Automatic fire alarm indident report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Building details

• Building number

  Yes

  No

  N/A

• Building level

  Yes

  No

  N/A

• Type of building

  Yes

  No

  N/A

Type of alarm

• Smoke detector?

  Yes

  No

  N/A

• Thermal detector?

  Yes

  No

  N/A

• Sprinkler?

  Yes

  No

  N/A

• Vesda?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Personnel responding

• SLHD Fire officers

  Yes

  No

  N/A

• FRNSW

  Yes

  No

  N/A

• NSW Police

  Yes

  No

  N/A

• Ambulance service of NSW

  Yes

  No

  N/A

Class of fire

• Ordinary combustibles

  Yes

  No

  N/A

• Electrical

  Yes

  No

  N/A

• Flammable liquid

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Method of extinguishing

• Portable extinguisher

  Yes

  No

  N/A

• Hose reel

  Yes

  No

  N/A

• Fire blanket

  Yes

  No

  N/A

• Sprinkler

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Casualties

• Patients

  Yes

  No

  N/A

• Staff

  Yes

  No

  N/A

• Visitors

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Statement relating to the incident

• Statement

  Yes

  No

  N/A

Hospital fire officer recommendation

• Recommendations

  Yes

  No

  N/A

Sign of

• Add signature

  Sign

• Select date

  Date