New Jersey Department of Community Affairs DIVISION OF FIRE SAFETY CIVILIAN BURN PATIENT FORM Date of Burn: Alarm Time (24 Hr): Age of Victim: Male Victim s Name: Part(s) of body burned (or % BSA):.
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How to fill out the Civilian Burn Form online
Filling out the Civilian Burn Form accurately is crucial for documenting burn incidents and ensuring appropriate responses. This guide will provide a clear, step-by-step approach to completing the form online, suitable for all users, regardless of their experience level.
Follow the steps to complete the Civilian Burn Form online
- Press the ‘Get Form’ button to obtain the Civilian Burn Form and open it in your preferred online editor.
- Enter the date of the burn in the designated field.
- Provide the alarm time using a 24-hour format.
- Input the age of the person affected by the burn.
- Indicate the victim's name in the specified field.
- Detail the parts of the body burned or the percentage of body surface area affected.
- Fill in the street address where the burn incident took place.
- Enter the victim’s home address, including street, city, and zip code.
- Name the fire department involved in the incident.
- Provide the fire department identification number (FDID).
- Name the reporting person who is completing the form.
- Specify the reporting agency associated with the incident.
- Input the phone number of the reporting person.
- Select the type of burn by checking one of the boxes provided.
- Determine the severity of the burn by checking one of the options.
- If applicable, describe the cause of the fire.
- Indicate whether a detector was present using 'Y' for yes or 'N' for no.
- Specify if the detector operated during the incident.
- Identify the room where the burn originated.
- Include any remarks or additional details in the provided space.
- Indicate the hospital where the victim was transported.
- Once all fields are complete, review the form for accuracy. You can save your changes, download a copy, print the form, or share it as needed.
Complete and submit your Civilian Burn Form online to ensure prompt action and support.
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