Title Page

  • Assessment date

  • Activity / Item / Area

  • Poeple At Risk

  • Responsible Person

  • Use of premises or site works taking place

  • Assessor

  • Review Date

  • Monitoring Frequency

  • Authorised by

Hazard Table

Sources of Ignition

  • A. Smokers - Cigarettes, Matches, Lighters

  • B. Naked flames - gas, open flame

  • C. Electric, gas, cable strike

  • D. Hot processes, welding, cutting, grinding

  • E. Cooking equipment

  • F. Lighting

  • G. Arson

  • H. Faulty / misused equipment / poor maintenance

  • I. Reactive chemicals

Sources of Fuel

  • J. Textiles / clothing

  • K. Flammable liquids / solvents

  • L. Plastics / rubber

  • M. Waste materials

  • N. Flammable gases

  • O. Combustible construction materials - walls, floors, doors

  • P. Combustible storage materials

  • Q. Packaging materials

Sources of Oxygen

  • R. Natural ventilation through doors / windows

  • S. Explosion

  • T. Oxidising chemicals

  • U. Oxygen cylinders

Additional Sources

  • V

  • Degree of Risk

  • W

  • Degree of Risk

  • X

  • Degree of Risk

  • Y

  • Degree of Risk

  • Z

  • Degree of Risk

Potential for Fire to Spread

Conduction (Heating Through Materials)

  • AA. Through Arcing High Voltage Equipment

  • BB. Through piping / services

  • CC. Doors (if not fire doors)

  • DD. Hoarding

Convection (Hot Air Movement)

  • EE. Stairs

  • FF. Shafts / service ducts

  • GG. Windows

  • HH. Doors (open, wedged, not-self closing, damaged)

  • II. Roof voids

Radiation

  • JJ. Direct heat

Additional Hazards

  • KK

  • Degree of Risk

  • LL

  • Degree of Risk

  • MM

  • Degree of Risk

  • NN

  • Degree of Risk

  • OO

  • Degree of Risk

Monitoring Information

  • Person carrying out the monitoring (print name)

  • Department / Location

  • Checked by

  • Date

Control Measures

  • Fire Fighting equipment - state Number, Types and Locations

  • How many

  • Location(s)

  • How Many

  • Location(s)

  • How Many

  • Location(s)

  • How Many

  • Location(s)

  • How Many

  • Location(s)

  • Fire Detection and Warning System - State Numbers, Types and Locations

  • How Many

  • Location(s)

  • How Many

  • Location(s)

  • How Many

  • Location(s)

  • Notices/ Records/ Procedures

  • Escape Routes

  • Maintenance and Testing of Equipment

  • Building Design – Features of Escape Routes

  • Housekeeping / Storage of Waste and Materials

  • Additional Control Measures

Further Actions Required

  • 1.Action

  • Action

  • Action

  • Action

  • Action

  • Action

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