Fireworks Incident Report

Arkansas Division of
Emergency Management

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ADEM – Fireworks Incident Report

Fire Department:(Required)

County:(Required)

Incident Number:(Required)

Incident Date:(Required)

Submitter Email Address:(Required)

Incident Location:(Required)

Street Address Address Line 2 City State ZIP Code

Injury or Death(Required)

Name, Gender, Age, Date of Injury or Death:(Required)

Last Name, First Name; Gender; Age; Date of Injury or Death / Example: Doe, John; Male; 42; 01/20/2026

Injury Type and Location:(Required)

Type; Location / Example: Burn; Hand

Contributing Factors:(Required)

Were drugs, alcohol, and/or intoxicants involved? Was adult supervision present? Was a trained fireworks technician there? Were there any mitigating factors with the weather or location? Please be specific.

Notes:

Contact ADEM

Building 9501
Camp Joseph T. Robinson
North Little Rock, AR 72199
501-683-6700
Contact Form

Helpful ADEM links

Arkansas Business Emergency Listing Registration (ABEL)

National Incident Management System (NIMS)

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