Information

  • Project/Site:

  • Date & Time

  • Form Completed By

  • Project Leader/Building Manager

1 The Building

  • No of floors:

  • Floor area: (per floor)

  • Brief details of construction:

  • Occupancy type:

2 The occupants

  • Maximum number of occupants:

  • Maximum number of occupants at any given time:

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

3 Occupants at special risk

  • Sleeping occupants:

  • Disabled occupants:

  • Occupants in remote areas:

  • Lone workers:

  • Other activities:

4 Fire loss experience

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5 Other relevant background

  • undefined

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?

  • Comments and hazards observed:

7 Smoking

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

  • Is smoking prohibited in the building?

  • 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?

  • Comments and hazards observed:

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?

  • Comments and hazards observed:

9 Portable heaters and heating installation

  • Is the use of portable heater 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?

  • Comments and hazards observed:

10 Cooking

  • Are reasonable measures taken to prevent cooking fires?

  • Are filters changed and ductwork cleaned regularly?

  • Are suitable extinguishers available?

  • Comments and hazards observed:

11 Lightning

  • Has the building an effective lightning protection system?

  • Comments and hazards observed:

12 Other significant ignition sources that warrant consideration

  • List other ignition sources:

  • Comments and hazards observed:

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?

  • Comments and hazards observed:

14 Hazards introduced by outside contractors and building works

  • Is there sufficient control over works by outside contractors (e.g. Permits to work & hot works permits)?

  • Are fire safety conditions and instructions communicated to contractors?

  • Are in-house maintenance personnel sufficiently controlled?

  • Comments and hazards observed:

15 Means of escape from fire

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

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  • Are there sufficient exits?

  • Are exits easily and immediately openable where necessary?

  • Do fire exits open in the direction of travel?

  • 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?

  • Comments and observations:

16 Measures to limit fire spread and development.

  • Is there a sufficient standard of compartmentalisation?

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

  • Comments and observations:

17 Escape lighting

  • Is an adequate standard of escape lighting provided?

  • Comments and observations:

18 Fire safety signs and notices

  • Are fire safety signs and notices suitable and sufficient?

  • Comments and observations:

19 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?

  • Comments and observations:

20 Manual fire extinguishing appliances

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

  • Are hose reels provided?

  • Comments and observations:

21 Relevant automatic fire extinguishing systems

  • Type of system:

  • Comments and observations:

22 Other relevant fixed systems

  • Type of system:

  • Comments and observations:

23 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)

  • Are there people nominated to respond to fire?

  • Is here appropriate liaison with the fire service?

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

  • Comments and observations:

24 Training and drills

  • Are staff given instruction on induction?

  • Do staff receive occasional refresher training?

  • Are staff with special responsibilities given appropriate training?

  • Are fire drills carried out at least twice a year?

25 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, six-monthly and annual testing of the emergency lighting?

  • Is there annual maintenance of fire extinguishing equipment?

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

  • Other relevant inspection and test

  • Comments and observations:

26 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?

  • Comments and observations:

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