• Document No.

  • Public Building Name

  • Address
  • Conducted on

  • Officer

  • Public building use

  • Maximum number of persons permitted

  • Contact person

  • Licensed Premises<br>

Certificate and Documentation

  • Certificate of approval prominently displayed.

  • Number of persons at time of inspection

  • Exit sign log book

  • Evacuation plan

  • Emergency lighting log book

General Provisions & Maintenance

  • Modification of building since last assessment

  • Change of use from approval

  • Stage curtains fire retardant

  • Exterior building satisfactory

  • Interior building satisfactory

  • Equipment storage satisfactory

  • Refuse storage & disposal facilities adequate

  • Exit doors easily opened


  • Approved latches & locks

  • Exit to open space and pathways unobstructed

  • Exit signs on all designated exits

  • Exit signs clearly visible

  • Exit signs illuminated


  • Aisles on both sides of seat rows

  • Rows of 10-42 seats

  • Seating secured to the floor or fastened in groups of at least four seats

  • Aisles clear to exits and of uniform width

Lighting / Electrical

  • Adequate illumination

  • Switch protection from the public

  • Emergency lighting

  • Power cables inaccessible to public

  • Switchboard correctly labelled

Fire Prevention and Control

  • Fire extinguishers and hose reels in service

  • Fire blanket available in kitchen

  • Smoke control devices

Ventilation / Heating

  • Fans fixed and guarded

  • Fans - ceiling 2.4m above floor

  • Heaters 2.1m from floor

Sanitary Facilities

  • Facilities in good repair and clean

  • Gender signage provided

  • Adequate illumination provided

  • All facilities accessible

Steps and Landings

  • Hand rails and balustrades satisfactory

  • Raised areas and tiered seating provided with enclosing wall or guard rail

  • Step treads adequate

Actions / Follow up


  • Follow up action

  • I have read and understood the contents of this assessment

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.