Information
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Client / Site
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Conducted on
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Prepared by
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Photo of site
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PART 1 GENRAL INFORMATION
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Name of responsible person
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Contact details of responsible person
1 The Building
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Number of floors
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Floor area ( m2 per floor )
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Floor area ( m2 total )
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Brief details of construction
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Occupancy type
2 The Occupants
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Maximum number of occupants
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Maximum number of occupants
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Maximum number of occupants at any given time
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Maximum number of members of the public at any given time
3 Occupants at Special Risk
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Are children employed on the premises ?
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Are there sleeping occupants ?
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Are there disabled occupants ?
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Are there occupants in remote areas ?
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Are there lone workers ?
4 Previous fire loss experience
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Is there any previous history of fire loss in the premises ( if yes give details )
5 Other relevant background
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Are there any residential properties in or attached to the building ?
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Is there a prohibition notice in force ? ( if yes give details )
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Is there an alteration notice in force ? ( if yes give details )
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Is there an enforcement notice in force ? ( if yes give date of when work is to be completed by )
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PART 2 FIRE HAZARDS AND ELIMINATION OR CONTROL
6 Electrical sources of ignition
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Are reasonable measures taken to prevent fires of electrical origin ?
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Is the fixed wiring periodically tested and inspected ?
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Are portable appliances tested/inspected ?
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Is there suitable policy about the use of personal electrical appliances ?
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Is there a suitable limitation on the use of trailing leads and adapters ?
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Is luminous discharge lighting installed ?( if yes does installation meet with currant standards )
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Is all electrical equipment tested and records on site ?
7 Smoking
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Are reasonable measures taken to prevent fires as a result of smoking ?
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Is smoking prohibited in the building ?
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Is smoking prohibited in appropriate areas ?
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Are suitable arrangements made for those who wish to smoke ?
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Is there absence of any evidence of breaches of smoking policy ?
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Is the appropriate smoking prohibition notice displayed at the buildings entrance ?
8 Arson
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Does the basic security against arson appear reasonable ?
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Is there sufficient control of unnecessary fire load in close proximity to the building or available for ignition by outsiders ?
9 Portable heaters and heating installations
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Is the use of portable heaters avoided as far as reasonably practicable ?
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If portable heaters are used are the more hazardous types ( radiant bars and LPG ) avoided ?
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If portable heaters are used are suitable measures taken to minimise the risk of ignition of combustible materials ?
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Are fixed heater installations subject to regular maintenance ?
10 Cooking Facilities
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Are reasonable measures taken to prevent cooking fires ?
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Are filters changed and ductwork cleaned regularly ?
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Are suitable extinguishers available ?
11 Lightning
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Does the building have lightning protection system if required ? ( if yes has it been tested and are records kept ?
12 Other significant ignition sources that warrant consideration
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List other ignition sources
13 Housekeeping
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Is the standard of housekeeping adequate ?
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Are combustible materials separate from ignition sources ?
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Is the unnecessary accumulation of combustibles and waste avoided ?
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Is there appropriate storage of hazardous materials ?
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Are combustible materials stored appropriately ?
14 Hazards introduced by contractors and building works
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Is there sufficient control over works by contractors ( eg. Permits to work and hot works permits ) ?
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Are there arrangements for the safe storage of gas bottles and other hazardous materials ?
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Are the safety conditions and instructions communicated to contractors ?
15 Dangerous substances
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Are dangerous substances present on the premises ?
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Has the risk to relevant persons been adequately eliminated or reduced ?
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PART 3 FIRE PROTECTION MEASURES
16 Means of escape
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Is the building provided with adequate means of escape in case of fire ?
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Are there sufficient exits ?
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Are exits easily and immediately openable where necessary ?
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Do fire exits open in the direction of travel where necessary ?
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Have sliding or revolving doors been avoided as fire exits ?
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Are there adequate means of securing exits ?
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Are there reasonable distances of travel where there is a single direction of travel ?
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Are there reasonable distances of travel where there are alternative means of escape ?
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Are escape routes adequately protected ?
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Are there suitable fire precautions for all inner rooms ?
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Are escape routes unobstructed ?
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Are there suitable means of escape to disabled occupants ?
17 Measures to limit fire spread and development
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Is there sufficient standard of compartmentation and sub-compartmentation ?
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Are linings that promote fire spread avoided as far as reasonably practicable ?
18 Escape lighting
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Is there reasonable standard of escape lighting provided ?
19 Fire safety signs and notices
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Are fire safety signs and notices suitable and sufficient ?
20 Means of giving warning in the event of fire
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Is a manually operated electrical fire alarm system provided ?
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Automatic fire detection system provided ?
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Is there remote transmission of alarm signals ?
21 Manual fire extinguishing appliances
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Is there suitable and sufficient provision of portable fire extinguishers ?
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Are hose reels provided ?
22 Relevant automatic fire extinguishing systems
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Types of system
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Comments and obsevations
23 Facilities, equipment and devices for the protection of fire fighters
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Types of facilities
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Comments and observations
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PART 4 MANAGEMENT OF FIRE SAFETY
24 Procedures and arrangements
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Person responsible for fire safety
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Are there competent persons available to assist in implementing fire safety arrangements ?
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Are appropriate fire procedures in place ? ( including arrangements for calling the fire service )
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Fire Emergency Plan in place and recorded ?
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Does the plan take account of other emergency plans applicable in the building ?
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Is the emergency fire plan readily available for staff to read ?
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Is the emergency plan available to the enforcing authority ?
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Are there persons nominated to respond to fire ?
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Are persons nominated to assist with evacuation ?
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Is there appropriate liaison with the fire service ?
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Do routine in-house inspections of fire precautions take place ?
25 Training and drills
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Are staff given instruction on induction ?
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Do staff receive periodic refresher training at suitable intervals ?
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Are staff with special responsibilities given appropriate training ?
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Are fire drills carried out at appropriate intervals ?
26 Testing and maintenance
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Is the workplace adequately maintained ?
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Is there weekly testing and periodic servicing of the fire detection and alarm system ?
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Is there monthly, six monthly, and annual testing of the emergency lighting ?
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Is there annual maintenance and testing of fire extinguishing equipment ?
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Is there annual inspection and test of the lightning protection system ?
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Is there six monthly and annual testing of wet/dry risers ?
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Is there weekly testing and periodic inspection of sprinkler installations ?
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Is there routine checks of fire doors and final exit rooms ?
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Other relevant inspection and test
27 Records
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Are there records of fire drills ?
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Are there records of training ?
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Are there records of fire alarm system ?
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Are there records of emergency lighting tests ?
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Are there records of maintenance and testing of other fire protection systems ?
PART 5: RISK RATING AND RECOMMENDATIONS
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ITEM 1
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Item
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Probability ( likelihood of fire )
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Consequence ( impact on life safety )
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Risk rating score
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Recommendations
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Action
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ITEM 2
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Item
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Probability ( likelihood of fire )
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Consequence ( impact on life safety )
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Risk rating score
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Recommendations
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Action
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ITEM 3
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Item
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Probability ( likelihood of fire )
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Consequence ( impact on life safety )
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Risk rating score
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Recommendations
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Action
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ITEM 4
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Item
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Probability ( likelihood of fire )
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Consequence ( impact on life safety )
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Risk rating score
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Recommendations
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Action
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ITEM 5
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Item
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Probability ( likelihood of fire )
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Consequence ( impact on life safety )
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Risk rating score
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Recommendations
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Action
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ITEM 6
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Item
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Probability ( likelihood of fire )
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Consequence ( impact on life safety )
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Risk rating score
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Recommendations
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Action
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ITEM 7
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Item
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Probability ( likelihood of fire )
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Consequence ( impact on life safety )
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Risk rating score
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Recommendations
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Action
PART 6: SIGNED AND RECEIVED
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Name and signature of responsible person
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Assessors name and signature