• Client / Site

  • Conducted on

  • Prepared by

  • Photo of site


  • Name of responsible person

  • Contact details of responsible person

1 The Building

  • Floor area m2

  • Number of floors

  • Brief details of construction

  • Occupancy type

2 The Occupants

  • Maximum number of occupants

  • Maximum number of members of the public at any given time

3 Occupants at Special Risk

  • Are children employed on the premises ?

  • Are there sleeping occupants ?

  • Are there disabled occupants ?

  • Are there adequate precautions in place for pregnant occupants ?

  • Are there occupants in remote areas ?

  • Are there lone workers ?

4 Previous fire loss experience

  • Is there any previous history of fire loss in the premises ( if yes give details )

5 Other relevant background

  • Are there any residential properties in or attached to the building ?

  • Is there a prohibition notice in force ? ( if yes give details )

  • Is there an alteration notice in force ? ( if yes give details )

  • Is there an enforcement notice in force ? ( if yes give date of when work is to be completed by )

  • Is there any insurance stipulations


6 Electrical sources of ignition

  • Are reasonable measures taken to prevent fires of electrical origin ?

  • Is the fixed wiring periodically tested and inspected ?

  • Are portable appliances tested/inspected ?

  • Is there suitable policy about the use of personal electrical appliances ?

  • Is there a suitable limitation on the use of trailing leads and adapters ?

  • Is luminous discharge lighting installed ?( if yes does installation meet with current standards )

  • Is all electrical equipment tested and records on site ?

7 Smoking

  • Are reasonable measures taken to prevent fires as a result of smoking ?

  • Is smoking prohibited in the building ?

  • Is smoking prohibited in appropriate areas ?

  • Are suitable arrangements made for those who wish to smoke ?

  • Is there absence of any evidence of breaches of smoking policy ?

  • Is the appropriate smoking prohibition notice displayed at the buildings entrance ?

8 Arson

  • Does the basic security against arson appear reasonable ?

  • 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

  • Is the use of portable heaters avoided as far as reasonably practicable ?

  • If portable heaters are used are the more hazardous types ( radiant bars and LPG ) avoided ?

  • If portable heaters are used are suitable measures taken to minimise the risk of ignition of combustible materials ?

  • Are fixed heater installations subject to regular maintenance ?

10 Cooking Facilities

  • Are reasonable measures taken to prevent cooking fires ?

  • Are filters changed and ductwork cleaned regularly ?

  • Are suitable extinguishers available ?

11 Lightning

  • 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

  • List other ignition sources

  • Add media

13 Housekeeping

  • Is the standard of housekeeping adequate ?

  • Are combustible materials separate from ignition sources ?

  • Is the unnecessary accumulation of combustibles and waste avoided ?

  • Is there appropriate storage of hazardous materials ?

  • Are combustible materials stored appropriately ?

14 Hazards introduced by contractors and building works

  • Is there sufficient control over works by contractors ( eg. Permits to work and hot works permits ) ?

  • Are there arrangements for the safe storage of gas bottles and other hazardous materials ?

  • Are the safety conditions and instructions communicated to contractors ?

15 Dangerous substances (gas, fuels, flammable liquids, oxidising agents)

  • Are dangerous substances present on the premises ?

  • Has the risk to relevant persons been adequately eliminated or reduced ?


16 Means of escape

  • Is the building provided with adequate means of escape in case of fire ?

  • Are there sufficient exits ?

  • Are exits easily and immediately openable where necessary ?

  • Do fire exits open in the direction of travel where necessary ?

  • Have sliding or revolving doors been avoided as fire exits ?

  • Are there adequate means of securing exits ?

  • Are there reasonable distances of travel where there is a single direction of travel ?

  • Are there reasonable distances of travel where there are alternative means of escape ?

  • Are escape routes adequately protected ?

  • Are there suitable fire precautions for all inner rooms ?

  • Are escape routes unobstructed ?

  • Are there suitable means of escape to disabled occupants ?

17 Measures to limit fire spread and development

  • External fire spread

  • Add media

  • Is there sufficient standard of compartmentation and sub-compartmentation ?

  • Are linings that promote fire spread avoided as far as reasonably practicable ?

  • Are fire doors fitted correctly with a gap not exceeding 4mm

  • Is the door set identified as a fire door?

  • Is the doors hardware fire rated

  • Does the fire door have intumescent strip and or smoke seals correctly fitted

  • Is there any sign of repairs to fire doors?

18 Escape lighting

  • Is there reasonable standard of escape lighting provided ?

  • Is there reasonable standard of escape lighting on any change of level?

19 Fire safety signs and notices

  • Are fire safety signs and notices suitable and sufficient ?

  • Are escape routes clearly signed?

  • Are fire doors clearly signed?

  • Is the fire action notice displayed?

20 Means of giving warning in the event of fire

  • Is a manually operated electrical fire alarm system provided ?

  • Automatic fire detection system provided ?

  • Is there remote transmission of alarm signals ?

21 Manual fire extinguishing appliances

  • Is there suitable and sufficient provision of portable fire extinguishers ?

  • Are extinguishers serviced?

22 Relevant automatic fire extinguishing systems

  • Types of system

  • Comments and observations

23 Facilities, equipment and devices for the protection of fire fighters

  • Smoke control

  • Types of facilities

  • Comments and observations


24 Procedures and arrangements

  • Person responsible for fire safety

  • Are there competent persons available to assist in implementing fire safety arrangements ?

  • Are appropriate fire procedures in place ? ( including arrangements for calling the fire service )

  • Fire Emergency Plan in place and recorded ?

  • Does the plan take account of other emergency plans applicable in the building ?

  • Is the emergency fire plan readily available for staff to read ?

  • Is the emergency plan available to the enforcing authority ?

  • Are there persons nominated to respond to fire ?

  • Are persons nominated to assist with evacuation ?

  • Is there appropriate liaison with the fire service ?

  • Do routine in-house inspections of fire precautions take place ?

25 Training and drills

  • Are staff given instruction on induction ?

  • Do staff receive periodic refresher training at suitable intervals ?

  • Are staff trained on how to use fire extinguishers?

  • Are fire drills carried out at appropriate intervals ?

26 Testing and maintenance

  • Is the workplace adequately maintained ?

  • Is there weekly testing and periodic servicing of the fire detection and alarm system ?

  • Is there monthly, six monthly, and annual testing of the emergency lighting ?

  • Is there annual maintenance and testing of fire extinguishing equipment ?

  • Is there annual inspection and test of the lightning protection system ?

  • Is there six monthly and annual testing of wet/dry risers ?

  • Is there weekly testing and periodic inspection of sprinkler installations ?

  • Is there routine checks of fire doors and final exit rooms ?

  • Other relevant inspection and test

27 Records

  • Are there records of fire drills ?

  • Are there records of training ?

  • Are there records of fire alarm system ?

  • Are there records of emergency lighting tests ?

  • Are there records of maintenance and testing of other fire protection systems ?


  • Name and signature of responsible person

  • Assessors name and signature

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.