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Incident_Request
Monday, May 13, 2024
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Last updated
7/29/2011
© 2005 CCFD
Clark County Fire Department
Custodian of Records
575 E. Flamingo Road, Las Vegas, NV 89119
(702) 455-7322
Fax# (702) 455-7137
Incident Request Form
NOTE !
All fields must be filled out. Thank you.
Click Submit when done.
Type of Incident
*Please Select*
Medical
Structure Fire
Vehicle Fire
Please make a selection.
Date of Incident
(MM/DD/YYYY)
Required
Time of Incident
*Please select*
1
2
3
4
5
6
7
8
9
10
11
12
:00
:05
:10
:15
:20
:25
:30
:35
:40
:45
:50
:55
AM
PM
Requested By
Required
Contact Phone
(xxx-xxx-xxxx)
Required
Invalid phone number
Contact Fax
(xxx-xxx-xxxx)
Invalid phone number
Company
Address
Required
City
Required
State
*Please Select*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please make a selection.
Zip
Required
Incident Location
(address or cross streets)
Address
Cross Streets
Street Number
Required
Invalid number
Street Dir
East
South
West
North
Street Name
Required
Street Type
UN
AV
BLVD
CIR
CT
CV
DR
FWY
HWY
HOLLOW
LN
LOOP
NA
PKWY
PASS
PATH
PL
PT
RD
RTE
ST
TER
TRL
WASH
WY
OTHER
Suite
Pick up the report at:
Clark County Fire Department Administration
575 E. Flamingo Road, Las Vegas, NV 89119.
--Click
here
to view a map.
Have the report faxed to the fax number I provided.
Please note, medical reports cannot be faxed.
Purpose of Report Request
Required
Please provide your e-mail address so we may notify you when the report is ready:
IT MAY TAKE UP TO 30 DAYS TO PROCESS YOUR REQUEST. SUBMITTING DUPLICATE REQUESTS WILL NOT EXPIDITE THE PROCESS.