Incident Report Request

Personal Information

Name (required)

Company

Phone number (required)

Fax

Email address (required)

Address (required)

City (required)

State

Kansas

ZIP Code (required)

Date of Request (required)

Incident Information

Preferred Method of Receiving Report

US Mail

Fax

Pick Up at Administrative Office

Incident Date (required)

Incident #: (required)

Incident Location

Incident Description

Type of Report requested (required)

MEDICAL INCIDENT REPORT (Approval by the Medical Officer)

FIRE INCIDENT REPORT (Approval by the Deputy Chief and/or Fire Prevention Division)

FIRE INVESTIGATION REPORT (Approval by the Fire Prevention Division)