Part 1: GENERAL INFORMATION

The responsible person for fire safety

  • Name of the responsible person

  • Contact details of responsible person

1 The Building

  • Number of Floors

  • Brief details of construction:

  • Occupancy type:

2 The Occupants

  • Maximum number of occupants at any given time:

  • Maximum number of members of the public at one time:

3 Occupants At Special Risk

  • Are children employed at the premises?

  • Are there sleeping occupants?

  • Are there disabled occupants?

  • Are there occupants in remote areas?

  • Are there lone workers?

4 Previous Fire Loss Experience

  • Is there any previous history of fire loss in the premises (if yes give details)

5 Other Relevant Background

  • Are there any residential properties in or attached to the building

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

  • Is there an alteration 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)

Part 2: FIRE HAZARDS AND ELIMINATION OR CONTROL

6 Electrical Sources Of Ignition

  • Are reasonable measures taken to prevent fires of electrical origin?

  • Is the fixed wiring installation periodically tested and inspected?

  • Are portable appliances tested/inspected?

  • Is there a suitable policy about the use of personal electrical appliances?

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

  • Is Luminous Discharge Lighting installed? (if yes does the installation meet with current standards)

7 Smoking

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

  • Is smoking prohibited in appropriate areas?

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

  • Is the appropriate smoking prohibition notice displayed at the building's entrance?

8 Arson

  • Does the basic security against arson appear reasonable?

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

9 Portable Heaters & Heating Installations

  • Is the use of portable heaters avoided as far as reasonably practicable?

  • If portable heaters are used, are the more hazardous types (radiant bars and LPG) avoided?

  • If portable heaters are used are suitable measures taken to minimise the risk of ignition of combustible materials?

  • Are fixed heating installations subject to regular maintenance?

10 Cooking Facilities

  • Are reasonable measures taken to prevent cooking fires?

  • Are filters changed and ductwork cleaned regularly?

  • Are suitable extinguishers available?

11 Lightning

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

12 Other Issues That Warrant Further Consideration

  • List other ignition sources:

13 Housekeeping

  • Is the standard of housekeeping adequate?

  • Are combustible materials separated from ignition sources?

  • Is the unnecessary accumulation of combustibles and waste avoided?

  • Is there appropriate storage of hazardous materials?

  • Are combustible materials stored appropriately?

14 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 and others hazardous materials

  • Are fire safety conditions and instructions communicated to contractors?

15 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

16 Means of escape

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

  • Are there sufficient exits?

  • Are exits easily and immediately openable where necessary?

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

  • Have sliding or revolving doors been avoided as fire exits?

  • Are there adequate means of securing exits?

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

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

  • Are escape routes adequately protected?

  • Are there suitable fire precautions for all inner rooms?

  • Are escape routes unobstructed?

  • Are there suitable means of escape for disabled occupants?

17 Measures to limit fire spread and development.

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

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

18 Escape lighting

  • Is there a reasonable standard of escape lighting provided?

19 Fire safety signs and notices

  • Are fire safety signs and notices suitable and sufficient?

20 Means of giving warning in the event of fire

  • Is a manually operated electrical fire alarm system provided?

  • Is automatic fire detection provided?

  • Is there remote transmission of alarm signals?

21 Manual fire extinguishing appliances

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

  • Are hose reels provided?

22 Relevant automatic fire extinguishing systems

  • Type of system:

  • Comments and observations:

23 Facilities, equipment and devices for the protection of Fire-Fighters

  • Types of facilities:

  • Comments and observations:

Part 4: MANAGEMENT OF FIRE SAFETY

24 Procedures and arrangements

  • Person responsible for fire safety:

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

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

  • Fire Emergency Plan in place and details recorded?

  • Does the plan take account of other Fire Emergency Plans applicable in the building?

  • Is the Fire Emergency Plan readily available for staff to read?

  • Is the Fire Emergency Plan available to the enforcing authority?

  • Are there persons nominated to respond to fire?

  • Are persons nominated to assist with evacuation?

  • Is there appropriate liaison with the fire service?

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

25 Training and drills

  • Are staff given instruction on induction?

  • Do staff receive periodic refresher training at suitable intervals?

  • Are staff with special responsibilities given appropriate training?

  • Are fire drills carried out at appropriate intervals?

26 Testing and maintenance

  • Is the workplace adequately maintained?

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

  • Is there monthly and annual testing of the emergency lighting?

  • Is there annual maintenance and testing of fire extinguishing equipment?

  • Is there annual inspection and test of the lightning protection system?

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

  • Is there weekly testing and periodic inspection of sprinkler installations?

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

  • Other relevant inspection and test

27 Records

  • Are there records of fire drills?

  • 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

  • Item 1

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 2

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 3

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 4

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 5

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 6

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 7

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 8

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 9

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Item 10

  • Probability (likelihood of fire)

  • Consequence (impact on life safety)

  • Risk rating score (probability x consequence)

  • Recommendations

  • Action Completed (please sign and date when complete)

  • Received by responsible person / representative

  • Assessor Signature

  • Pictures

Re-Assessment

  • Recommended date for re-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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.