Title Page
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Location Name
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Location Address
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Photo of Building
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How many employees does the site have?
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Inspection Date
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Completed By
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Job Number
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What work is being completed onsite?
- EPM
- Diagrams
- Pre-Training Establishment
Building Details
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What services does the building/business provide? (eg. banking, plumbing supplies, hearing tests etc.)
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Building Classification
- Class 1a - Residential Home
- Class 1b - Residential Hostel <300m2
- Class 2 - Residential Apartment
- Class 3 - Hotel, Hostel
- Class 4 - Residential within Non-Residential
- Class 5 - Office
- Class 6 - Retail
- Class 7a - Carpark
- Class 7b - Warehouse
- Class 8 - Manufacturing
- Class 9a - Hospital, Clinic
- Class 9b - Community Hall, Church, University
- Class 9c - Aged Care
- Class 10a - Workshed, Carport
- Class 10b - Swimming Pool, Fence
- Class 10c - Bushfire Shelter
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How many occupants are they certified for?
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What are the staffing hours including staffing numbers eg. 6am-2pm 2RNs 6PCs
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Hours of Operation
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Please include weekend trading hours
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How many buildings are on site?
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What is the rise in stories? Detail how many Basement floors if relevant.
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What levels do the Business operate out of?
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If only a secondary occupier update the stack plan in EvacConnect. Clarify levels or section of building. eg. Levels 1-3, North Mall or Food Court.
Consultant Information
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Where is the FM office located?
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What is the best parking solution? onsite. closest / appropriate parking location
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What is the primary training location? note any alternatives
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What equipment is required / supplied? Is a consultant required to use a projector.
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What space will be used for Flaim if appropriate.
EPC Contact Details
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Building Owner/Property Manager
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Company Name
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Contact Person
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Contact Address
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Telephone
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Email
Tenancy Responsible Person
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Tenancy Name
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Level or Area occupied
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Contact Person
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Contact Address
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Telephone
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Email
Evacuation Coordinator / Chief Warden
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Company Name
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Contact Person
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Contact Address
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Telephone
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Email
Training Provider
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Does EvacServices provide training for this site?
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Company Name
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Address
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Telephone
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Email
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If in QLD: is a Fire Safety Advisor Required?
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FSA required if Class 2 & 3 Higher than 25m OR a workplace employing 30+ persons.
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Who operates as the Fire Safety Advisor?
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Get sales to send through an email to quote them on the service.
Fire Safety Advisor
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Company Name
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Contact Person
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Email
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Phone
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FSA RTO
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Certificate #
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FSA Issue Date
Assembly Area
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What is the maximum occupancy of the building?
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Provide a description of the Assembly Area location
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Photo of the Assembly Area
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What is the approximate distance from the building?
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Is the area sufficient to hold the maximum occupancy of the building?
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Is the path of travel appropriate for mobility impaired and a large number of occupants?
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Is there any overhead cover?
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Would the Assembly Area impact on the arrival of Emergency Services?
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Where is the Master Emergency Control Point located? (Where the Chief Warden would meet Emergency Services)
Installed Fire Safety Systems
Essential Safety Measure
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Upload photo of Essential Safety Measure certificate or similar
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Upload photo of Certificate of Classification or similar
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Is there a Fire Alarm and Detection System?
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Related Systems
- Fire Control Room
- EWS
- EWIS
- Smoke Detectors
- Thermal Detectors
- Concealed Detector
- Manual Call Points
- EWS Visual indicators
- VESDA System
- Fire Indicator Panel - no occupant warning
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Where is the FIP located?
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What is the ASE serial number
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Is there a connected SFIP, Mimic Panel or VESDA System? Where is it located?
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Is a accurate Fire Alarm Block Plan installed adjacent to FIP?
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Is there a Interface Cause and Effect Matrix installed adjacent to FIP?
Fire Suppression
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What Fire Suppression Systems Installed?
- Fire Extinguishers
- Fire Hose Reel
- Fire Blankets
- Hydrants
- Hydrant Booster
- Sprinklers
- Sprinkler Booster
- Wall Wetting Sprinklers & Drencher System
- Automatic Fire Suppression System (FM200 etc...)
Means of Escape & Misc.
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What Means of Escape Systems are Installed?
- Emergency Lighting
- Emergency Exit Signs
- Fire Doors
- Smoke Doors
- Stairwell Pressurisation
- Smoke Exhaust System
- Emergency Lifts
- Fire Dampers
- Fire Curtains
- Fire Shutters and Windows
Risk Assessment
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What risks have been identified?
- Fire
- Medical Emergency
- Bomb Threat (Including Suspect Object)
- Contaminated Mail
- Civil Disobedience
- Power Outage
- Severe Storm
- Flood
- Cyclone
- Bush Fire
- Earthquake
- Hazardous Materials Incident (External)
- Hazardous Materials Incident (Internal)
- Lift Failure
- Structural Instability
- Building Services Failure - Temporary
- CBD Emergency Plan
- Motor Vehicle Incident
- Gas Leak
Material
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Name
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Location on Site
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What is the maximum quantity?
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Is there any site specific procedures in place for this material?
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Please Provide description of Gas Shutoff Valve Location and provide photo
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Do any of the neighbouring site pose a risk?
Additional Info
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Does the building have any Fire Engineered Performance/ Alternative Solutions?
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Please Attach Fire Engineering Report.
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Details may be on a plaque adjacent the FIP or on the Certificate of Classification (QLD)
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Is there any site specific procedures or annex's that need to be added to the EPM?
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In detail explain any procedures and upload any documentation to Sharepoint.
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Does the building have existing diagrams?
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What Warden Identification is present on site?
- Hats/Caps
- Helmets
- Vests
- Other
