Incident / Investigation Report Request Form

Type of Report Requested: *

Fire Incident Report

Medical Incident Report

Fire Investigation Report

Other (please describe)

Other:

Date of Incident:

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Location of Incident: *

Street Address (including City, State and Zip Code), Intersection, or Description of Location

Report Disposition: *

I request that this report be:

Hold for pickup at BTFD Fire HQ - 357 Fording Island Rd

Hold for pickup at BTFD Admin Annex - 178 May River Rd

Email to email address provided below (Emailed reports containing sensitive / protected information may be encrypted.)

Mail to mailing address provided below

Mail via Certified Mail to mailing address provided below (An up-front fee will be charged to recoup USPS Certified Mail service charges.)

FAX to the FAX number provided

Requestor Information:

Name: *

Phone Number: *

including area code

FAX Number:

Email Address:

Street Address:

Street Address including City, State and Zip Code

I hereby request a copy of the above referenced report for the incident described above.
I understand that, due to review and scheduling issues and as well as to insure accuracy of the report, it may take up to two (2) weeks for the report to be made ready for release. Certain reports, such as reports of an investigative nature, may take many months to complete and a copy of said report will not be available until such a time as the report is complete and finalized.
I understand that, in accordance with Federal and State Regulations, certain information of a sensitive nature which may be contained in incident or investigative reports, such as description of crime scenes, results of laboratory tests, identification and statements of witnesses, or any other information of like type which may tend to compromise or impede an on-going investigation or prosecution may be redacted or removed from all Fire Incident / Investigative and/or Medical (EMS) Reports maintained by this organization which have been prepared for release to the public.
I understand that, in accordance with Federal Regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II), all protected medical information (as well as personal identifying information of a nature where the identity of a protected individual may be surmised) of any one or more individual(s) referenced in any report for which the Bluffton Township Fire District has not received a properly executed medical release statement (or its equivalent), will be redacted or removed from all Fire Incident / Investigative and/or Medical (EMS) Reports maintained by this organization which have been prepared for release to the public.

Signature: *

Date Requested:

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Incident / Investigation Report Request Form

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