Title Page

  • Conducted on

  • Prepared by

  • Location
  • What is your Fire Warden area?

Fire Extinguishers

  • Are extinguishers in labelled locations?

  • Are extinguisher pins in place and seals unbroken (for 2018/19 the extinguisher pins are blue)? <br>

  • Are extinguishers easily accessible and unobstructed?

  • If a gauge is fitted, is the needle in the green zone?

Fire Escape Routes

  • Are emergency exit routes clearly signposted?

  • Are escape routes clear and free of obstructions?

  • Do Fire Doors self-close effectively into the door frame?

  • Are Fire Doors kept closed (not held/wedged open)?

Fire Safety Notices and Signs

  • Are all Fire Safety notices and signs clearly visible and not defaced?

  • Are ‘Fire Action’ notices in place and do they indicate the location of Fire Assembly Point?

  • Is the sign at the Fire Assembly Point in place, clearly visible, and undamaged?

Fire Exits

  • Are final exits from buildings clear of obstructions, both inside and outside the building?

  • Can emergency exits be opened without the use of a key?

  • Do Fire Exits discharge into a place of safety?

  • Is the Fire Assembly Point clearly identifiable and is it in a clear safe area away from traffic?

Electrical Equipment

  • Are all electric cables tidy and free from trip hazards?

  • Are all extension cables fully extended (uncoiled) and routed safely?

  • Is all electrical equipment entirely and satisfactorily free from evidence of temporary repair of or damage?

Heating Equipment

  • Are heaters, flues, vents and hot pipes clear of furniture, clothing, paper or other combustible materials?

General Housekeeping

  • Are all work areas tidy?

  • Is the smoking policy seen to be working?

  • Are packing and stationery materials securely contained and stored?

  • Are flammable materials stored in a secure location?

  • Is combustible waste safely stored away from heat sources and disposed of regularly?<br>

  • Signed: (Fire Warden) *.............................................................Date: ............................

  • Signed: (Safety Manager) *........................................................ Date: ........................... Fire Wardens & ASMs should keep a copy of this form for their records. The Fire Warden should forward the completed form, signed* and dated* to the appropriate Area Safety Manager. The ASM should forward the completed copy to the SHE office and action remedial measures where necessary. *When submitting an electronic copy of this form, insertion of the Fire Warden’s / Area Safety Manager’s name with the appropriate date will constitute an authorisation signature.

  • Comments: (please use this space to support any of your answers)

  • Please add any photo evidence to support your answers here.

Fire Extinguishers

  • Are extinguishers in labelled locations?

  • Are extinguisher pins in place and seals unbroken (for 2018/19 the extinguisher pins are blue)?

  • Are extinguishers easily accessible and unobstructed?

  • If a gauge is fitted, is the needle in the green zone?

Fire Escape Routes

  • Are emergency exit routes clearly signposted?

  • Are escape routes clear and free of obstructions?

  • Do Fire Doors self-close effectively into the door frame?

  • Are Fire Doors kept closed (not held/wedged open)?

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.