In the realm of fire safety within a business or organization, the Fire Risk Assessment Self-Assessment Form stands as a vital tool designed to guide the responsible person through a comprehensive evaluation of potential fire hazards and control measures. Originating from the advisory framework of the Regulatory Reform (Fire Safety) Order 2005, this form serves as a cornerstone for addressing a broad spectrum of fire safety considerations. Notably, it underscores the necessity for the responsible party to delve into the relevant fire risk assessment guides prior to embarking on this self-assessment journey. Despite being a freely available resource courtesy of Safelincs, it's expressly stated that this form is not intended for use by professional fire risk assessors. The self-assessment form encompasses various facets of fire safety, from identifying sources of fuel and potential ignition to evaluating building occupancy and the fire resistance of materials within the premises. It also stresses the importance of updating the assessment in the event of significant alterations to the building or its use. Through a structured approach, it prompts the assessor to meticulously document control measures for identified risks and to annex additional sheets for risks not covered within the form. In essence, this form offers a structured framework for responsible persons to critically assess fire risks and implement necessary controls, thereby fostering a safer environment for occupants and assets alike.
| Question | Answer |
|---|---|
| Form Name | Fire Assessment Self Form |
| Form Length | 31 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 7 min 45 sec |
| Other names | fire risk assessment self, fire self assessment, self certify fire risk, self assessment fire risk assessment |
FIRE RISK ASSESSMENT – Self Assessment
Important! This fire risk assessment form is to be filled in by the responsible person within a business or organisation. As this is a free download for the use of end users, this form must not be used by professional fire risk assessors. This form, while provided free of charge by Safelincs, has NOT BEEN completed by Safelincs! This fire risk assessment form helps to address the majority of fire safety considerations stated in the official fire risk assessment guides related to the Regulatory Reform (Fire Safety) Order 2005. However, before filling in this form you must nevertheless read the relevant fire risk assessment guide(s). This assessment form must be used in conjunction with the official fire risk assessment guide(s)!
There might be fire safety risks not addressed in this form. These risks must be assessed and recorded on separate sheets which must be attached to this form.
If the building is materially altered or the occupancy changes the fire risk assessment must be updated.
Responsible Person
Name of Premises or
Company
Address
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Name of Assessor(s) |
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Signature of Assessor(s) |
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Date of Assessment |
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Date of Review with |
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Building |
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Property Use |
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No of floors |
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No of floors below |
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ground |
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Approx area in m2 of footprint |
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Age of building |
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of building |
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Brief details of construction |
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Building Occupants |
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Occupancy Profile: |
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Weekdays |
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Weekends |
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Maximum Number of persons, in the |
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most highly occupied compartment |
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Are people sleeping in premises? |
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If so, how many |
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Description of Occupants: |
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Atypically mobile for this type of occupancy |
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Average mobility for this type of occupancy |
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Predominant Type |
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Untypically vulnerable for this type of occupancy |
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Reviewed: 29/09/2019 |
1 |
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686 - v1.2 |
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Building Plan
Insert plan of your building here or if you do not possess one, use this space to draw your building floor plan (this does not have to be to scale). Further guidance can be found in Part 1 Section 4.1 of the appropriate guide. Mark on all fire precautions equipment e.g. Fire doors, Extinguishers, Emergency lighting, Fire alarm and any fire detection.
KEY
Reviewed: 29/09/2019 |
2 |
686 - v1.2 |
FIRE HAZARDS AND THEIR ELIMINATION OR CONTROL
1. SOURCES OF FUEL
1.1 Are there any highly flammable substances in the premises. E.g. |
Yes |
paints, thinners, flammable gases etc, flammable chemicals, |
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plastics, rubber, foams – polystyrene / polyethylene? |
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Control Measures
Replace them with safer alternatives
Remove or significantly reduce any highly flammable substances
Keep them in fire resisting stores
Separate them from heat sources by use of fire resisting construction
Keep minimum quantity in workroom
Ensure all containers are kept closed when not in use
Other (state here):
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1.2 Are flammable liquids or gases used or stored in areas without |
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Yes |
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adequate ventilation? |
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Control Measures
Improve ventilation
Other (state here):
No
No
1.3 Are there quantities of combustible material stored, on display, or in |
Yes |
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use in the premises. E.g. Paper, cardboard, packaging, fabrics, |
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wood? |
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Control Measures
Replace stocks of combustible materials with
Reduce stocks of readily combustible materials to a minimum
Separate such materials from heat sources or by fire resisting construction
No
Reviewed: 29/09/2019 |
3 |
686 - v1.2 |
Other (state here):
1.4Are quantities of combustible waste allowed to accumulate in the premises such as Paper, cardboard, wood shavings, dust?
Control Measures
Improve the arrangements for the disposal of waste and rubbish
Improve the general housekeeping
Ensure staff are aware of the standard of housekeeping required
Give specific additional training to the staff responsible
Other (state here):
Yes
No
1.5 Does the premises contain foam filled furniture which is not |
Yes |
combustion modified (see label) or is worn to the point that it exposes the |
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foam interior? |
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Control Measures
Replace or repair
Other (state here):
No
1.6Are areas of walls or ceilings covered with combustible linings? such as walls covered with carpet tiles, ceilings covered
with polystyrene tiles.
Do notice boards have large amounts of loose paper on them?
Yes
No
Control Measures
Remove
Reduce
Treat with fire resisting solution
Cover
Replace large notice boards with small
Other (state here)
Reviewed: 29/09/2019 |
4 |
686 - v1.2 |
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1.7 Are combustible seasonal or promotional decorations, artificial foliage or |
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Yes |
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plants used to decorate the premises? |
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Control Measures
Remove
Treat with fire retardant spray/liquid
Introduce real plants
Replace with non combustible plants
Other (state here):
No
1.8 Are there additional sources of oxygen stored or used, such as |
Yes |
oxidising chemicals, oxygen cylinders or piped systems? |
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Control Measures
Move oxidising material away from any heat or flammable materials
Control use and storage of oxygen and chemicals
Remove sources of ignition
Other (state here):
No
Reviewed: 29/09/2019 |
5 |
686 - v1.2 |
Note any significant findings from section 1:
Reviewed: 29/09/2019 |
6 |
686 - v1.2 |
2. SOURCES OF IGNITION
2.1 Does the work activity involve hot work processes such as welding or flame |
Yes |
cutting, hot surfaces, sparks? Are hazards introduced by outside contractors |
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and building works? |
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Control Measures
Replace with a cold system
Implement a hot work permit system
Minimise the amount of combustible materials on the work area
Arrange so that hot metal and sparks are safely contained
Eliminate hot surfaces/sparks
Ensure satisfactory control over works carried out by outside contractors
Impose fire safety conditions on outside contractors
Other (state here)
No
2.2Does the work activity involve processes such as incinerating or Cooking?
Control Measures
Ensure that cookers, incinerators, etc. are used in accordance with manufacturer instructions.
Ensure they are cleaned regularly including surfaces, ducts or flues
Ensure food cooking is not left unattended
Give additional specific training to staff responsible
Ensure correct type of extinguisher if deep fat fryers are used
Other (state here)
Yes
No
Reviewed: 29/09/2019 |
7 |
686 - v1.2 |
Yes
2.3 Are heating appliances portable or of a radiant or open flame type?
Control Measures
Replace equipment with fixed convector heaters
Ensure that gas or oil burning equipment is used in accordance with manufacturers instructions
Ensure that all heaters are adequately guarded
Ensure all portable heaters are stable and void of flammable materials
Other (state here)
No
Yes
2.4 Is smoking permitted?
Control Measures
Implement a smoking policy which provides for a safe smoking area and prohibition elsewhere
Ensure suitable arrangement for informing visitors
Enforce the prohibition of matches and lighters in
Other (state here)
No
Yes
2.5 Are there light fittings near combustible materials?
Control Measures
Remove combustible materials
Replace tungsten/halogen bulbs with fluorescent tubes in areas where there is a possibility that combustible materials may be ignited
No
Other (state here)
Reviewed: 29/09/2019 |
8 |
686 - v1.2 |
2.6 Is electrical equipment and wiring: Faulty, damaged or not used in |
Yes |
accordance with the Manufacturers Recommendations? |
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Control Measures
Repair or replace faulty or damaged equipment
Portable Appliance Testing carried out
Fixed installations periodically inspected and tested
Suitable policy regarding the use of personal electrical appliances
Ensure all fuses are the correct rating
Other (state here)
Yes
2.7 Are inspection lamps or extension leads used?
Control Measures
Ensure extension leads are fully uncoiled
Limit extension leads and adaptors
Ensure extension leads are not overloaded
Suitable guards are covering inspection lamps
Ensure flexible power cables are kept as short as possible and safely routed
Other (state here)
No
No
Reviewed: 29/09/2019 |
9 |
686 - v1.2 |
2.8 Is Arson a potential problem?
Control Measures
Improve security measures e.g. lighting, cameras
Remove combustible storage / waste bins from perimeter of building
Ensure combustible storage is contained with lid secure
Install
Train occupants about handling of arson
Ensure that occupants are aware of the alternative exits
Other (state here)
Yes
No
2.9 Is lightning a potential problem?
Yes
No
Control Measures
Install lightning protection system
Extend fire detection to cover roof void
Incorporate measures in your emergency plan
Other (state here)
Reviewed: 29/09/2019 |
10 |
686 - v1.2 |
Note any significant findings from section 2:
Reviewed: 29/09/2019 |
11 |
686 - v1.2 |
3. IDENTIFY PEOPLE AT RISK
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3.1 Are there any groups of people at increased risk from fire i.e. work in |
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Yes |
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remote areas, lone working, sleeping? |
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Control Measures |
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Can they be |
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Improve the means for warning them about fire i.e. alarm and detection |
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system |
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Improve means of escape |
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Other (state here) |
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No
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3.2 Are there people present who may be unable to react quickly to a fire |
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Yes |
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due to safety critical work process? |
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Control Measures |
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Introduce appropriate close down procedure |
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Improve means of warning / means of escape |
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Other (state here) |
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No
3.3 In the event of a fire are there people present whose disabilities |
Yes |
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would put them at a disadvantage when required to evacuate in an |
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emergency? |
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Control Measures |
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Incorporate Measures in your Emergency Plan
Provide additional specialist equipment
If staff are required to assist in an evacuation ensure sufficient numbers and appropriate training
Provide safe refuges
Other (state here)
No
Reviewed: 29/09/2019 |
12 |
686 - v1.2 |
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3.4 Are visitors or members of the public likely to be unfamiliar with the |
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Yes |
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escape routes ? |
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Control Measures |
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Ensure employees are adequately trained to assist with evacuation |
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Improve signage (Fire Action Signs, escape route signs etc) |
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Install maintained emergency exit signs |
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Ensure escape procedure is explained to visitors |
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Other (state here) |
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No
3.5Are builders, contractors or maintenance workers temporarily on site?
Yes
No
Control Measures
Ensure they are aware of fire safety arrangements and emergency plan
Other (state here)
Reviewed: 29/09/2019 |
13 |
686 - v1.2 |
Note any significant findings from section 3:
Reviewed: 29/09/2019 |
14 |
686 - v1.2 |
4. MEANS OF ESCAPE FROM FIRE
Yes
4.1 In the event of fire can everyone safely escape from the premises?
Control Measures
Ensure existing exit routes and exits are available and unobstructed
Improve fire alarm / detection system
Provide additional routes and exits
Provide training for safe evacuation
Secure reasonable arrangements for disabled occupants
Implement routine checks
Other (state here)
No
4.2In the event of fire can everyone turn their back on the fire and evacuate to a place of safety?
Yes
No
Control Measures
Provide additional escape routes
Provide and maintain protected routes
Provide compensating features i.e. smoke detection, engineer solution
Other (state here)
4.3Do doors on escape routes, where necessary, open in the direction of travel?
Yes
No
Control Measures
Reduce number of people using exit to less than 60 people
Other (state here)
Reviewed: 29/09/2019 |
15 |
686 - v1.2 |
4.4Are door fastenings on exit routes and final exits easily operable?
Control Measures
Replace with a more suitable fastening
Provide notices giving information on how to operate exit doors
Provide training on operating techniques Other (state here)
Yes
No
4.5Is there a need for additional fire doors?
Control Measures
Install fire doors (specify where and the rating)
Fit surface mounted fire door seals (secify intumescent or intumescent/smoke)
Other (state here)
Yes
No
4.6Are any fire doors a poor fit or requiring fitment or attention to a self closing mechanism?
Yes
No
Control Measures
Fit self closers
Ensure doors fit correctly
Implement routine check on door operation and maintain as required
Other (state here)
Reviewed: 29/09/2019 |
16 |
686 - v1.2 |
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4.7 Are any of the fire door intumescent or intumescent/smoke seals missing or |
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Yes |
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damaged? |
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Control Measures |
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Replace fire door seals |
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Fit surface mounted fire door seals (specify intumescent or |
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intumescent/smoke) |
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Other (state here) |
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No
Yes
4.8 Are any fire doors wedged or propped open?
Control Measures
Remove any wedges etc
Install Fire Door Retainers to hold open doors legally
Explain fire doors and the need to allow them to close to occupants
Other (state here)
No
Yes
4.9 Are all exit routes and exits adequately signed ?
Control Measures
Install sufficient signs to enable people to find their way out
Ensure signs are unobstructed and clearly visible from an appropriate distance
Other (state here)
No
Reviewed: 29/09/2019 |
17 |
686 - v1.2 |
4.10 Are all exit routes and exits adequately illuminated?
Control Measures
Install emergency lighting
Improve existing emergency lighting
Other (state here)
Yes
No
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4.11 If the building is compartmentalised, are the walls and ceilings of sufficient |
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Yes |
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fire resistance? |
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Control Measures |
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Carry out detailed survey |
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Strengthen fire resistance |
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Other (state here) |
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No
4.12If the building is compartmentalised, are there openings that could allow the spread of fire between compartments?
Yes
No
Control Measures
Seal openings
Install passive fire protection
Other (state here)
4.13Are there structural features that could promote the spread of fire and therefore affect escape routes. Eg open plan floors?
Yes
No
Control Measures
Compartmentalise
Create additional escape routes
Reviewed: 29/09/2019 |
18 |
686 - v1.2 |
Other (state here)
Compliance Section 4
Indicate the preventative and protective fire safety measures taken to show compliance with Part 2 of the Order for Emergency routes and exits.
Reviewed: 29/09/2019 |
19 |
686 - v1.2 |
Reviewed: 29/09/2019 |
20 |
686 - v1.2 |
5. FIRE FIGHTING AND FIRE DETECTION
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5.1 Are there sufficient extinguishers and hose reels of the appropriate |
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Yes |
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type for the risk and are they located correctly? |
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Control Measures |
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Provide suitable additional fire fighting equipment including specialist |
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equipment for special hazards |
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No
Locate on stands or brackets
Make visible and unobstructed
Provide additional signage
Other (state here)
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5.2 Are inspection labels on fire fighting equipment in date? Where self- |
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Yes |
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maintained portable fire extinguishers are installed, is there an inspection |
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record? |
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Control Measures |
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No
Carry out service/inspection of fire fighting equipment
Other (state here)
5.3Have sufficient people been trained in the use of fire fighting equipment?
Control Measures
Implement training programme
Other (state here)
Yes
No
5.4In the event of fire are there suitable arrangements for giving warning, including where necessary automatic fire detection?
Yes
No
Control Measures
Install a more effective fire alarm system and or detection system
Other (state here)
Reviewed: 29/09/2019 |
21 |
686 - v1.2 |
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5.5 Does the automatic fire detection system comply with industry guidelines for |
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Yes |
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this type of building/occupancy? (Specify current arrangements in the |
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compliance field at the end of section 5) |
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Control Measures
Install a more effective fire alarm system and or detection system
Other (state here)
No
5.6Is the signage for the fire fighting equipment and fire alarm satisfactory?
Control Measures Improve signage
Other (state here)
Yes
No
5.7Are all appropriate persons trained on how to operate the fire warning system and the action they should take upon hearing it?
Yes
No
Control Measures
Implement training programme
Provide clear instructions
Other (state here
Reviewed: 29/09/2019 |
22 |
686 - v1.2 |
Compliance Section 5
Indicate the preventative and protective fire safety measures taken to show compliance with Part 2 of the Order for Fire fighting and Fire detection.
Reviewed: 29/09/2019 |
23 |
686 - v1.2 |
6. PROCEDURES, ARRANGEMENTS AND TRAINING
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6.1 |
Are sufficient person(s) available to assist in implementation of fire |
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No |
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safety measures? |
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6.2 |
Are appropriate fire procedures in place, recorded and available for |
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Yes |
No |
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relevant persons to read? |
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6.3 |
Are people nominated to respond to fire and assist with evacuation? |
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Yes |
No |
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6.4 |
Is there appropriate liaison with the Fire and Rescue Authority? |
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Yes |
No |
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Yes |
No |
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6.5 |
Are routine |
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6.6 |
Are new employees, tenants or building users given fire safety instruction on |
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Yes |
No |
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induction or taking over use of the premises? |
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Yes |
No |
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6.7 |
Are all staff given periodic refresher training at suitable intervals? |
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Yes |
No |
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6.8 |
Are building occupants aware of specific actions if there is a fire? |
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6.9 |
Are staff with special responsibilities e.g. Fire Marshals/Wardens/stewards |
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Yes |
No |
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given additional training? |
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6.10 Have the Employers of contractors working at the premises ie. cleaners |
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Yes |
No |
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been informed of significant findings and fire procedures? |
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6.11 Are persons under 18 employed, if so has an assessment been made of risks |
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Yes |
No |
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special to them and have their parents been informed of significant findings |
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and fire procedures? |
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Yes |
No |
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6.12 Are fire drills carried out at appropriate intervals?
Reviewed: 29/09/2019 |
24 |
686 - v1.2 |
Indicate any deficiencies in this section :-
Reviewed: 29/09/2019 |
25 |
686 - v1.2 |
7. MAINTENANCE AND TESTING
7.1 Are the premises adequately maintained?
Yes
No
Control Measures
Correct any deficiencies and implement maintenance programme
Other (state here)
Yes
7.2 Are door fastenings on all exit doors adequately maintained?
Control Measures
Correct any deficiencies and implement maintenance programme
Other (state here)
No
Yes
7.3 Do all self closing devices and hold open devices work correctly?
Control Measures
Correct any deficiencies and implement maintenance programme
Other (state here)
No
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7.4 Has the emergency lighting system been tested and serviced (Monthly, |
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Yes |
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Control Measures |
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Correct any deficiencies and implement maintenance programme |
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Other (state here) |
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No
7.5Has the fire alarm / detection system been regularly tested and serviced (Weekly, Annually) and according to manufacturers instructions?
Yes
No
Control Measures
Correct any deficiencies and implement maintenance programme
Reviewed: 29/09/2019 |
26 |
686 - v1.2 |
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Other (state here) |
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7.6 |
Have all fire extinguishers and hose reels been regularly inspected and |
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Yes |
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Serviced (Monthly, Annually) in accordance to manufacturer’s |
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instructions? |
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Control Measures |
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Correct any deficiencies and implement maintenance programme |
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Other (state here) |
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7.7 |
Has the sprinklers and fixed fire fighting systems been regularly tested |
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Yes |
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and serviced (Weekly, Quarterly, |
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to manufacturers instructions? |
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Control Measures |
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Correct any deficiencies and implement maintenance programme |
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Other (state here) |
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No
No
Reviewed: 29/09/2019 |
27 |
686 - v1.2 |
Compliance Section 7
Indicate the preventative and protective fire safety measures taken to show compliance with Part II of the Order for Maintenance.
Reviewed: 29/09/2019 |
28 |
686 - v1.2 |
8. FIRE SAFETY RECORDS
8.1 |
Have fire safety arrangements been recorded in a way that can be easily |
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Yes |
No |
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interpreted? |
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8.2 |
Are there details of any significant findings from the fire risk assessment |
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Yes |
No |
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and any actions taken? |
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8.3 |
Are there records of testing and checking of escape routes, including |
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Yes |
No |
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final exit locking mechanisms such as panic devices, emergency exit |
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devices and any electromagnetic devices? |
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8.4 |
Are there records of testing and maintenance of emergency lighting? |
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Yes |
No |
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8.5 |
Are there records of testing and maintenance of fire alarm / detection |
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Yes |
No |
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systems? |
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8.6 |
Are there records of false fire alarms? |
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Yes |
No |
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8.7 |
Are there records of testing and maintenance of fire extinguishers, hose |
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Yes |
No |
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reels and sprinkler systems etc.? |
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8.8 |
Are there records of relevant training of employees including evacuation |
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Yes |
No |
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drills? |
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8.9 |
Are there records of emergency plans and actions for the relevant people |
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Yes |
No |
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to take in the event of fire? |
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Indicate any deficiencies in this section
Reviewed: 29/09/2019 |
29 |
686 - v1.2 |
Significant Findings (filled in by Assessor)
Item
No
Section
and Sub
Paragraph
Description of Unsatisfactory Condition
Proposed Remedial Action.
REVIEWED: 29/09/2019 |
30 |
686 - V1.2 |
Review of the Significant Findings
Date
Item
No
Section
and Sub
Paragraph
Remedial Action agreed
By when?
Who is responsible
for Action?
REVIEWED: 29/09/2019 |
31 |
686 - V1.2 |