The Leadenhall Building Incident Report

• Reported by

• Location

• Time and Date of Incident

  Date

• What was the incident?

  Select

Details of device

• What type of device activated?

  Smoke Head

  Flame detector

  Break glass point

  Vesda

  Sprinkler head

• Details of device (Node, loop, zone)

• Demise location

• Device location

Cause of activation.

• Cause of Activation

  Select Accidental activation Fire Dust Faulty Equipment Food / Kitchen related Hot Works Maintenance Power related Smoking Faulty Device Other

  • Accidental activation
  • Fire
  • Dust
  • Faulty Equipment
  • Food / Kitchen related
  • Hot Works
  • Maintenance
  • Power related
  • Smoking
  • Faulty Device
  • Other

Incident details

• Incident details. ( Brief description of incident.)

• Name of person sent to investigate cause?

Evacuation

• Did the building evacuate, either partially or fully?

  Yes

  No

• Was the evacuation partial or a full evacuation?

  Partial

  Full

• Which floors evacuated?

• Name of security officer(s) sent to assembly point to manage evacuation.

• Time building was fully evacuated.

  Date

• Time all clear message received,

  Date

• Time building reocupied

  Date

Emergency Services

• Were the emergency services contacted

  Yes

  No

• Emergency services requested:

  Select Fire Service Police Ambulance Other

  • Fire Service
  • Police
  • Ambulance
  • Other

• Time fire service on site

  Date

• Details of senior fire officer in attendance. ( Name / badge number and station)

• Time fire service left site.

  Date

• Time police on site

  Date

• Details of senior police officer in attendance. ( Name / badge number and station)

• Time police left site.

  Date

• Time ambulance on site

  Date

• Details of senior ambulance officer in attendance. ( Name / badge number and station)

• Time ambulance left site.

  Date

• Details of other emergency service requested together with name of senior officer, time on site and off site.

First Aid

• Was any first aid required or administered?

  Yes

  No

• Details of person(s) requiring first aid treatment.

Person

• Name

• Company

• Reason for first aid treatment

• Was an ambulance required?

  Yes

  No

• Was hospital treatment required?

  Yes

  No

• Details of hospital person attended.

• Name of person completing accident book.

Fire alarm panel

• Following the fire alarm activation have any zones or devices been isolated?

  Yes

  No

• Which zones or devices have been isolated?

• Who authorised the isolation of the zones or device?

• Name of person who entered details in the fire log book.

• Time fire panel was reset.

  Date

Action taken

• Action taken to control incident together with details of persons in attendance.

• Action taken to prevent reoccurrence.

• Brief description of Incident

• Persons sent to investigate

CCTV / BodyCams

• Was the incident captured on CCTV / Bodycams

  Yes

  No

• Which Cameras. / Body Cams recorded the incident

• Has the recorded footage been saved

  Yes

  No

Emergency Services

• Were the emergency services contacted

  Yes

  No

• Emergency services requested:

  Select Fire Service Police Ambulance Other

  • Fire Service
  • Police
  • Ambulance
  • Other

• Details of senior fire officer in attendance. ( Name / badge number and station)

• Time fire service left site.

  Date

• Time police on site

  Date

• Details of senior police officer in attendance. ( Name / badge number and station)

• Time police left site.

  Date

• Time ambulance on site

  Date

• Details of senior ambulance officer in attendance. ( Name / badge number and station)

• Time ambulance left site.

  Date

• Details of other emergency service requested together with name of senior officer, time on site and off site.

Escalation

• Were Property Management Informed

  Yes

  No

• Name of Person Informed

  linda Aloe

  Teri Kuzminska

  Ryan Thompson

• How were they informed

  In Person

  Phone

  Email

  Text

• What time were they informed

  Date

• Was the Security Manager informed

  Yes

  No

• How was he informed

  In Person

  Phone

  Email

  Text

• What time was he informed

  Date

Location and cause of water leak or flood

• Detail exact location of flood or water leak.

• Detail cause of activation.

Incident details

• Incident details. ( Brief description of incident.)

• Photograph(s) of incident.

  Media

• Name of person sent to investigate cause?

• Was there any CCTv coverage of the incident?

  Yes

  No

• Details of cameras that have recorded incident.

First Aid

• Was any first aid required or administered?

  Yes

  No

• Details of person(s) requiring first aid treatment.

Person

• Name

• Company

• Reason for first aid treatment

• Was an ambulance required?

  Yes

  No

• Was hospital treatment required?

  Yes

  No

• Details of hospital person attended.

• Name of person completing accident book.

Fire alarm panel

• Following the water leak / flood have any zones or devices been isolated on the fire alarm panel?

  Yes

  No

• Which zones or devices have been isolated?

• Who authorised the isolation of the zones or device?

• Name of person who entered details in the fire log book.

Action taken

• Action taken to control incident together with details of persons in attendance.

• Action taken to prevent reoccurrence.

• Time and date incident was terminated.

  Date

Location of accident.

• Where did the accident take place.

Incident details

• Incident details. ( Brief description of incident.)

• Photograph(s) of scene of incident.

  Media

• Name of person sent to investigate incident.

• Was there any CCTv coverage of the incident?

  Yes

  No

• Details of cameras that have recorded incident.

• Did the accident involve vehicles or personnel?

  Select Vehicle Personnel Other

  • Vehicle
  • Personnel
  • Other
Vehicle details

• Vehicle Registration No.

• Name of Driver

• Make of vehicle

• Model of vehicle

• Colour of vehicle

• Description of damage to vehicle

• Description of other damage sustained in the accident

• Personnel details

• Personnel

Personnel

• Name of person involved.

• Company

• Contact details

• Brief details of injury

Emergency Services Required

• Were the emergency services contacted?

  Yes

  No

• Emergency services requested:

  Select Fire Service Police Ambulance Other

  • Fire Service
  • Police
  • Ambulance
  • Other

• Time fire service on site

  Date

• Details of senior fire officer in attendance. ( Name / badge number and station)

• Time fire service left site.

  Date

• Time police on site

  Date

• Details of senior police officer in attendance. ( Name / badge number and station)

• Time police left site.

  Date

• Time ambulance on site

  Date

• Details of senior ambulance officer in attendance. ( Name / badge number and station)

• Time ambulance left site.

  Date

• Details of other emergency service requested together with name of senior officer, time on site and off site.

First Aid

• Was any first aid required or administered?

  Yes

  No

• Details of person(s) requiring first aid treatment.

Person

• Name

• Company

• Reason for first aid treatment

• Was an ambulance required?

  Yes

  No

• Was hospital treatment required?

  Yes

  No

• Details of hospital person attended.

• Name of person completing accident book.

Action taken

• Action taken to control incident together with details of persons in attendance.

• Action taken to prevent reoccurrence.

Incident termination.

• Time and date incident was terminated.

  Date

Details of lift or cradle failure.

• Detail which lift or cradle has failed and cause. (if known).

Incident details

• Incident details. ( Brief description of incident.)

• Name of person sent to investigate lift / cradle breakdown.

• Was there any CCTv coverage of the incident?

  Yes

  No

• Details of cameras that have recorded incident.

Lift / cradle entrapment

• Were any persons trapped in the lift / cradle?

  Yes

  No

• Was the entrapment lift or cradle?

  Lift

  Cradle

• Name of lift company.

• Time lift company were contacted to deal with entrapment.

  Date

• Time lift company on site.

  Date

• Detail length of time persons were trapped in the lift.

• Details of persons trapped in lift.

Persons involved.

• Name

• Company

• Details of persons trapped in cradle.

Persons involved.

• Name

• Company

• Detail length of time persons were trapped in the cradle.

• Name of lift / cradle company.

• Time lift / cradle company were contacted.

  Date

• Time lift / cradle company on site.

  Date

Emergency Services

• Were the emergency services contacted?

  Yes

  No

• Emergency services requested:

  Select Fire Service Police Ambulance Other

  • Fire Service
  • Police
  • Ambulance
  • Other

• Time fire service on site

  Date

• Details of senior fire officer in attendance. ( Name / badge number and station)

• Time fire service left site.

  Date

• Time police on site

  Date

• Details of senior police officer in attendance. ( Name / badge number and station)

• Time police left site.

  Date

• Time ambulance on site

  Date

• Details of senior ambulance officer in attendance. ( Name / badge number and station)

• Time ambulance left site.

  Date

• Details of other emergency service requested together with name of senior officer, time on site and off site.

First Aid

• Was any first aid required or administered?

  Yes

  No

• Details of person(s) requiring first aid treatment.

Person

• Name

• Company

• Reason for first aid treatment

• Was an ambulance required?

  Yes

  No

• Was hospital treatment required?

  Yes

  No

• Details of hospital person attended.

• Name of person completing accident book.

Action taken

• Action taken to control incident together with details of persons in attendance.

• Action taken to prevent reoccurrence.

Incident termination.

• Time and date incident was terminated.

  Date

• Brief Description of incident

CCTV / BodyCams

• Was the incident captured on CCTV / Bodycams

  Yes

  No

• Which Cameras. / Body Cams recorded the incident

• Has the recorded footage been saved

  Yes

  No

Emergency Services

• Were the emergency services contacted

  Yes

  No

• Emergency services requested:

  Select Fire Service Police Ambulance Other

  • Fire Service
  • Police
  • Ambulance
  • Other

• Details of senior fire officer in attendance. ( Name / badge number and station)

• Time fire service left site.

  Date

• Time police on site

  Date

• Details of senior police officer in attendance. ( Name / badge number and station)

• Time police left site.

  Date

• Time ambulance on site

  Date

• Details of senior ambulance officer in attendance. ( Name / badge number and station)

• Time ambulance left site.

  Date

• Details of other emergency service requested together with name of senior officer, time on site and off site.

Escalation

• Were Property Management Informed

  Yes

  No

• Name of Person Informed

  Select Roxana Puscasu Lee Owen Jessica Howcroft Angelo Christou

  • Roxana Puscasu
  • Lee Owen
  • Jessica Howcroft
  • Angelo Christou

• How were they informed

  In Person

  Phone

  Email

  Text

• What time were they informed

  Date

• Was the Security Manager informed

  Yes

  No

• How was he informed

  In Person

  Phone

  Email

  Text

• What time was he informed

  Date

Incident Terminated

• Time Incident terminated

  Date

• Brief description of Incident

CCTV / BodyCams

• Was the incident captured on CCTV / Bodycams

  Yes

  No

• Which Cameras. / Body Cams recorded the incident

• Has the recorded footage been saved

  Yes

  No

Emergency Services

• Were the emergency services contacted

  Yes

  No

• Emergency services requested:

  Select Fire Service Police Ambulance Other

  • Fire Service
  • Police
  • Ambulance
  • Other

• Details of senior fire officer in attendance. ( Name / badge number and station)

• Time fire service left site.

  Date

• Time police on site

  Date

• Details of senior police officer in attendance. ( Name / badge number and station)

• Time police left site.

  Date

• Time ambulance on site

  Date

• Details of senior ambulance officer in attendance. ( Name / badge number and station)

• Time ambulance left site.

  Date

• Details of other emergency service requested together with name of senior officer, time on site and off site.

Escalation

• Were Property Management Informed

  Yes

  No

• Name of Person Informed

  Select Roxana Puscasu Lee Owen Jessica Howcroft Angelo Christou

  • Roxana Puscasu
  • Lee Owen
  • Jessica Howcroft
  • Angelo Christou

• How were they informed

  In Person

  Phone

  Email

  Text

• What time were they informed

  Date

• Was the Security Manager informed

  Yes

  No

• How was he informed

  In Person

  Phone

  Email

  Text

• What time was he informed

  Date

Incident Terminated

• Time Incident terminated

  Date

• Brief Description of Incident

  Yes

  No

  N/A

CCTV / BodyCams

• Was the incident captured on CCTV / Bodycams

  Yes

  No

• Which Cameras. / Body Cams recorded the incident

• Has the recorded footage been saved

  Yes

  No

Emergency Services

• Were the emergency services contacted

  Yes

  No

• Emergency services requested:

  Select Fire Service Police Ambulance Other

  • Fire Service
  • Police
  • Ambulance
  • Other

• Details of senior fire officer in attendance. ( Name / badge number and station)

• Time fire service left site.

  Date

• Time police on site

  Date

• Details of senior police officer in attendance. ( Name / badge number and station)

• Time police left site.

  Date

• Time ambulance on site

  Date

• Details of senior ambulance officer in attendance. ( Name / badge number and station)

• Time ambulance left site.

  Date

• Details of other emergency service requested together with name of senior officer, time on site and off site.

Escalation

• Were Property Management Informed

  Yes

  No

• Name of Person Informed

  Select Roxana Puscasu Lee Owen Jessica Howcroft Angelo Christou

  • Roxana Puscasu
  • Lee Owen
  • Jessica Howcroft
  • Angelo Christou

• How were they informed

  In Person

  Phone

  Email

  Text

• What time were they informed

  Date

• Was the Security Manager informed

  Yes

  No

• How was he informed

  In Person

  Phone

  Email

  Text

• What time was he informed

  Date

Incident Terminated

• Time Incident terminated

  Date