Title Page
-
Site conducted
-
Document No.
-
Type of incident
-
Location
-
Conducted on
-
Prepared by
Fire/False alarm details
-
Date and time
-
Location details
-
Was the fire alarm sounded
-
If no, why not
-
How was alarm raised
-
Name of person
Fire/False alarm events
-
How did the fire/false alarm happen? Please give full details
-
Was an attempt made to extinguish the fire?
-
If Yes, by whom. If No, why not
-
Was the Fire Brigade in attendance
-
Time
Life Risk
-
Approximate no of persons in building
-
Occupancy type
- Residential
- General needs
- Vulnerable adults
- Office
- Community room
- Training room
- Sheltered housing
- Housing with care
- Young persons
-
Was an evacuation necessary?
-
How long did it take and who organised it?
-
Were there any injuries?
-
Give details of any injuries/treatment administered.
-
A separate accident form needs to be filled in if there were any injuries resulting from this incident
Additional factors
-
Did any of the following cause or were noticed at the location
- Structural changes
- Excessive storage
- Electrical overload
- N/A
-
If any of the above selected, please give details
Conclusion
-
Is the building/room/area safe to be used?
-
What needs to be done?
-
If the location has a fire panel, has this been reset and the system fault free?
-
Please give further information including when and by whom this was done
-
Are there any further actions that need to be taken?
-
Actions required and by whom