Reidsville Gas Chamber Leak #2
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Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
A
07907
NC
10/06/2004
FS3
2004001692
00
FDID
State
Incident Date
Station
Incident Number
Exposure
Location
B
336-349-1024
NFIRS -1 Basic
See Wildland Fire Module for Location
1 Street address
Census Tract
1401
W
HARRISON
ST
Number/Milepost
Prefix
Street or Highway
Street Type
Apt./Suite/Room
REIDSVILLE
NC
27320-
City
State
Zip Code
Suffix
RAMP Cross Street or Directions
Incident Type
C
Dates & Times
E1
424 Carbon monoxide incident
Date
Incident Type
D
Dispatch
Aid Given or Received
x
N None
Arrival
Action Taken
G1
Last Unit Cleared
0 0 1
0 0 1
Other
Check box if resource counts include aid received resources.
Additional Action Taken (3)
J
Fire-2 Structure-3 Civilian Fire Cas.-4 Fire Serv. Casualty-5 EMS-6 HazMat-7 Wildland Fire-8 Apparatus-9 Personnel-10 Arson-11
H1
Casualties
Fire Service
Deaths
x
None
H3
Local Option
D
0
Shift or platoon
Alarms
E3
1 District
Special Studies Local Option
11:39:45
G2 Personnel
EMS
Additional Action Taken (2)
11:00:47 11:00:47
Shifts & Alarms
Special Study ID#
Apparatus Suppression
42 HazMat detection, monitoring, sampling, &
Completed Modules
10/06/2004
Resources
Primary Action Taken (1)
Time
: :
Check this box and skip this section if an Apparatus or Personnel form is used.
86 Investigate
x x
10/06/2004 10/06/2004
Controlled
x
F
E2
Special Study Value
Estimated Dollar Losses & Values
LOSSES: Required for all fires if known.
None
Optional for non fires.
Property
$
Contents
$
0 0
x x
0 0
x x
PRE-INCIDENT VALUE: Property
$
Contents
$
Hazardous Materials Release
I
Mixed Use Property
Injuries N None
NN Not mixed use
Civilian
H2
Detector
Property Use 593 Office: veterinary or research
M
Authorization 530 D Officer in charge ID
Signature
BATTCH
C5
10/06/2004
Rank
Assignment
Date
BATTCH
C5
10/06/2004
Rank
Assignment
Date
John E Harris Check box if same as Officer in charge
x 530 D Member making report ID
Signature
John E Harris
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
336-349-1024 Incident: 2004001692-00
K1
Person/Entity Involved
REIDSVILLE VETERINARY HOS
( )
Local Option
Business name (if applicable)
Phone Number
Check this box if same address as incident location. Then skip the three duplicate address lines.
MRS
CINDY
Mr., Ms., Mrs.
First Name
-
PARROTT MI
Last Name
Suffix
1401
W
HARRISON
ST
Number
Prefix
Street or Highway
Street Type
Suffix
REIDSVILLE Post Office Box
K2
Owner Local Option
Check this box if same address as incident location. Then skip the three duplicate address lines.
Apt./Suite/Room
NC
27320-
State
Zip Code
City
( )
Same as person involved? Then check this box and skip Business name (if applicable) the rest of this section.
Mr., Ms., Mrs.
First Name
Number
Prefix
Post Office Box
MI
Last Name
Suffix
Street or Highway
Apt./Suite/Room
-
Phone Number
Street Type
Suffix
City
State
L
Zip Code
Remarks: Local Option
FM HARRIS REQUESTED TO CHECK CARBON MONOXIDE LEVELS IN AREA OF EUTHANASIA CHAMBER AT ABOVE LOCATION. UPON ARRIVAL FM HARRIS SPOKE TO CINDY PARROTT WHO ADVISED THAT ALL REPAIRS HAD BEEN MADE TO PURGE VALVE SYSTEM AND ALL SAFETY SYSTEMS WERE IN PLACE AND FUNCTIONING. (SEE INCIDENTS # 04-1502, 04-1549 & 04-1659) MRS. PARROTT ADVISED THAT AN AIR PURGE VALVE HAD BEEN MISTAKENLY INSTALLED BACKWARDS AND HAD BEEN CORRECTED. FM HARRIS COLLECTED CARBON MONOXIDE READINGS USING AN MSA MINICORESPONDER CARBON MONOXIDE METER. ( CALIBRATION DATE 10-06-04) DURING INITIAL OPERATION OF THE CHAMBER A PEAK READING OF 41ppm WAS OBTAINED AND DISSIPATED TO MINIMAL LEVELS IN UNDER 5 SECONDS. NO ELEVATION IN CARBON MONOXIDE LEVELS WERE DETECTED DURING OPERATION. ALL CYCLES OF THE OPERATION APPEARED TO FUNCTIONED PROPERLY. UPON COMPLETION OF OPERATION, A READING OF 135 ppm WAS OBTAINED AT THE DOOR TO THE CHAMBER THAT DISSIPATED TO Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
L2
336-349-1024
Remarks: Local Option
MINIMAL LEVELS IN LESS THAN 10 SECONDS OF THE CHAMBER DOOR BEING OPENED. UNIT HAS BEEN REPAIRED AND APPEARS TO BE IN SAFE WORKING CONDITION.
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
A B
Delete
07907
NC
10/06/2004
FS3
2004001692
00
FDID
State
Incident Date
Station
Incident Number
Exposure
Apparatus or Resource
Dates and Times
Sent
Check if same date as alarm date
Use codes listed below
1
336-349-1024
ID
C5
Type
92
Dispatch Arrival Clear
X X X
Type of Apparatus or Resource Ground Fire Suppression 11 Engine 12 Truck or aerial 13 Quint 14 Tanker & pumper combination 16 Brush truck 17 ARF (Aircraft Rescue and Firefighting) 10 Ground fire suppression, other
10/06/2004 10/06/2004 10/06/2004
X
1100 1100 1139
Aircraft 41 Aircraft: fixed wing tanker 42 Helitanker 43 Helicopter 40 Aircraft, other Marine Equipment 51 Fire boat with pump 52 Boat, no pump 50 Marine apparatus, other
Heavy Ground Equipment 21 Dozer or plow 22 Tractor 24 Tanker or tender 20 Heavy equipment, other
Support Equipment 61 Breathing apparatus support 62 Light and air unit 60 Support apparatus, other
Number of People
1
Change
Use
NFIRS - 9 Apparatus or Resources Actions Taken
Check ONE box for each apparatus to indicate its main use at the incident.
X Other
86
42
Medical & Rescue 71 Rescue unit 72 Urban search & rescue unit 73 High angle rescue unit 75 BLS unit 76 ALS unit 70 Medical and rescue unit, other
More apparatus? Use additional sheets.
Other 91 Mobile command post 92 Chief officer car 93 HazMat unit 94 Type 1 hand crew 95 Type 2 hand crew 99 Privately owned vehicle 00 Other apparatus/resource
NN None UU Undetermined
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
A B
07907
NC
10/06/2004
FS3
2004001692
00
FDID
State
Incident Date
Station
Incident Number
Exposure
Apparatus or Resource
Dates and Times
Sent
Check if same date as alarm date
Use codes listed below
1
336-349-1024
ID
C5
Type
92
Dispatch Arrival Clear
X X X
10/06/2004 10/06/2004 10/06/2004
Personnel ID
530 D
Name
Harris, John E
1100 1100 1139
X
Number of People
1 Rank or Grade
BATTCH
Change
Use Check ONE box for each apparatus to indicate its main use at the incident.
Action Taken
86
Actions Taken List up to 4 actions for each apparatus and each personnel
86
X Other
Attend
NFIRS - 10 Personnel
Delete
Action Taken
42
Action Taken
42
Action Taken
A
07907
NC
10/06/2004
FS3
2004001692
00
FDID
State
Incident Date
Station
Incident Number
Exposure
Location
B
336-349-1024
NFIRS -1 Basic
See Wildland Fire Module for Location
1 Street address
Census Tract
1401
W
HARRISON
ST
Number/Milepost
Prefix
Street or Highway
Street Type
Apt./Suite/Room
REIDSVILLE
NC
27320-
City
State
Zip Code
Suffix
RAMP Cross Street or Directions
Incident Type
C
Dates & Times
E1
424 Carbon monoxide incident
Date
Incident Type
D
Dispatch
Aid Given or Received
x
N None
Arrival
Action Taken
G1
Last Unit Cleared
0 0 1
0 0 1
Other
Check box if resource counts include aid received resources.
Additional Action Taken (3)
J
Fire-2 Structure-3 Civilian Fire Cas.-4 Fire Serv. Casualty-5 EMS-6 HazMat-7 Wildland Fire-8 Apparatus-9 Personnel-10 Arson-11
H1
Casualties
Fire Service
Deaths
x
None
H3
Local Option
D
0
Shift or platoon
Alarms
E3
1 District
Special Studies Local Option
11:39:45
G2 Personnel
EMS
Additional Action Taken (2)
11:00:47 11:00:47
Shifts & Alarms
Special Study ID#
Apparatus Suppression
42 HazMat detection, monitoring, sampling, &
Completed Modules
10/06/2004
Resources
Primary Action Taken (1)
Time
: :
Check this box and skip this section if an Apparatus or Personnel form is used.
86 Investigate
x x
10/06/2004 10/06/2004
Controlled
x
F
E2
Special Study Value
Estimated Dollar Losses & Values
LOSSES: Required for all fires if known.
None
Optional for non fires.
Property
$
Contents
$
0 0
x x
0 0
x x
PRE-INCIDENT VALUE: Property
$
Contents
$
Hazardous Materials Release
I
Mixed Use Property
Injuries N None
NN Not mixed use
Civilian
H2
Detector
Property Use 593 Office: veterinary or research
M
Authorization 530 D Officer in charge ID
Signature
BATTCH
C5
10/06/2004
Rank
Assignment
Date
BATTCH
C5
10/06/2004
Rank
Assignment
Date
John E Harris Check box if same as Officer in charge
x 530 D Member making report ID
Signature
John E Harris
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
336-349-1024 Incident: 2004001692-00
K1
Person/Entity Involved
REIDSVILLE VETERINARY HOS
( )
Local Option
Business name (if applicable)
Phone Number
Check this box if same address as incident location. Then skip the three duplicate address lines.
MRS
CINDY
Mr., Ms., Mrs.
First Name
-
PARROTT MI
Last Name
Suffix
1401
W
HARRISON
ST
Number
Prefix
Street or Highway
Street Type
Suffix
REIDSVILLE Post Office Box
K2
Owner Local Option
Check this box if same address as incident location. Then skip the three duplicate address lines.
Apt./Suite/Room
NC
27320-
State
Zip Code
City
( )
Same as person involved? Then check this box and skip Business name (if applicable) the rest of this section.
Mr., Ms., Mrs.
First Name
Number
Prefix
Post Office Box
MI
Last Name
Suffix
Street or Highway
Apt./Suite/Room
-
Phone Number
Street Type
Suffix
City
State
L
Zip Code
Remarks: Local Option
FM HARRIS REQUESTED TO CHECK CARBON MONOXIDE LEVELS IN AREA OF EUTHANASIA CHAMBER AT ABOVE LOCATION. UPON ARRIVAL FM HARRIS SPOKE TO CINDY PARROTT WHO ADVISED THAT ALL REPAIRS HAD BEEN MADE TO PURGE VALVE SYSTEM AND ALL SAFETY SYSTEMS WERE IN PLACE AND FUNCTIONING. (SEE INCIDENTS # 04-1502, 04-1549 & 04-1659) MRS. PARROTT ADVISED THAT AN AIR PURGE VALVE HAD BEEN MISTAKENLY INSTALLED BACKWARDS AND HAD BEEN CORRECTED. FM HARRIS COLLECTED CARBON MONOXIDE READINGS USING AN MSA MINICORESPONDER CARBON MONOXIDE METER. ( CALIBRATION DATE 10-06-04) DURING INITIAL OPERATION OF THE CHAMBER A PEAK READING OF 41ppm WAS OBTAINED AND DISSIPATED TO MINIMAL LEVELS IN UNDER 5 SECONDS. NO ELEVATION IN CARBON MONOXIDE LEVELS WERE DETECTED DURING OPERATION. ALL CYCLES OF THE OPERATION APPEARED TO FUNCTIONED PROPERLY. UPON COMPLETION OF OPERATION, A READING OF 135 ppm WAS OBTAINED AT THE DOOR TO THE CHAMBER THAT DISSIPATED TO Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
L2
336-349-1024
Remarks: Local Option
MINIMAL LEVELS IN LESS THAN 10 SECONDS OF THE CHAMBER DOOR BEING OPENED. UNIT HAS BEEN REPAIRED AND APPEARS TO BE IN SAFE WORKING CONDITION.
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
A B
Delete
07907
NC
10/06/2004
FS3
2004001692
00
FDID
State
Incident Date
Station
Incident Number
Exposure
Apparatus or Resource
Dates and Times
Sent
Check if same date as alarm date
Use codes listed below
1
336-349-1024
ID
C5
Type
92
Dispatch Arrival Clear
X X X
Type of Apparatus or Resource Ground Fire Suppression 11 Engine 12 Truck or aerial 13 Quint 14 Tanker & pumper combination 16 Brush truck 17 ARF (Aircraft Rescue and Firefighting) 10 Ground fire suppression, other
10/06/2004 10/06/2004 10/06/2004
X
1100 1100 1139
Aircraft 41 Aircraft: fixed wing tanker 42 Helitanker 43 Helicopter 40 Aircraft, other Marine Equipment 51 Fire boat with pump 52 Boat, no pump 50 Marine apparatus, other
Heavy Ground Equipment 21 Dozer or plow 22 Tractor 24 Tanker or tender 20 Heavy equipment, other
Support Equipment 61 Breathing apparatus support 62 Light and air unit 60 Support apparatus, other
Number of People
1
Change
Use
NFIRS - 9 Apparatus or Resources Actions Taken
Check ONE box for each apparatus to indicate its main use at the incident.
X Other
86
42
Medical & Rescue 71 Rescue unit 72 Urban search & rescue unit 73 High angle rescue unit 75 BLS unit 76 ALS unit 70 Medical and rescue unit, other
More apparatus? Use additional sheets.
Other 91 Mobile command post 92 Chief officer car 93 HazMat unit 94 Type 1 hand crew 95 Type 2 hand crew 99 Privately owned vehicle 00 Other apparatus/resource
NN None UU Undetermined
Reidsville Fire Department - 402 S. Scales St., Reidsville, NC 27320
A B
07907
NC
10/06/2004
FS3
2004001692
00
FDID
State
Incident Date
Station
Incident Number
Exposure
Apparatus or Resource
Dates and Times
Sent
Check if same date as alarm date
Use codes listed below
1
336-349-1024
ID
C5
Type
92
Dispatch Arrival Clear
X X X
10/06/2004 10/06/2004 10/06/2004
Personnel ID
530 D
Name
Harris, John E
1100 1100 1139
X
Number of People
1 Rank or Grade
BATTCH
Change
Use Check ONE box for each apparatus to indicate its main use at the incident.
Action Taken
86
Actions Taken List up to 4 actions for each apparatus and each personnel
86
X Other
Attend
NFIRS - 10 Personnel
Delete
Action Taken
42
Action Taken
42
Action Taken
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