Audit

Name and Address of Premise
Telephone Number of Premise
Building Owner
Building Occupier
Building/ Ward Name
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Use of Premises

Organisation/ Trust Responsible Person

Name and Status of Nominated Person

Name and relevant details of any competent persons appointed to assist with the fire safety measures.

General Information

Have there been any fires or near miss experiences since the last Fire Risk Assessment/Fire Safety Audit

Incident details

Competent/ Responsible Persons

Organisation/Trust Responsible Person

Estates Premises condition and PPMs

Local Responsible Person, Fire Safety Management

Names of nominated Fire Wardens

Conclusions;

It can be concluded that with the implementation of the recommendations within the timescales provided as found in the Part E - Significant Findings and Recommendations: Significant Findings and Action Plans of this risk assessment and the continued support of SSSFT Compliance and Risk Services Team, the occupants of the building are working within a safe environment that is broadly compliant with the Regulatory Reform (Fire Safety) Order 2005.

It must be noted if the recommendations are not implemented within required timescales, persons within the risk assessed and adjacent building/department/ward/unit will be at a greater life risk should a fire incident occur.

Building Details

Number of floors
Floor Area (m2 total)
Building/ Fire Plans

Brief Deatils of Construction

Choose from drop down list
Occupancy Type

Are there internal fire hydrants installed?

Location and numbers of fire hydrants

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Date of last test

Fire Service Access

Is there access for Emergency Vehicles?

How many sides by Vehicle

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How many sides by foot

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Building Occupants

What is the maximum numbers of staff at any given time

What is the maximum numbers of patients at any given time

What is the maximum numbers of the public at any given time

What is the maximum total numbers of persons at any given time including security, site services etc.

Occupants at Special Risk

Are young persons/ work experience persons employed at the premises?

Numbers of young persons

Are there any sleeping occupants at the premises?

Numbers of persons
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Are there any disabled persons at the premises?

Have PEEP forms been completed (if required) for disabled staff members?

Numbers of persons

Are young lone workers at the premise?

Numbers of young persons

Are there any workers in remote areas at the premises?

Have PEEP forms been completed (if required) for disabled staff members?

Numbers of persons

Previous Fire Loss Experience

Is there any History of Fires in the Premises?

Details of fire loss. Include dates and times and note if a fire report was completed (include reference and upload copy of report(s)

Insert web link to report(s) here.

Fire Service Notices

Are there any Fire Service Notices in force for this premise

Details of Notice

Issue Date of Notice

Additional relevant information.

Fire Service Inspections by operational crews

Has there been any Local Authority Fire inspections?

Date of last inspection

Relevant details.

Fire Hazards and their Elimination or Control

Are there any current control measures in place to reduce the risk from fire?

Current control measures

Electrical Sources of Ignition

Are reasonable measures taken to prevent fires of electrical origin?

What measures are there to mitigate the effects of an electrical fire?
Date of last PAT test
Upload photo of test label

Is the fixed wiring installtion tested in accordance with "The Electricity at Work Regulations" recommended test interval of 5 years (Commercial) in accordance with BS7671.

Date of last inspection

Is the use of portable/ supplementary heaters avoided as far as is reasonably practicable?

Types of portable/ suplementary heaters in use

Smoking

Is there a current Trust Smoke Free Policy?

Date of ratification of current policy
Upload photo of front page of smoke free policy

Smoke free policy statement: The Smoke Free Policy’s principal purpose is the promotion of the health benefits of a smoke free environment, in order to prevent the detrimental health consequences of smoking tobacco, the Trust remains committed to helping people who use our service stop smoking and smoke-free hospital sites are a part of this strategy, as are all NHS organisations.

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

Detail measures taken to prevent fires as a result of smoking
show location of no smoking sign

Is there evidence of breaches of Trust policy

Details of breaches observed

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Arson

Does the basic security against arson appear reasonable?

Risk of arson due to:
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Is there sufficient control of unnecessary fire load in close proximity to the building or available for ignition by outsiders?

Risk of ignition by outsiders due to:
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Cooking facilities

Are reasonable measures taken to prevent cooking fires?

Control measures taken to prevent fires
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Is there ductwork and filters in the cooking area?

Items cleaned
Date of last certified cleaning.

Are suitable fire extinguishers available?

Types of extinguishers present

Lightning Protection

Does the building have a lightning protection system installed

Date of last test

Sources of Fuel and Housekeeping

Is the standard of housekeeping adequate?

Bad house keeping practice
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Hazards Introduced by Contractors and Building Works

Is there sufficient control over works by contractors (e.g. Permits to work & hot works permits)?

Are there arrangements for the safe storage of gas bottles

Details of storage arrangements

Dangerous Substances

Are dangerous substances present on the premises?

Show substances present
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Further information

Has a suitable and sufficient COSHH risk assessment been completed for all substances?

Details of risk assessment

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Fire Protection Measures/ Means of escape

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

Inadequate Means of Escape due to:
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Is the building provided with sufficient exits?

Insufficient exits due to:
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Are exits easily and immediately openable where necessary?

Unable to easily open Exit doors due to:
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Do fire exits open in the direction of travel where necessary?

Doors do not open in the direction of travel due to:
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Have sliding or revolving doors been avoided as fire exits?

Are there adequate means of securing exits?

Exits secured by:
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Are there reasonable distances of travel where there is only a single direction?

Maximum travel distance in one direction, in metres

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

Travel distance in metres

Are all fire exits easily to open without the use of a key?

The fire exit door is secured in place due to:
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Are escape routes adequately protected?

Escape routes are inadequately proteced due to:
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Are there suitable fire precautions for all inner rooms?

Reasons for unsuitable precautions with the inner room
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Are escape routes unobstructed?

Escape route obstructed due to:
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Are there suitable means of escape for disabled occupants?

Disabled means of escape is unsuitable due to:
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Have PEEP forms been completed (if required) for disabled staff members?

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Measures to limit fire spread and development

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

Insufficient compartmentation and sub-compartmentation due to:
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Further information

Where required are there suitable and sufficient dampers installed

Are linings that promote fire spread avoided as far as reasonably practicable?
To inhibit the spread of fire within the building, the internal linings shall:
adequately resist the spread of flame over their surfaces; and
have , if ignited, a rate of heat release or a rate of fire growth, which is reasonable in the circumstances.

Fire Doors

Is there a planned preventative maintenance programme (PPM) for all fire doors to ensure correct working?

Location of records of PPM`s

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Are fire resisting doors that are secured for security reasons go fail-safe on the fire alarm or power failure?

Door location and identification

Further information

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Are the fire resisting, self-closing doors to escape routes effectively self-closing?

Door location and identification
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Remedial work required

Further information

Are the fire resisting doors to cupboards, stores and plant rooms kept locked shut with appropriate signs fitted?

The following remedial work is required
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Where fire resisting doors are held open by electro-magnetic means, is smoke detection both sides of the door and correct signs fitted?

Remedial work required
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Are all Fire resisting doors in a good state of repair, with no damage or breaches to the door sett

Door location and identification
The following remedial work is required
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Door location and identification
The following remedial work is required
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Door location and identification
The following remedial work is required
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Door location and identification
The following remedial work is required
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Are the Intumescent strips and Cold Smoke Seals in a good state of repair

Door location and identifcation
The following remedial work is required
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Escape Lighting

Is there a reasonable standard of escape lighting provided? (based upon a visual inspection of luminaires).

Escape lighting defects
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Fire safety signs and notices

Are directional fire safety signs suitable and sufficient?

Fire safety signage requirements

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Are the Fire Action notices suitable and sufficient

The following remedial work is required

Means of giving warning in the event of fire

Is a manually operated electrical fire alarm system provided?

Call point type

Is automatic fire detection provided?

Is an appropriate standard of Fire Alarm system installed (i.e. L1, L2, L3, L5 )

Are the number and type of detectors appropriate for the premise

Detection required
Location
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Is the alarm audible throughout the workplace?

Provide and install additional sounders

Is there remote transmission of alarm signals?

Manual fire extinguishing appliances

Is there suitable and sufficient provision of portable fire extinguishers?

Are Hose reels provided?

Were staff members aware of the types of extinguishers within their work place?

Relevant automatic fire extinguishing systems

Type of system

Comments and observations

Fire Dampers

Are there any fire dampers installed?

Type of system

Is there servicing of the Damper system according to HTM 03-1 (fire dampers in hospitals) which states - must be tested every twelve months.

Date of last damper service
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Management of fire safety

Person responsible for the site/building/department fire safety:

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

Persons available to assist in implementing fire safety arrangements?

Name of any addition person available to assist in implementing fire safety arrangements?

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

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Is the Fire Emergency Procedure readily available for staff to read?

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Is there a Fire Plan of the building in the site Log Book?

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Is the Fire Plan available to the enforcing authority?

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Does the procedure take account of other Fire Emergency Procedures applicable in the building?

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Are there identified roles/persons nominated to respond to fire?

Are there identified roles/persons nominated to assist with evacuation?

Names of other designated persons to assist with evacuation.

Is there appropriate liaison with the fire service?

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

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Training and drills

Are staff given instruction on induction?

Details of location of training records

Do staff receive periodic refresher training at suitable intervals?

Type and frequency of training delivered

Are staff with special responsibilities given appropriate training?

Are fire drills carried out at appropriate intervals?

Date of last fire drill

Is the Fire Assembly point suitably located and sign posted

Location detail:

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Testing and maintenance

Is the workplace adequately maintained?

Evidence of poor maintenance standards

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

Date of last weekly test
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Is there annual servicing of the fire detection and alarm system

Date of last annual test
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Is there monthly testing of the emergency lighting system

Date of last monthly test
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Is there annual testing of the emergency lighting system

Date of last annual test
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Is there annual maintenance of the fire extinguisher equipment?

Date of last test

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

Date of last test

Is there weekly testing and periodic inspection of sprinkler installations?

Date of last test

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

Date of last PPM
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Other relevant inspections or tests

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

Date of last test

Records

Are there records of Fire Drills

Date of last fire drill

Are there records of fire training?

Are there records of fire alarm tests?

Are there records of monthly emergency lighting tests?

Are there records of annual emergency lighting tests?

Are there records of maintenance and testing of the fire damper system?

Are there records of maintenance and testing of the fire suppression system?

Date of last test

Significant Findings and Recommendations

The Priority ratings used in this fire risk assessment are based upon the following:

Very High Priority: Imminent loss of life from fire, or there are substantial quantities of combustible materials, or there are any highly flammable substances, or there exists the likelihood of the rapid spread of fire, heat or smoke between compartments

High Priority: There is a serious risk to life from fire, or there are quantities of combustible materials present, or there exists the likelihood of the rapid spread of fire, heat or smoke between compartments

Essential Priority: There is a moderate risk to life from fire, or there are combustible materials present, or there exists the likelihood of the spread of fire, heat or smoke between compartments.

Low Priority: There is hardly any risk to life from fire, few combustibles materials, no flammable substances, virtually no sources of heat and there is no risk of the spread of fire, heat or smoke between compartments.

Base upon this the expectation of a completion time range is that :-

Very High Priority - Any identified actions should be completed within the following time range - at the time of the inspection > 48hrs

High Priority - Any identified actions should be completed within the following time range - 48hrs > 7 days

Essential Priority - Any identified actions should be completed within the following time range - 1 week > 12 weeks.

Low Priority - Any identified actions should be completed within the following time range - 3 months > 6 months


The action plan associated with this Fire Risk Assessment, documents the significant findings, the required actions and identifies the person or department responsible for the completion of the actions.

It is the responsibility of the named persons or head of department to ensure prompt completion of their actions and notification to the assessor named at the foot of the assessment of the completion date of each action for updating of the original.

Findings and Action Plan

Are you inspecting a fire door?

Fire Door
Location
Details of defect
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Have you discovered any fire compartment breaches?

Fire compartment breaches
Location
Details of defect
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Have you discovered sources of ignition?

Sources of ignition
Location
Details of ignition source
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Have you discovered sources of fuel?

Sources of fuel
Location
Details of fuel source
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Have you discovered sources of oxygen?

Sources of oxygen
Location
Details of oxygen source
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Are there people at risk?

People at risk
Location

Are there PEEP`s in place?

Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Is there a defect with the fire alarm system?

Fire alarm system
Location
What are the defects?
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Is there a defect with the escape lighting?

Escape or emergency lighting
Location
Details of defect
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Are there any missing fire notices?

Fire notices
Location
Details of defect
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Is there a problem with the fire extinguishers?

Fire Extinguishers
Location
Details of defect
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Have you discovered fire compartment breaches?

Fire Door
Location
Details of defect
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Is there a problem with the fire dampers?

Fire Dampers
Location
Details of defect
Action required

Action assigned to:

Priority risk rating

Target date for completion
Date of final completion

Name of person responsible for completion

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.