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Genitals
Shoulder Right
Chest
Hand Left
Foot Right
Basement
Cooking
Explosive Gun power TNT dynamite
Structure Fire Any uncontained burning within a structure including smoking accidents trash fires etc
Transferred
Face
Shoulder Left
Arm Left
Hand Right
Leg Right
Buttocks
Head
Arm Right
Abdomen
Foot Left
Back
Inhalation
Neck
Leg Left
Groin
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Home
Bathroom
Bedroom
Living Room
Kitchen
Garage
Outdoors
Sleeping
Home Maintenance Repair
Vehicle Maintenance Repair
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Chemical Contact or exposure to reactive caustic corrosive or irritation substance
Contact with Hot Liquid Not Burning Hot water coffee tea hot food hot tar melted plastics etc
Contact with Hot Object Woodstove stovepipe furnace iron steam pipe exhaust pipe etc
Cooking Stove oven hotplate barbecue hot grease
Electrical Electrocution Electrical equipment and flash burns
Fireworks Sparklers firecrackers rockets smoke bombs etc
Flammable Liquids Ignition of flammablecombustible liquids such as gasoline kerosene diesel fuel jet fuel lighter fluid
GasVapor Explosion Ignition of flammable gases or the explosion of flammable liquid vapors
Other Open Flame Welding matches lighter torch etc
Outside Fires Grass and brush forest bonfires dump trash and refuse fires etc
Radiation Burns caused by contact or exposure to any radioactive materials
Steam Caused by escaping steam from radiators boilers pipes etc
Sunburn Exposure to ultraviolet light including sun lamps and tanning beds
Vehicle Fire Car truck plane boat tractor lawnmower etc carburetor and engine fires etc
Other Describe
Discharged
Expired
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Additional Signatures Required