1. 1 NFIRS 5 - Fire Service Casualty Module Used to report injuries, deaths or exposures to fire service personnel.

2. A - Header Header information is repeated on all modules... ­ In an automated system, this information is entered once and imported into all modules

3. B - Injured Person Identifies personal information name gender (sex) Department type volunteer (include paid-on-call) career 1 2 First NameLast NameSuffix Injured Person B Identification Number MI Male Female 1 2 Career Volunteer 1 2

4. C - Casualty Number Each fire service casualty is assigned a number begin with 1 1 2 Casualty Number C

5. D - Age or Date of Birth Identifies the age or date of birth of the fire service casualty 1 2 In years OR Date of Birth Age or Date of Birth D DayMonthYear Age

6. E - Date and Time Identifies the date and time of injury midnight is 0000 Time of InjuryDate of Injury Date & Time of Injury E Midnight is 0000. MonthDayYear Hour Minutes

7. F - Responses Identifies the number of responses that the firefighter made during the previous 24 hours 1 2 Responses F Number of prior responses during past 24 hours

8. G 1 - Usual Assignment Identifies the usual assignment of the injured fire service personnel this might not be the same as the individuals activity at the time of injury x G 1 Usual Assignment Suppression EMS Prevention Training Maintenance Communications Administration Fire investigation Other 1 2 3 4 5 6 7 8 0

9. G 2 - Physical Condition Identifies the condition of the firefighter prior to the injury 21 Bedroom G 2 Physical Condition Just Prior To Injury Rested Fatigued Ill or injured Other 1 2 3 0

10. G 3 - Severity Identifies the severity of the injury ­ Used to report injuries, deaths or exposures to fire service personnel. Exposure of fire service personnel to toxic substances or harmful physical agents may be reported 1 2 Report only, including exposure First aid only Treated by physician (no lost time) Moderate (lost time) Severe (lost time) Life threatening (lost time) Death Severity G 3 1 2 3 4 5 6 7

11. G 4 - Taken To Identifies where the fire service casualty was taken after the injury occurred x G 4 Taken To Hospital Doctors office Morgue/funeral home Residence Station or quarters Other Not transported 1 4 5 6 7 0 N

12. G 5 - Activity at Time of Injury Identifies what the firefighter was doing at the time of injury codes are found in the Handbook or QRG x Activity at Time of Injury G 5 Activity at time of injury

13. H 1 - Primary Apparent Symptom Block H 1 : Primary Apparent Symptom describe most serious apparent injury Coded field codes are found in Handbook and QRG x H 1 Primary apparent symptom Primary Apparent Symptom

14. H 2 - Area of Body Injured Identifies the part of the body which sustained the most serious injury Primary injured body part or area H 2 Primary Area of Body Injured

15. I 1 - Cause of Injury Identifies the cause of the firefighter injury codes can be found in the Handbook or QRG Cause of Firefighter Injury Cause of injury I 1

16. I 2 - Contributing Factors Identifies the most significant factor contributing to the injury Contributing factor Factor Contributing to Injury I 2

17. I 3 - Object Involved in Injury Is used to clarify what object contributed to the injury 632Hot Plate XRS 130 34-2345 1985 Object involved in injury Object Involved in Injury I 3 None

18. J 1 - Where Injury Occurred Describes the location of the fire service casualty at the time of injury 632Hot Plate XRS 130 34-2345 1985 Where Injury Occurred J 1 Enroute to FD location At FD location Enroute to incident scene Enroute to medical facility At scene in structure At scene outside At medical facility Returning from incident Returning from med facility Other 1 2 3 4 5 6 7 8 9 0

19. J 2 - Story Where Injury Occurred Identifies the story above or below grade where the injury occurred Complete only for structures 632Hot Plate XRS 130 34-2345 1985 J 2 Story Where Injury Occurred Complete for structures only. Below grade Story of injury

20. J 3 - Specific Location Provides additional details on the specific location of the casualty at the time of injury Complete J 4 if casualty was in a vehicle when injured 632Hot Plate XRS 130 34-2345 1985 J 3 Specific Location Complete as applicable 65 64 63 61 54 53 49 45 36 35 34 33 32 31 28 27 26 25 24 23 22 00 In aircraft In boat or ship or barge In rail vehicle In motor vehicle In sewer In tunnel In structure In attic In water In well In ravine In quarry or mine In ditch or trench In open pit On steep grade On fire escape/outside stairs On vertical surface or ledge On ground ladder On aerial ladder or in basket On roof Outside at grade Other

21. J 4 - Vehicle Type Complete only if the fire service casualty was in a vehicle at the time of injury Suppression vehicle EMS vehicle Other FD vehicle Non-FD vehicle Vehicle Type J 4 1 2 3 4 Complete ONLY if Specific Location code is >60

22. K 1 - Protective Equipment If protective equipment failed and was a factor in this injury, complete Section K If the answer to K 1 is yes complete equipment sequence field, and the remainder of the Module

23. K 1 - Equipment Sequence A unique number assigned to each piece of equipment that failed and contributed to the injury First piece of faulty equipment is always 001 (consecutively number additional pieces) 1 2

24. K 2 - Protective Equipment Item Identifies each piece of equipment that contributed to the injury of the firefighter – If more than one piece of protective equipment was a factor in the firefighters injury, use additional sheets. 632Hot Plate XRS 130 34-2345 1985 K 2 Protective Equipment Item 11 12 13 14 15 16 17 10 Head or Face Protection Helmet Full face protector Partial protector Goggles/eye protection Hood Ear protector Neck protector Other

25. K 3 - Protective Equipment Problem 632Hot Plate XRS 130 34-2345 1985 Describes the most serious problem with the piece of equipment that failed and contributed to the injury (Partial list)

26. K 4 - Equipment Manufacturer, Model, & Serial Number Provide detailed information on the specific equipment that failed and contributed to the injury K 4 Equipment Manufacturer, Model & Serial Number Manufacturer Model Serial Number.

27. Summary The Fire Service Casualty Module (NFIRS 5) is used to report firefighter injuries or deaths related to an incident Exposure of fire service personnel to toxic substances or harmful physical agents should be reported, even if no signs or symptoms are present Fire service casualty information can be used by Health and Safety Officers to reduce risks at incidents

28. 1. Firefighter injured (or killed) during training exercise 2. Firefighter injured (or killed) playing basketball while on duty Scenarios