Fire Safety Risk Assessment Form

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location/Building name
  Address

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  Media

• Add signature

  Sign

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• Select date

  Date

• Building Name & Details

• Initial Assessment

• Equipment Change

• New Procedures/Processes

• Review

• Estimated number of people expected to be in the facility during normal hours/late shifts (includes visitors, cleaners etc.)

  Yes

  No

  N/A

• Section 1. Hazard Identification (Part A)
  
  Remember ... 3 things are needed to start a fire:
  1. Fuel (anything that burns) Examples; Paper. textiles, rubbish, flammable liquids & solvents, plastics, furniture, packaging materials
  2. A Source of Ignition (heat) Examples: Naked flame, cigarettes, heaters, sparks, hot processes, cooking, faulty electrical equipment
  3 Oxygen
  
  Indicate below where in your business all three could potentially come together to start a fire.
  

• Risk Evaluation:
  
  When recording potential hazards, attempt to classify the risks as either LOW (minimal risk of fire), NORMAL (outbreak of fire likely to remain confined with warning system allowing persons to escape safely) or HIGH (where flammable or explosive materials are stored / used or where reaction times of individuals may be an issue).
  

• Potential Hazard

  Safe

  At Risk

  N/A

• Potential Hazard

  Safe

  At Risk

  N/A

• Potential Hazard

  Safe

  At Risk

  N/A

• Potential Hazard

  Safe

  At Risk

  N/A

• Potential Hazard

  Safe

  At Risk

  N/A

• Potential Hazard

  Safe

  At Risk

  N/A

• Potential Hazard

  Safe

  At Risk

  N/A

• Section 1. Hazard Identification (Part B)
  
  The following checklist has been designed to help you identify many of the key issues that need to be considered during the risk assessment process.
  
  NA = Not applicable
  
  *Note: if existing controls are determined 'Not Adequate', develop a plan of action to reduce these risks to a minimum or acceptable level in Section 2.
  

Fire Safety Checklist/Housekeeping and Storage

Existing Controls*

• Is the workplace free from rubbish and combustible waste materials?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are materials stacked neatly with adequate space around them to maneuver?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are storage areas separate from other areas of the business?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are storage areas checked regularly?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is all waste removed from the building at the end of each day?

  Yes

  No

  N/A

• Adequate

• Not Adequate

Training & Testing

• Do all employees know what to do if fire breaks out?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are staff aware of the evacuation procedures, locations and muster stations?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Have staff been trained in the use of fire extinguishers, hose reels and basic fire protection?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is a fire drill conducted at least once per year?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is the fire alarm tested at least annually?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are there tested plans in place to assist visitors to evacuate the premises in the event of an emergency?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are employees and contractors aware of the importance/function of fire doors?

  Yes

  No

  N/A

• Adequate

• Not Adequate

Means of Escape

• Are all escape routes and exit doors free from clutter and obstruction?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are escape routes free from slipping and tripping hazards?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Where appropriate, have escape routes been mapped out and communicated to staff?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are there enough exits allowing staff to exit the building quickly? <br>

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are all escape routes adequately lit?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• In the event of a power failure, do all escape routes have emergency lighting

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Do doors on escape routes open in the direction of travel?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are all exit doors clearly marked?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are fire alarm pull stations clearly visible and unobstructed?

  Yes

  No

  N/A

• Adequate

• Not Adequate

Flammable Liquids

• Are all flammable liquids properly stored?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are separate receptacles used to dispose of flammable liquids and materials

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is there adequate ventilation where flammable materials are kept and used?

  Yes

  No

  N/A

• Adequate

• Not Adequate

Electricity & Heating

• Are electrical heaters (if any)...<br>Securely guarded and fixed in position?<br>

  Yes

  No

  N/A

• Not Adequate

• Adequate

• Inspected regularly?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Kept a safe distance from combustible materials?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are any cables/plugs damaged?

  Yes

  No

  N/A

• Not Adequate

• Adequate

• If the fire detection and warning system is electric, is there a backup if there is a power loss?

  Yes

  No

  N/A

• Adequate

• Not Adequate

Fire Extinguishers & Other Systems

• Do you have the correct type and size of fire extinguisher {s) within the workplace?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are there sufficient fire extinguishers located throughout the workplace?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are all fire extinguishers properly placed in position with secure mountings?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Have all fire extinguishers been inspected within the last month and ready for use?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Have all fire extinguishers been serviced/maintained within the last 12 months?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is fire-fighting equipment indicated by signage?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is fire safety first aid equipment provided?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is there an automatic fire detection and warning system?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is there an automatic sprinkler system?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are internal fire doors identified accordingly and kept closed or have electromagnetically controlled door closers?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are fire action notices displayed prominently throughout the workplace?

  Yes

  No

  N/A

• Adequate

• Not Adequate

Maintenance & General Policy

• Is equipment properly maintained and inspected as per manufacturer specifications?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is equipment regularly cleaned?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is there evidence that Hot Work permits are being used and completed correctly?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Do you have a visitor control system acknowledging any visitors/contractors in the building at all times?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are designated smoking areas clearly indicated by signage?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is the smoking policy strictly enforced?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are smoking areas equipped with receptacles for safe and easy disposal of cigarette ends?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Is the building constructed of combustible materials (eg. Polyurethane foam insulation)?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Are all staircases properly maintained with handrails?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Has the maintenance of fire extinguishers and other equipment been recorded into a log?

  Yes

  No

  N/A

• Adequate

• Not Adequate

• Have adequate measures been taken to protect against arson?

  Yes

  No

  N/A

• Adequate

• Not Adequate

Section 2. Risk Reduction Action Plan Use this section to develop action plans aimed at reducing risks identified within Section 1. to minimum or acceptable levels

Hazard Identified From Section 1. Where existing controls deemed “Not Adequate”

Persons at Risk / Location

Action Plan

• Select date

  Date

Hazard Identified From Section 1. Where existing controls deemed “Not Adequate”

Persons at Risk / Location

Action Plan

• Select date

  Date

Hazard Identified From Section 1. Where existing controls deemed “Not Adequate”

Persons at Risk / Location

Action Plan

• Select date

  Date

Section 3. Workplace Layout Issues I Alternatives Use this grid to sketch any potential problem areas within your workplace resulting from the assessment process or to develop possible alternatives to help reduce the risk of fire within various locations. All Action Plans must be entered into Intelex for tracking and recording evidence of completion.

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  Date

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