# Form - Incident Safety Officer Report > Fire Service Safety Management System, version 0.3.3 (2026-10-25). The Human Factor. Document FSSMS-FRM-27. > > Canonical: https://thehumanfactor.ca/library/fire-service-safety/form-incident-safety-officer-report > > Licence: CC BY-NC-SA 4.0 with the Adopting Agency Grant (https://creativecommons.org/licenses/by-nc-sa/4.0/) > > General information only, not legal, medical or other professional advice. Verify every requirement against the current official text of the law, standards and manufacturer instructions that apply to you. Obtain your own legal review and consult your joint health and safety committee before adopting anything. You adopt, adapt, implement and rely on this material entirely at your own risk and on your own responsibility. Full terms: Terms of Use, thehumanfactor.ca. ## Purpose and use Completed by the incident safety officer (ISO) for every assignment that meets a trigger in [Emergency Operations Safety Program](https://thehumanfactor.ca/library/fire-service-safety/emergency-operations-safety-program) section 5.3, and by the incident commander where no ISO was assigned at an incident with a firefighter injury, mayday or near miss. It records what the ISO saw and did, and it is the ISO’s written post-incident analysis, which the safety officer standard expects the ISO to prepare with observations, concerns and recommendations [(NFPA 1550, 2024, s. 5.7)](https://thehumanfactor.ca/library/fire-service-safety/form-incident-safety-officer-report#ref-nfpa-1550). It answers the accreditation criterion for qualified ISO deployment to all risk events [(CPSE, 2019, criterion 11A.11)](https://thehumanfactor.ca/library/fire-service-safety/form-incident-safety-officer-report#ref-cpse-2019). Submitted to the health and safety officer and the program manager within 48 hours. One page is enough for a routine working fire; the form expands for a mayday or an injury. It is a learning record: observations about procedures that were adapted or not followed are written to explain what made sense at the time, not to name who did it ([Incident Investigation and Learning Program](https://thehumanfactor.ca/library/fire-service-safety/incident-investigation-and-learning-program)). ## The form ### Part A: Assignment | Field | Entry | |:---|:---| | Incident number; date; incident type | | | Trigger met (tick): working fire / second alarm or greater / hazmat above awareness / technical rescue / mayday, injury or near miss / over one hour in PPE / live fire or high-hazard training / requested | | | ISO (role, ID); qualified (Y/N); assigned by; time assigned; time on scene | | | Assistant safety officers (roles) and their areas | | | Incident commander (role); strategy at ISO arrival; strategy changes (times) | | ### Part B: What the ISO found and did | Area | Observations (time, what, where) | Action taken (stopped, altered, advised, none) | IC informed (time) | |:---|:---|:---|:---| | Size-up and 360: construction, lightweight indicators, basement, occupancy, vacant status | | | | | Hazard control zones and collapse zones set (times); kept clear (Y/N) | | | | | Accountability: entry control staffed (time); board matched crews inside (Y/N); PARs on time (Y/N); any crew missed | | | | | IRIC in place at first entry (Y/N); RIT in place (time); RIT deployed (Y/N) | | | | | Mayday (Y/N; time; outcome) | | | | | Air management: low-air exits, out-of-air events, work cycles | | | | | PPE and SCBA worn in the hazard zone; hoods; PASS armed; SCBA kept on in overhaul | | | | | Fire behaviour: flow path, ventilation timing, rapid fire progression, flashover indicators | | | | | Rehab established (time); members evaluated; any transported | | | | | Utilities controlled; roadway blocked; lighting; weather | | | | | Decontamination before leaving; contaminated PPE bagged | | | | | Mutual aid companies within host accountability (Y/N) | | | | ### Part C: Activities stopped, altered or suspended by the ISO | Time | Activity | Hazard | What was ordered | IC acknowledged (time) | Outcome | |:-----|:---------|:-------|:-----------------|:-----------------------|:--------| | | | | | | | ### Part D: Stop-work, challenge and withdrawal calls by members | Time | Who (role) | What they said (hazard and action) | Officer’s response | Reviewed at debrief (Y/N) | |:---|:---|:---|:---|:---| | | | | | | ### Part E: Injuries, exposures and near misses | Type (injury, exposure, near miss, good catch) | Time | Member (role; name only on the injury report) | What happened | Report filed (form; date) | ISO began on-scene investigation (Y/N; time) | |:---|:---|:---|:---|:---|:---| | | | | | | | ### Part F: Adaptations and deviations, and what made them necessary Describe any point where the work differed from the procedure (an entry before the RIT was in place, a crew that split, a ventilation opening ahead of water, a PAR missed) and the conditions that led to it: staffing, time, building, equipment, communications. This is for learning under the firewall; do not record names. ### Part G: What went well Three things worth repeating, with who did them (by role) so they can be recognized. ### Part H: Recommendations and hand-over | \# | Recommendation | Suggested owner (role) | Suggested priority (P1 to P4) | |:----|:---------------|:-----------------------|:------------------------------| | | | | | The ISO suggests a priority on the department’s one scale; the health and safety officer confirms it when the item enters the [Corrective Action Register](https://thehumanfactor.ca/library/fire-service-safety/corrective-action-register). P1 (Imminent): interim control immediately, the same shift, with the fire chief and JOHSC co-chairs told within 24 hours; plan due in two working days; closed within seven days. P2 (Serious): interim control within 24 hours where practicable; plan due in seven days; closed within 30 days. P3 (Moderate): plan due in 30 days; closed within 90 days. P4 (Improvement): plan by the next quarterly program update; closed within 365 days or the next budget cycle. Extensions and escalation follow the [Corrective Action Register](https://thehumanfactor.ca/library/fire-service-safety/corrective-action-register). Hazards handed over at demobilization (to whom, when): \_\_\_. Triage tier recommended: ☐ Tier 1 AAR ☐ Tier 2 PIA ☐ Tier 3 independent review. Peer support offered (Y/N). ISO signature (role, date); received by HSO (date); received by program manager (date). ## Fields | Field | Type | Required | Who completes | |:---|:---|:---|:---| | Incident number, date, type | Text; date; lookup | Yes | ISO | | Trigger met | Multi-choice | Yes | ISO | | ISO role and ID; qualified; assigned by; times | Lookup; yes/no; times | Yes | ISO | | Assistant safety officers | Lookup list | No | ISO | | IC and strategy with change times | Lookup; list of time-stamped choices | Yes | ISO | | Part B observations, actions, IC informed | Free text per row; choice; time | Yes (each row, “none observed” allowed) | ISO | | Part C stops and alterations | Repeating group: time, text, time, choice | Yes if any | ISO | | Part D member calls | Repeating group | Yes if any | ISO | | Part E events | Repeating group linked to [Form - Injury and Incident Report](https://thehumanfactor.ca/library/fire-service-safety/form-injury-and-incident-report) and [Form - Near-Miss and Good-Catch Report](https://thehumanfactor.ca/library/fire-service-safety/form-near-miss-and-good-catch-report) | Yes if any | ISO | | Part F adaptations | Free text, no names | Yes | ISO | | Part G went well | Free text | Yes | ISO | | Part H recommendations | Repeating group: text, role, priority P1 to P4 | No | ISO; HSO confirms the priority | | Hand-over, triage tier, peer support | Text; single choice; yes/no | Yes | ISO | | Signatures and receipt dates | Role and date | Yes | ISO; HSO; program manager | ## Records Kept in {{Records system}} with the incident record per [05 Document Control and Records](https://thehumanfactor.ca/library/fire-service-safety/document-control-and-records). Recommendations go to the [Corrective Action Register](https://thehumanfactor.ca/library/fire-service-safety/corrective-action-register); triage goes through [Form - Event Triage Record](https://thehumanfactor.ca/library/fire-service-safety/form-event-triage-record). Parts C, D and F are learning records under the firewall and are not placed in personnel files. > **Note: Customize** > > Add any local trigger (marine, airport, industrial) to Part A. Decide whether Part B is printed as a pocket card for use on scene with the full form completed afterwards. ## References Center for Public Safety Excellence \[CPSE\]. (2019). *Fire and emergency service self-assessment manual* (10th ed.). Commission on Fire Accreditation International. National Fire Protection Association. (2024). *NFPA 1550, Standard for emergency responder health and safety* (consolidates NFPA 1500, 1521 and 1561).