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Incident Report Request Form

  1. Aptos - La Selva Fire District

  2. Use this form to provide information about the incident you are requesting a report for. Please provide as much information about the incident as possible, so we can best serve you. Incident Report Requests are typically responded to within 2 full business days after submittal (excluding holidays and weekends). Production of the requested report may take longer depending on the type of incident, any non-disclosable or confidential info contained therein, or the ongoing investigation of an incident. Requests for medical information reports (i.e. Pre-Hospital Care Reports) may require additional authorization.

  3. Estimated time that incident occurred.

  4. Include cross street, if known.

  5. Fire, Vehicle Accident, Medical, etc.

  6. Was requestor involved in the incident? Acting on behalf of an involved party? Other interest?

  7. E-Signature Agreement*

    By clicking "I Agree", you agree and acknowledge that 1) your Incident Report Request will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.*

  8. Leave This Blank:

  9. This field is not part of the form submission.