Fire and EMS reports are available by request. Completion of this form will allow for a copy of a report be sent by email and provides the information needed to submit an insurance claim. Please note the report will not include any patient information as it is protected by the Health Insurance Portability and Accountability Act (HIPAA). Fire reports offer minimal information as to the cause of a fire as this is documented in a separate confidential report.

What was the date of the fire? (Please be as specific as possible.)*

What type of property was involved?*

House Business Apartment Vehicle Wildland Other

Please describe the property if you checked "other":

What is the address where the fire or incident occurred? (For example: 215 S Church St or the intersection of S Church and Front streets.)*

Was your property burned or damaged because of someone else's fire? For example: The siding on your house was damaged because your neighbor's house was on fire. If so, please check the box to the right.

Provide your address if you checked the box above.

What email address shall the form be sent to?*

What is your phone number? (In case there is a question.)*

Name of person submitting this request:*

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Burlington Fire Department Home Page

Please feel free to contact 336-229-3133 if you have any questions!