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Fire Sprinkler & Smoke Alarm Saves Reporting
Office of the State Fire Marshal
Date of Activation *
MM
/
DD
/
YYYY
Time of Activation *
Time
:
Address *
Your answer
Address 2
Your answer
City *
Your answer
Zip Code *
Your answer
County *
Occupancy Type *
Number of Stories?
Your answer
Did the Fire Start Inside the Building?
Your answer
Story of Origin
Your answer
Room of Origin
Your answer
Number of People Home During Fire *
If none mark "0"
Your answer
Number of People Injured/Deceased During Fire *
If none mark "0"
Your answer
Was there a Fire Sprinkler Activation? *
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