Information

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Part 1: GENERAL INFORMATION

RESPONSIBLE PERSON

  • Name of the responsible person or persons

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  • Contact details of responsible person or persons

  • 1 The Building
  • Facility Name

  • Number of Floors

  • Brief details of construction:

  • Occupancy type:

2 The occupants

  • Maximum number of occupants:

  • Maximum number of occupants at any given time:

3 Occupants at special risk

  • Are there occupants in remote areas?

  • Are there lone workers?

4 Previous Fire Information

  • Is there any previous history of fire occurring in structures of this type? (if yes give details)

5 Other relevant background

  • Is there a prohibition notice in force? (if yes give date of issue)

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

  • Is there an alteration notice in force? (if yes give date of issue)

Part 2: SOURCES OF IGNITION

6 Electrical

  • Fixed wiring checked by competent persons and certificates available?

  • Add media

  • All portable equipment checked and certificates available?

  • Add media

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

  • Add media

  • All breakers, fuses etc of correct rating and suitable for purpose?

  • Add media

  • Is there a policy in place for non use of personnel electrical items?

  • Is there a procedure in place for faulty electrical equipment? (If yes, give details)

  • Add media

  • Comments and hazards observed:

  • Take picture of any hazards:

7 Smoking

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

  • Add media

  • Is smoking prohibited in the building?

  • Add media

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

  • Add media

  • Is smoking waste disposed of sensibly and not with general waste?

  • Add media

  • Are metal containers or ashtrays provided within the smoking areas?

8 Lightning

  • Does the building have lightning protection system if required? (if yes has it been tested and are records of testing kept)

  • Add media

9 Housekeeping

  • Is the standard of housekeeping adequate?

  • Add media

  • Are combustible materials stored appropriately?

  • Add media

  • Are combustible materials separated from ignition sources?

  • Add media

  • Is the unnecessary accumulation of combustibles and waste avoided?

  • Add media

10 Ventilation and Machinery

  • Is all ventilation subject to routine maintenance?

  • Does the ventilation equipment switch off when the fire alarm activates?

  • Is all machinery subject to routine maintenance by competent persons?

  • Is there any equipment or machinery would give rise excessive amounts of friction?

  • List other ignition sources:

  • Is there appropriate storage of hazardous materials?

  • Add media

11 Hazards introduced by contractors and general maintenance 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?

  • Are there arrangements for the safe storage of hazardous materials?

  • Are fire safety evacuation procedures and instructions communicated to contractors?

12 Dangerous Substances

  • Are dangerous substances present on the premises?

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

Part 3: FIRE PROTECTION MEASURES

13 Means of escape

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

  • Add media

  • Are there sufficient exits? ( please state how many)

  • Add media

  • Are escape routes clearly signed?

  • Add media

  • Are exits easily and immediately openable where necessary?

  • Add media

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

  • Add media

  • Are there adequate means of securing exits?

  • Add media

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

  • Add media

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

  • Add media

  • Are escape routes adequately protected?

  • Add media

  • Are there suitable fire precautions for all inner rooms?

  • Add media

  • Are escape routes unobstructed?( if no take picture)

  • Take picture of obstruction

14 Measures to limit fire spread and development.

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

  • Add media

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

  • Add media

  • Does extraction and supply plant shut down on fire alarm evacuation?

  • Add media

15 Escape lighting

  • Is there a reasonable standard of escape lighting provided?

  • Add media

  • Is this tested regularly and is documentation available?

  • Add media

16 Fire safety signs and notices

  • Are fire safety signs and notices suitable and sufficient?

  • Add media

  • Are evacuation routes and procedures displayed?

  • Add media

17 Means of giving warning in the event of fire

  • Is a manually operated electrical fire alarm system provided?

  • Add media

  • Is automatic fire detection provided?

  • Add media

  • Is there remote transmission of alarm signals to shore?

  • Add media

18 Manual fire extinguishing appliances

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

  • Add media

19 Relevant automatic fire extinguishing systems

  • Type of system:

  • Comments and observations:

Part 4: MANAGEMENT OF FIRE SAFETY

20 Procedures and arrangements

  • Are appropriate fire procedures in place?

  • Are there persons nominated to respond to fire?

  • Is there appropriate liaison with the fire service?

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

21 Training and drills

  • Are staff given instruction on induction?

  • Are fire drills carried out at appropriate intervals?(if yes give date of last drill carried out)

22 Testing and maintenance

  • Is the plant and machinery adequately maintained? (Give details of last service on equipment and plant)

  • Is there monthly, six-monthly and annual testing of the emergency lighting? ( give details of last tests)

  • Is there annual maintenance and testing of fire extinguishing equipment?(give details of last service)

  • Is there weekly testing and periodic inspection of sprinkler installations?(give details of last service)

  • Other relevant inspection and test

23 Records

  • Are there records of fire training?

  • Are there records of fire alarm tests?

  • Are there records of emergency lighting tests?

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

Part 5: RISK RATING AND RECOMMENDATIONS

Risk Items identified

  • Item 1

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action

  • Item 2

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action

  • Item 3

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action

  • Item 4

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action

  • Received by responsible person / representative

  • Assessor Signature

  • Pictures

Re-Assessment

  • Date for re-assessment

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