FIRE RISK ASSESSMENT

• XYLEM site

• Conducted on

  Date

• Prepared by

• Reason for assessment:

• ​New construction ​

• Addition to existing structure ​

• New property acquisition/lease ​

• Layout/process change ​

• Evaluation of current fire protection/life safety system ​

• Other:

Site Description & Activities

• 1. Describe the location and structures (buildings, size including number of floors, usage, construction, fire ratings). Attach a site map.

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• Is property owned or leased?

• 2. Number of employees

• Do any employees work alone? In remote areas?

• Do visitors (non-employees) ever come on-site?

• 3. Are any of the following potential sources of ignition present at the site: ​​Welding ​​

• Brazing ​​

• Stator-dropping using an open flame/torch ​

• Heating of parts using an open flame/torch ​ ​

• Cutting using a flame/plasma arc ​

• Portable heaters ​

• Grinding (spark-producing) ​

• Cooking area. If yes, specify if “normal kitchen” or canteen/cafeteria:

• If these activities are performed, how will the fire risk be minimized?

• Describe other heat-generating activities conducted at the location, including any that might use an open flam

• 4. Describe utilities (electricity, water supply, natural gas):

• 5. What chemicals are used on-site? Indicate if the chemicals are flammable or combustible and quantities stored.

• Describe chemical storage and indicate locations on site plan.

• 6. Has Factory Mutual evaluated the site?

• recommendations

• Has the local Fire Department evaluated the site? If yes, recommendations?

Life Safety

• 7. Does the facility have an evacuation plan? Attach plan or describe. Attach evacuation map.

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• What is the longest travel distance to an emergency exit?

• How many stories does the building have? Fire escapes from the upper stories?

• 8. Are evacuation drills conducted periodically? Frequency? Describe alarm system. Is alarm system tested periodically?

• 9. Are any designated exits not doors? For example, are windows used as emergency exits?

• Do all emergency exits lead to a place of safety?

• Are emergency exits always unlocked when premises are occupied? Do doors open in direction of travel?

• Are escape routes marked and lit? Are emergency exits visible in the dark?

• 10. What evacuation procedures are in place for visitors?

Policies/Training

• 11. Is there a smoking policy? Designated smoking areas?

• 12. Is there a Hot Work Program?

• 13. Have employees been trained on actions to take in the event of a fire?

• Have employees been trained to use fire extinguishers?

Fire Detection/Fire Fighting Capabilities

• 14. Is all or part of the facility equipped with smoke detectors? Is the system connected to a central monitoring system?

• 15. Describe fire-fighting capabilities at the location.

• Number and type of fire extinguishers:

• Who services the fire extinguishers? Frequency?

• 16. Distance to nearest fire department:

• Mode of alarm:

• 17. Has the facility ever been involved in a fire? If yes, describe the incident, resulting damages and preventative measures taken.

Financial Assessment

• 18. Cost to install sprinkler system (attach cost estimate) (Include any required upgrades to water system):

• 19. Cost of potential losses:

• Building/property

• Fixed assets, equipment

• Stock

• activity loss (i.e., sales)

Conclusions

• 20. Please provide your conclusions or recommendations based on the analysis of the information. ( by FM GLOBAL)

Approvals

• Site ESH Coordinator:

• Name

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• Value Center ESH Manager:

• Name

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• Management Company ESH Director:

• Name

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