Source: XpertHR P&D Date: 01/10/2006 Publisher: XpertHR

Health and safety: Fire risk assessment record (form)

TOPICS:
health and safety  law and codes of practice
incidents
health and safety management

AUTHOR: David Pratt


This form is provided by RSK ENSR Health & Safety Ltd.

Form wording:

Premises location  
General description  
Risk assessment ref no  
Date of assessment  
Assessment by  

(1) Fire hazards

What Ignition Sources may be present? Yes Possible No Notes
Smoking materials - cigarettes and matches        
Naked flames        
Gas- or oil-fired heaters        
Gas- or oil-fired boilers        
Gas cooking equipment        
Electric cooking equipment        
Faulty or misused electrical equipment        
Special lighting equipment, eg halogen lamps        
Hot surfaces in equipment        
Petrol/diesel engines        
Machinery        
Hotwork, eg welding or grinding        
Arson        

Others (specify)

 

 

 

       
What Fuel Sources may be present? Yes Possible No Notes
Paper or card        
Wood        
Plastics, rubber, polyurethane or polystyrene foam        
Textiles        
Flammable symbol Flammable liquids, eg petrol, paraffin, white spirit        
Products with flammable liquids, eg paint, adhesive        
Flammable gases, eg LPG or acetylene        
Loose packaging materials        
Waste materials, eg wood shavings, offcuts, dust, paper or textiles        

Others (specify)

 

 

 

       
What Oxygen Sources may be present? Yes Possible No Notes
Natural airflow        
Ventilation, extraction or air conditioning systems        
Oxygen cylinders        
Oxidising chemicals (see special symbol on labels) Oxidising symbol        

(2) Persons at risk

What People may be at risk in the event of fire? Yes No How many Notes
Employees        
Visitors or contractors        
Tenants' employees        
Tenants' visitors or contractors        
Other building occupiers or visitors (specify)        

(3) Fire hazard reduction measures

Have suitable measures been taken to reduce ignition sources? Yes No N/A Notes
Smoking prohibited throughout building        
Smoking restricted to designated areas only        
Prohibition of naked flames in high-risk areas        
Removal of unnecessary heat sources        
Replacement of naked flames or radiant heaters with fixed convector heaters or central heating        
Correct electrical fuses, circuit breakers ensured        
Proper maintenance of electrical equipment        
Proper maintenance of mechanical equipment        
Proper maintenance of gas- or oil-fired equipment        
Ensuring electrical equipment not overloaded        
Ensuring all equipment left in a safe condition        
Permit-to-work control for all hotwork, eg welding        
Security precautions to avoid the risk of arson        

Others (specify)

 

 

 

       
Have suitable measures been taken to reduce Ignition Sources? Yes No N/A Notes
Reducing flammable materials and substances to minimum necessary        
Replacing flammable materials and substances with less flammable alternatives        
Flammable symbol Storing highly flammable substances in fire resisting stores        
Keeping minimum quantities in fire-resisting cabinets in workrooms        
Regularly clearing flammable waste materials        
Security precautions to avoid the risk of arson        
Improving fire resistance of workplace construction        

Others (specify)

 

 

 

       
Have suitable measures been taken to reduce Oxygen Sources? Yes No N/A Notes
Closing doors, windows not needed for ventilation        
Shutting down ventilation systems when not needed        
Controlling use and storage of oxygen cylinders        
Storing any oxidising materials away from any heat source or flammable materials        

(4) Fire precautions

Are there suitable means of Fire Detection? Yes No N/A Notes

Fire detection fitted:

  • Smoke detector/alarms fitted?
  • Automatic fire detection system with suitable detector devices installed?
  • Back-up power supply for detection system?
       
Can the means of detection discover a fire quickly enough to raise the alarm so that all occupants can escape to a safe place?        
Are there suitable means of Fire Warning? Yes No N/A Notes
Is fire warning system fitted?        
Electric-powered fire alarm with manual call points on exit routes and adjacent to final exits?        
Public address system based fire warning system?        
Manually operated fire warning gong or similar?        
Back-up power supply for powered alarm system?        
Can the means of warning be heard throughout the premises when initiated from a single point?        
Are instructions posted about how to operate the fire warning system and action to take on hearing a warning?        
Are there suitable means of Escape? Yes No N/A Notes
Are means of escape provided?        
Are there enough exits and are the exits in the right places?        
Are exits suitable in type and size for the number of people who need to use them?        
Are escape routes easily identifiable, free from obstructions, adequately illuminated?        
Can all occupants escape to a place of safety in a reasonable length of time once fire is detected?        
Are instructions posted about means of escape?        
Have staff been trained in using the means of escape?        
Is there suitable Fire Fighting Equipment? Yes No N/A Notes
Is fire-fighting equipment provided?        

Are fire extinguishers provided:

  • of suitable type and sufficient capacity?
  • in sufficient numbers throughout premises?
  • located close to fire hazards?
  • easily accessible and signed where necessary?
       
Have people likely to use fire extinguishers been instructed and trained?        

Is other equipment provided where needed:

  • hose reels?
  • fire blankets?
  • sprinkler system?
  • special fixed fire-fighting systems?
       
Is there adequate Maintenance and Testing? Yes No N/A Notes
Are systems maintained and tested?        

Are there regular visual checks of:

  • fire doors, escape routes, escape signs and lighting?
  • fire detection and alarm equipment?
  • fire-fighting equipment?
       
Is fire alarm system test regularly, eg weekly?        

Are there periodic checks and tests by a competent engineer of:

  • fire detection and alarm equipment?
  • fire extinguishers?
  • hose reels?
  • emergency lighting equipment?
       
Are there suitable Fire Procedures and Training? Yes No N/A Notes
Are fire procedures and training provided?        
Is there an emergency plan taking account of all reasonably foreseeable circumstances?        

Has any emergency plan been:

  • made available to all who need to be aware?
  • tested with employees instructed and trained?
       
Is there adequate provision for disabled people with special needs?        

(5) Conclusions

Fire Risks - summary of any fire risks identified that are not adequately controlled

 

 

 

Action - details of actions required
Action Person responsible Target completion Completion date

 

 

 

 

 

 

 

 

 

 

 

 

Date for next reassessment  

Assessor details

Name  
Title  
Signature  
Date  

Approval

Name  
Title  
Signature  
Date  

 

Additional comments:

 

 

 

When to use the document

Use this document to record fire risk assessments.

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