Title Page
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Conducted on
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Prepared by
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Signature:
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Signature:
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Community Site:
- St Olav's Court, 43 & 49 Lower Road, SE16 2XB
- New Surrey Docks, 13 Blondin Way, SE16 6AE
- Lister Health Centre, 101 Peckham Road, SE15 5LJ
- West Norwood Health and Leisure Centre
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What is the GSTT staff occupancy of the premises?
- 1x staff member
- 2x staff member
- 3x staff member
- 4x staff member
- 5-10x staff members
- 20+ staff members
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What floor(s) of the premises are the GSTT staff using?
- Basement
- Ground
- First
- Second
- Third
- Fourth
- Fifth
- Sixth
- Seventh
- Eighth
- Ninth
- Tenth
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What activities are the GSTT staff member(s) performing on the premises?
- General health check ups
- Admin duties
- Children's services
- Adult services
- Elderly services
- Neighborhood Nursing
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What areas of the premises are the GSTT staff using?
- 1x Clinic room
- 2x Clinic rooms
- 3+ Clinic rooms
- Staff rest area
- Toilets
- Office space
- Common area
- Emergency routes
- Kitchen
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Was the GSTT staff member(s) present during the Fire Safety Short Audit?
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Name of staff member(s):
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Name of Responsible Person:
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Responsible Person email address:
1 - Are ignition sources adequately managed and controlled in the premises to reduce the risk of fire?
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1.1 Is smoking permitted on the premises?
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1.2 Is there a suitable management plan in place in regards to contactors activities, including hot works?
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1.3 Does the premises have a valid 5 year fixed electrical wiring certificate?
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1.4 Does electrical equipment have current PAT test?
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1.5 Does GSTT use areas have open element type heaters?
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1.6 Is arson a potential problem?
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1.7 Has there been any history of a fire in the premises within the last three years?
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1.8 Are excessive quantities of combustible materials used/stored in GSTT use areas?
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1.9 Is there gas on the premises?
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Does the premises have a valid gas safety certificate?
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2.0 Overall score regarding Ignition Sources.
2 - Are adequate measures in place to control the spread of a potential fire in the premises?
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2.1 What is the overall condition of the building?
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2.2 Is there evidence that Fire Stopping may be required in the GSTT use areas?
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2.3 Are all Fire Doors in the GSTT use areas fit for purpose?
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2.4 Are all Fire Doors in the GSTT use areas kept shut/locked/on hold backs as appropriate?
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2.5 Is the storage of hazardous materials in the GSTT use areas acceptable?
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2.6 Overall score regarding Adequate Measures in Place to Control the Spread of a Potential Fire.
3 - Can persons evacuate the premises safely in the event of a fire emergency in the premises?
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3.1 Does the GSTT staff member(s) have a PEEP in place?
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3.2 Does the GSTT staff member require a PEEP?
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3.3 Is emergency exit signage suitably in place for GSTT use areas?
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3.4 Is emergency lighting fitted within the premises?
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3.5 Does the premises have an emergency evacuation plan?
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3.6 Are all GSTT use emergency exit routes kept clear of obstruction?
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3.7 Are all GSTT use emergency stairwells kept clear of obstruction?
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3.8 Overall score regarding whether Persons Can Evacuate the Premises Safely in the Event of a Fire Emergency in the Premises.
4 - Can persons use the escape routes and final exits safely?
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4.1 How many emergency exit routes are available from GSTT use areas?
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4.2 Are the travel distance(s) acceptable for GSTT staff from their main use area?
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4.3 Is the final exit door(s) fit for purpose and clear of obstruction on both sides?
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4.4 Are the emergency exit routes from GSTT use areas well maintained and adequately protected?
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4.5 Overall score regarding Escape Routes and Final Exits.
5 - Is there adequate equipment in the premises for extinguishing small fires?
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5.1 Are there suitable Portable Fire Extinguishers available in and around the GSTT use areas?
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5.2 Are there Fire Blankets suitably positioned in GSTT use kitchen areas?
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Overall score regarding Equipment in the Premises for Extinguishing Small Fires .
6 - Are adequate arrangements in place to detect fires and raise the alarm to those people on the premises?
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6.1 Is the Fire Alarm System showing fully serviceable without fault and/or isolations?
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6.2 Is there suitable fire detection within GSTT use areas?
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6.3 Are Manual Call Points available with GSTT use areas?
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6.4 Overall score regarding Fire Detection on the Premises.
7 - Are adequate instructions or guidance on procedures to follow in an emergency provided for employees?
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7.1 Are GSTT Fire Awareness trained?
- All GSTT staff undergo annual Fire Awareness training. Records are kept on the trust's OLE intranet site.
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7.2 Is a Fire Safety induction given to new GSTT staff on the premises by the building manager?
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7.3 Are the GSTT staff member(s) fully aware of the emergency evacuation strategy for the premises?
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7.4 Are there suitably trained and available Fire Wardens in the premises?
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7.5 Are completed Fire Action Notices suitably placed in GSTT use areas?
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7.6 Overall score regarding Instructions or Guidance on Procedures to Follow in an Emergency.
8 - Are adequate management procedures in place to mitigate the effects of fires in the premises?
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8.1 Is a valid FRA available for the premises?
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8.2 Is a suitable schedule in place to check for building faults and maintenance issues?
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8.3 Overall score regarding Management Procedures in Place to Mitigate the Effects of Fires in the Premises.