S A F E N E T
Wildland Fire Safety & Health Reporting Network
Report unsafe situations in all wildland fire operations.

ID # 88WM29SAFE

The purpose of SAFENET is:
(1) To provide reporting and documentation of unsafe situations or close calls.
(2) To provide a means of sharing safety information throughout the fire community.
(3) To provide long-term data that will result in identifying trends.

Submitting a SAFENET is not a substitute for on-the-spot corrections !

When filing a SAFENET:
You are encouraged to submit it to your supervisor for immediate corrective action. You have the option of submitting a SAFENET to any level of the organization (local FMO, Fire Safety Officer, Incident Commander, Agency Administrator) for corrective action.
If you submit SAFENET directly to the national center, you are encouraged to provide a copy to your supervisor.
You have the right to report unsafe conditions anonymously, in accordance with 29 CFR 1960.

FIELDS MARKED WITH "" ARE REQUIRED.
REPORTED BY


Name : (Optional)


Phone : (Optional)


EMail : (Optional)


Date Reported :


Agency/Organization :





State Agency :

Required if Agency is "State"




Other Agency :

Required if Agency is "Other"


EVENT


Event Date :

(Format mm/dd/yyyy)

Local Time :

(Format 03:00 PM)


Incident Name :


Incident Number :


State :





Jurisdiction :


Local Unit :


Incident Type :

Incident Activity :

Stage of Incident :


Wildland
Prescribed
All Hazard
Training
Fuel Treatment
Work Capacity Test

Line
Support
Transport to/from
Readiness/Preparedness

Initial Attack
Extended Attack
Transfer of Command
Mop Up
Demobe
Non-Incident
Other


Position Title :

(Firefighter, division supervisor, facilities unit leader, etc.)


Task :

(Line construction, structure protection, camp activities, etc.)


Management Level :
1 2 3 4 5
(Type 5, 4, 3, 2, 1)


Resources Involved :

(Crew, equipment, overhead, etc.)
CONTRIBUTING FACTORS


Contributing Factors :
Fire Behavior Communications Equipment
Environmental Human Factors Other


Human Factors :
Decision Making Leadership Risk Assessment
Fatigue Performance Situational Awareness
Required if Contributing Factors is "Human Factors"


Other Factors :

Required if Contributing Factors is "Other"
NARRATIVE
Describe in detail what happened including the concern or potential issue, the environment (weather, terrain, fire behavior, etc), and the resulting safety/health issue.


ACTION TAKEN
Reporting Individual : please describe actions you took to correct or mitigate the unsafe/unheathful event.


AGENCY CORRECTIVE ACTIONS
Reserved space for Agencies Supplemental corrective Actions.


(You will be given an opportunity to PRINT this SAFENET once you have submitted the form)
Revision Date: 5/26/2009