Part A: General Information

Part A: General Information
Location Photo



Company Undertaking Assessment

Location

On behalf of (company/organisation)
Building Owner/Landlord
Building Occupier
Distribution List (Name, Job Title and Email)
A1. Significant Findings - Snap Shot of High Risk Findings
A2. Responsible/Competent Persons

Landlord/Owner of the Building

Organisation/Trust Responsible Person

Local Responsible Person

Competent Persons, Fire Safety Management
Estates Premises condition and PPMs

Fire Wardens

A3. Conclusion and Safety Rating
Current Site/Building/Ward/Unit LIFE Fire Risk Rating
Current Site/Building/Ward/Unit PROPERTY Fire Risk Rating
OVERALL Fire Risk Rating (taking life and property risk ratings into account)

Conclusion It can be concluded that with the implementation of the recommendations within the timescales provided as found in the Part 5 - Management of Hazards and Risk: Significant Findings and Action Plans of this risk assessment and the continued support of BHFT Compliance and Risk Services Team, the occupants of the building are working within a safe environment that is broadly compliant with the Regulatory Reform (Fire Safety) Order 2005. It must be noted if the recommendations are not implemented within required timescales, persons within the risk assessed and adjacent building/department/ward/unit will be at a greater life risk should a fire incident occur.

A4. The Building
Number of Floors

Floor area: (m2 per floor)

Floor area: (m2 total)

Building / Fire Plans

Brief details of construction:

Occupancy type:

Are fire hydrants and wet/dry risers clearly indicated and free from obstructions?

A5. Fire Brigade Access

Is there access for Emergency Vehicles?

If so, from how many sides, via vehicle?

If so, from how many sides, via foot?

A6. The occupants

Maximum number of occupants at any given time:

Maximum number of members of the public at one time:

Maximum number of patients:

Trust Personnel

Contractors

Other Staff (security, site services etc)

A7. Occupants at special risk

Are young persons/work experience employed at the premises?

Are there sleeping occupants?

Are there disabled occupants?

Are there occupants in remote areas?

Are there lone workers?

A8. Previous Fire loss experience

Is there any previous history of fire loss in the premises (if yes give details)

A9. Other relevant background

Are there any residential properties in or attached to the building

Is there a prohibition notice in force? (if yes give date of issue)

Is there an alteration notice in force? (if yes give date of issue)

Is there an enforcement notice in force? (if yes give date of issue and date of when work is to be completed by)

Is there a copy of Emergency and Preparedness Response (EPR) Log Book kept within the site/building?

Is the information within the EPR Log Book up to date?

Extra Relevant Information

Part B: FIRE HAZARDS AND ELIMINATION OR CONTROL
Current Control Measures

1. Smoking policy for the Trust – total smoking ban in Trust premises. 2. Fire and Arson policy for the Trust, regular waste collections. 3. Regular testing of electrical circuits and equipment. 4. Cooking is prohibited unless undertaken by appropriately trained personnel, within a designated kitchen environment. 5. Photocopiers should not have fuel stored around them, be in a well ventilated area, not on means of escape routes. Manufacturer’s instructions must be followed. 6. Gas boilers serviced on a regular basis by a Gas Safe registered contractor. 7. Portable heaters are not recommended but manufacturers instructions must be followed if used. 8. ‘Hot work permit’ issued by Estates for maintenance using hot work equipment. 9. Fire training for all personnel which includes fire prevention, precautions, raising of alarm and evacuation. 10. Correct storage facilities for paper and cardboard, low quantities maintained. 11. Items of furniture should comply with the Furniture & Furnishings (Fire Safety) Regulations 1988. 12. Regular waste disposal collections and correct storage containers. 13 Limited flammable liquids stored in correct containers and within appropriate facilities.

B1. Electrical sources of ignition

Are reasonable measures taken to prevent fires of electrical origin?

Is the fixed wiring installation periodically tested and inspected?

Are portable appliances tested/inspected?

Is there a suitable policy about the use of personal electrical appliances?

Is there a suitable limitation on the use of trailing leads and adapters?

Is all electrical equipment tested with records kept?

B2. Smoking

Are reasonable measures taken to prevent fires as a result of smoking?

Is smoking prohibited in the building?

Is smoking prohibited in appropriate areas?

Are there suitable arrangements made for those who wish to smoke?

Is there evidence of breaches of smoking policy?

Is the appropriate smoking prohibition notice displayed at the building's entrance?

B3. Arson

Does the basic security against arson appear reasonable?

Is there sufficient control of unnecessary fire load in close proximity to the building or available for ignition by outsiders?

B4. Portable heaters and heating installation

Is the use of portable heaters avoided as far as reasonably practicable?

If portable heaters are used, are the more hazardous types (radiant bars and LPG) avoided?

If portable heaters are used are suitable measures taken to minimise the risk of ignition of combustible materials?

Are fixed heating installations subject to regular maintenance?

B5. Cooking facilities

Are reasonable measures taken to prevent cooking fires?

Are filters changed and ductwork cleaned regularly?

Are suitable extinguishers available?

B6. Lightning

Does the building have lightning protection system if required? (if yes has it been tested and are records of testing kept)

B7. Other significant ignition sources that warrant consideration

List other ignition sources:

B8. Sources of Fuel and Housekeeping

Is the standard of housekeeping adequate?

Are combustible materials separated from ignition sources?

Is the unnecessary accumulation of combustibles and waste avoided?

Is there appropriate storage of hazardous materials?

Are combustible materials stored appropriately?

Further Information

B9. Hazards introduced by contractors and building works

Is there sufficient control over works by contractors (e.g. Permits to work & hot works permits)?

Are there arrangements for the safe storage of gas bottles and others hazardous materials

Are fire safety conditions and instructions communicated to contractors?

Further Information

B10. Dangerous Substances

Are dangerous substances present on the premises?

Has the risk to relevant persons been adequately eliminated or reduced?

Part C: FIRE PROTECTION MEASURES
C1. Means of escape

Is the building provided with adequate means of escape in case of fire?

Are there sufficient exits?

Are exits easily and immediately openable where necessary?

Do fire exits open in the direction of travel where necessary?

Have sliding or revolving doors been avoided as fire exits?

Are there adequate means of securing exits?

Are there reasonable distances of travel where there is a single direction of travel?

Are there reasonable distances of travel where there are alternative means of escape?

Are escape routes adequately protected?

Are there suitable fire precautions for all inner rooms?

Are escape routes unobstructed?

Are there suitable means of escape for disabled occupants?

Have PEEP forms been completed (if required) for disabled staff members?

C2. Measures to limit fire spread and development.

Is there a sufficient standard of compartmentation and sub-compartmentation?

Are linings that promote fire spread avoided as far as reasonably practicable?

C3. Escape lighting

Is there a reasonable standard of escape lighting provided?

C4. Fire safety signs and notices

Are fire safety signs and notices suitable and sufficient?

C5. Means of giving warning in the event of fire

Is a manually operated electrical fire alarm system provided?

Is automatic fire detection provided?

Is there remote transmission of alarm signals?

C6. Manual fire extinguishing appliances

Is there suitable and sufficient provision of portable fire extinguishers?

Are hose reels provided?

Were questioned staff members aware of the types of extinguishers within their work place?

C7. Relevant automatic fire extinguishing systems

Type of system:

Comments and observations:

C8. Facilities, equipment and devices for the protection of Fire-Fighters

Types of facilities:

Comments and observations:

Part D: MANAGEMENT OF FIRE SAFETY
D1. Procedures and arrangements

Person responsible for the site/building/department fire safety:

Are there competent persons available to assist in implementing fire safety arrangements?

Are appropriate fire procedures in place? (including arrangements for calling the fire service)

Is the Fire Emergency Procedure readily available for staff to read?

Is there a Fire Plan of the building in the site EPR Log Book?

Is the Fire Plan available to the enforcing authority?

Does the procedure take account of other Fire Emergency Procedures applicable in the building?

Are there persons nominated to respond to fire?

Are persons nominated to assist with evacuation?

Is there appropriate liaison with the fire service?

Do routine in-house inspections of fire precautions take place?

D2. Training and drills

Are staff given instruction on induction?

Do staff receive periodic refresher training at suitable intervals?

Are staff with special responsibilities given appropriate training?

Are fire drills carried out at appropriate intervals?

D3. Testing and maintenance

Is the workplace adequately maintained?

Is there weekly testing and periodic servicing of the fire detection and alarm system?

Is there monthly, six-monthly and annual testing of the emergency lighting?

Is there annual maintenance and testing of fire extinguishing equipment?

Is there annual inspection and test of the lightning protection system?

Is there six monthly and annual testing of wet/dry risers?

Is there weekly testing and periodic inspection of sprinkler installations?

Is there routine checks of fire doors and final exit doors?

Other relevant inspection and test

D4. Records

Are there records of fire drills?

Are there records of fire training?

Are there records of fire alarm tests?

Are there records of emergency lighting tests?

Are there records of maintenance and testing of other fire protection systems?

Part E: SIGNIFICANT FINDINGS AND RECOMMENDATIONS
E1. ITEMS

Item 1

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 2

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 3

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 4

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 5

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 6

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

E2. Document Recieved:
Received by local responsible person / representative
E3. Assessment completion date:
Assessor Signature
Pictures
E4. Re-Assessment

Based on OVERALL Fire Risk Rating, in Conclusion and Safety Rating section:

High Life Risk = 1 year review date.
Medium Life Risk = 3 year review date.
Low Life Risk = 5 year review date.

Recommended date for re-assessment
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.