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CART Incident Report
Submit the following information to the public education officer within 48 hours of the termination of the incident.
1. Date of incident:

2. Time dispatched:
Please enter a specific time, such as "2:35 p.m." or "10:15 a.m."

3. Time on scene:
Please enter a specific time, such as "2:35 p.m." or "10:15 a.m."

4. Time departed:
Please enter a specific time, such as "2:35 p.m." or "10:15 a.m."

5. Type of incident:

6. CART members responding:
First & Last Name of each

7. Incident Commander on scene:
First & Last Name

8. Fire Investigator on scene:
First & Last Name

9. Address of scene:
Enter a specific address, such as "1101 Texas Ave, College Station"

10. Number of individuals needing assistance:

11. Number of victims displaced:

12. Number of pets displaced:

13. Name and Phone Number of Property Manager:
Example: "John Doe, 979-764-3600"

14. Name, Age, Phone Number of victim(s):
Example: "John Doe, 38, 979-764-3600"

15. Resources used at scene:
Include item(s) and quantity, such as "shirts, 2"

16. If the residents were displaced, was a hotel voucher used? *
17. List the hotel(s) to which the resident was referred.

18. Was CIRT notified?*
19. Was the Red Cross notified?*
20. Name of Red Cross volunteer(s):
First & Last Name, if applicable

21. Narrative of the incident:
Please describe to the best of your ability.

22. To the best of my knowledge and recollection, I have accounted for the incident to which I responded as a CART member:
Enter your First & Last Name. This will serve as your signature.

A copy of this report will be filed as a permanent CART record. Copies will be sent to the fire inspector in charge and the incident commander on duty.

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