression, otherHeavy Ground Equipment21 Dozer or plow22 Tractor24 Tanker or tender20 Heavy equipment, otherAircraft41 Aircraft: fixed wing tanker42 Helitanker43 Helicopter40 Aircraft, otherMarine Equipment51 Fire boat with pump52 Boat, no pump50 Marine apparatus, otherSupport Equipment61 Breathing apparatus support62 Light and air unit60 Support apparatus, otherMedical & Rescue71 Rescue unit72 Urban search & rescue unit73 High angle rescue unit75 BLS unit76 ALS unit70 Medical and rescue unit, otherOther91 Mobile command post92 Chief officer car93 HazMat unit94 Type 1 hand crew95 Type 2 hand crew99 Privately owned vehicle00 Other apparatus/resourceNN NoneUU Undetermined
of 00

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