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

  • 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

  • If any of the above selected, please give details


  • 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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.