Schedule of Fire Stopping

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Enter Installation Reference

Installation Reference

• Reference No.

• Add photo.

  Media

• Wall, floor or ceiling?

  Wall

  Floor

  Ceiling

• Dats sheet Reference

• Description- Of penetration or opening in structure

• Manufacturer Product /system No

• Report reference-Location

Conclusion Statement

• I Mr Kim Taylor of Somerset Fire Solutions Pty Ltd being a properly qualified person for the purpose of assessing the essential fire safety measures hereby verify that I have inspected the above services and found they were able to perform to a Standard not less than the relevant provisions of the BCA and the Australian Standards( AS1530.4-2005 & AS4072.1-2005)

• Print name & sign

  Sign

• Certifire Accreditation – FA7030