Information

  • Document No.

  • Name of premises

  • Address

  • Postcode

  • Telephone number

  • Site code number

  • Conducted on

  • Prepared by

Site information

  • Compliance and assurance at Birmingham Community Healthcare NHS Trust at Priestley wharf keep a copy of the completed form, and a copy has been forwarded to the person responsible at the above location.

    NB. To comply with the Regulatory Reform (Fire Safety) Order 2005 a further copy must be kept on the premises which it relates, to be available for inspection by any person with appropriate authority I.e West Midlands Fire Service Officer

  • Staff can find more information with regards to fire safety in Birmingham Community Healthcare NHS Trust by visiting the trust intranet page at the link below. http://nww.bhamcommunity.nhs.uk/about-us/divisions-and-directorates/compliance-and-assurance-directorate/risk-management/fire/

Site information

  • Photo of building

  • Number of floors

  • Number of floors below ground level

  • Type of occupancy

  • Property use

  • Max number of people employed

  • Max number of people who resort

  • Total % area occupied by Birmingham Community Healthcare NHS Trust staff

  • Hours of occupancy

Fire Risk Assessment

Sources of fuel

  • 1. Are there any highly flammable substances in the work place e.g. Paints, thinners, flammable gases, etc, flammable chemicals, petroleum, plastics, rubber, foam, polystyrene, polyethylene.

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 2. Are flammable liquids or gases used or stored in areas without adequate ventilation

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 3. Are there quantities of combustible materials stored, on display, or in use in or outside the workplace e.g. Paper, cardboard, packaging, fabrics, wood, waste, bins too close to the premises.

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 4. Are quantities of combustible materials allowed to accumulate in the workplace or stored in risk areas, I.e. waste paper, cardboard boxes, bagged waste or other items.

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 5. Does the premises contain less than 75% of furniture and furnishings that does not comply with HTM 05-03 part C

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 6. Are areas of walls or ceilings covered with combustible linings I.e carpet tiles, ceilings covered with polystyrene tiles?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 7. Do notice boards cover more than 5% of the corridor?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 8. Are combustible artificial foliage or plants used to decorate the workplace?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 9. Is oxygen stored and/or are there additional sources of oxidising chemicals, oxygen or piped systems?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 10. Is signage required for the storage of oxygen cylinders?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 11. Are quantities of aerosol cans stored in the premises?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 12. Are there any other sources of fuel issues that require any action?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

Sources of ignition

  • 13. Are any changes required to the PERMIT TO WORK system (A permit is required for all hot work carried out on the premises)

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 14. Does the work activity involve processes such as incinerating or cooking I.e deep fat fryers?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 15. Are there any heaters including portable heaters or radiant or open flame type?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 16. Do the premises require carbon monoxide detectors?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 17. Is smoking permitted?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 18. Are there light fittings near combustible materials?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 19. Are there any other sources of ignition issues that require any action?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 20. Is the wiring or electrical equipment damaged or not used in accordance with the manufacturers recommendations?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 21. Are extension leads used?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 22. Have there been any recent incidents that could have developed in to an arson attack?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

Identify people at risk

  • 23. Are any staff at increased risk from fire I.e working in remote areas, lone working or sleeping?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 24. Are there people present who may be unable to react quickly to a fire?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 25. In the event of a fire are there people present whose disabilities would put them at a disadvantage when required to evacuate in an emergency? (Look at compartmentation, rescue equipment, refuges)?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 26. Are visitors or members of the public likely to be unfamiliar with escape routes

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 27. Are builders, contractors, or maintenance workers temporarily on site?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 28. Is there insufficient staff on duty at any time (day and night) for evacuation purposes?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

Fire fighting and detection

  • 29. Are there any fire extinguisher problems? Select yes if they are inappropriate type, require recharging, or the location is incorrect or obstructed?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 30. Is there requirements to increase or change the arrangements for giving warning of fire including automatic detection?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 31. Is there a requirement to improve the signage for the fire alarm system?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 32. Is additional training required to ensure that employees know how to operate and understand the basic functions of the fire alarm panel?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 33. Is there a need to recommend the fire alarm system be linked with an alarm monitoring company?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 34. Are new or additional fire routine notices required? (They should be clear be displayed through the workplace and the wording correct and inline with the procedure for this particular premises).

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 35. Does the fire routine procedure require amendment?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 36. Are there any other issues on fire fighting equipment and detection that require further action?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

Means of escape

  • 37. Are there any persons unable to turn their back on the fire and evacuate to a place of safety? (Unacceptable dead end)

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 38. Are there any doors that conflict with the requirements to open in the direction of travel if more than 50 persons are required to use them in an evacuation

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 39. Do any door fastenings on exit routes and final exits require changing to ensure they are easily opened?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 40. Are there any fire resisting doors that require a self closing mechanism or adjustments, to ensure the doors close correctly onto their rebates and gaps are not excessive?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 41. Do any of the fire doors require repairs to ensure their fire resistant integrity is maintained?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 42. Do any of the fire doors require new or repairs to the intumescent strip/smoke seals?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 43. Is work required to ensure adequate fire compartmentation in ceiling and roof voids I.e 20m centres in lofts/ceiling voids and above fire walls and door forming that compartment?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 44. Is additional signage required for fire doors, storeroom doors or fire exit routes?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 45. Is additional emergency lighting required in exit routes to ensure adequate illumination?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 46. Do corridors/gangways forming the exit route contain combustible materials of obstructions?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 47. Are additional arrangements required for the evacuation of disabled persons?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 48. Are extra measures required to ensure persons can escape safely from the premises or proceed to a fire compartment two doors away from the fire, ensuring there are sufficient exits of a suitable width?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 49. Are there any other means of escape issues (I.e fire doors wedged open).

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

Maintenance

  • 50. Are PAT tests on electrical equipment out of date?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 51. Are the electrical tests on the fixed electrical system due, to conform to the 16th edition of the IEE wiring regulations of BS 7671 2001, must have been completed in the last 5 years

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 52. Do door fastenings on any fire doors require maintenance?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 53. The emergency lighting system should be tested and serviced according to the BS. Is any action required to ensure this is being carried out?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 54. Is action required to ensure that all fire extinguishers, fire blankets, hose reels have been tested and serviced and are in good order?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 55. The fire alarm system should be tested and serviced according to the BS 5839 pt1 1988. Is any action required to ensure it is being carried out?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 56. Is any action required to ensure the sprinklers and other fixed fire fighting systems have been regularly tested and serviced in accordance with BS

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 57. Are any members of staff overdue their annual fire training?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 58. Is an annual fire drill overdue? A fire drill must have been carried out in the last 12 months.

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 59. Is training required in e use of specific evacuation and rescue equipment located in the premises?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 60. Do zoned fire plans need to be sited next to the fire panel?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 61. Has another agency been contacted regarding any matter arising from this inspection?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

  • 62. Are there deficiencies in the fire log book?

  • Fire alarm

  • Date tested/reported.

  • Emergency lighting

  • Date tested/reported.

  • Fire drills

  • Date last drill?

  • Fire extinguishers

  • Date last serviced?

  • Fire training

  • Date

  • Visit by fire officers

  • Date of visit?

  • Written fire procedure documents

  • Date

  • Copy of fire risk assessment?

  • Date

  • 63. Are there any other matters arising from this inspection, which are not identified on this form?

  • Control measures

  • Priority

  • Action by

  • Completed date

  • Picture

Plans

Building plans

  • Insert building plans

Staff preent

Staff present at the time of the inspection have been informed of the finding.

    Staff details
  • Staff member

  • Job title

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