Department of Fire Services Commonwealth of Massachusetts 2025

1. Click ‘Get Form’ to open the Cigarette Fire Investigation Checklist in the editor.
2. Begin by entering the 'Fire Date' and 'Fire Time' in the designated fields. Use the format MM/DD/YYYY for the date and HH:MM (24 hr.) for the time.
3. Fill in the 'FDID #' and 'Incident #' fields, followed by the 'Fire Location' which includes street number, street name, and town.
4. Document any casualties by indicating the number of injuries and deaths under 'Civilian'.
5. Select the brand and type of cigarettes involved from the provided options. If applicable, specify any other brands in the space provided.
6. Indicate whether FSC cigarettes were involved by selecting 'Yes', 'No', or 'Unknown'.
7. Describe how cigarettes were involved in ignition by choosing from options like 'Fell Asleep', 'Improper Disposal', or others as necessary.
8. Provide details about where the cigarettes were purchased, including store name and town.
9. Complete your report by filling in your information under 'Report by', including rank, name, department or agency.
10. Once completed, return your checklist to the Fire Data Unit via fax, mail, or email as indicated at the bottom of the form.

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