Fire risk assessment form template - Allianz risk management

Administration

Premises (e.g. "Colchester branch (main building)" or "Site canteen"):

Date of assessment:

Day Month Year

Assessed by:

Involved person

Other(s) involved:

Add another: Involved person

Signed off by:

Date for next assessment (if one is not required beforehand):

Day Month Year

The premises

Premises name and address:

Age:

Size:

Number of storeys:

Hint: Include basements and attics/lofts

Occupancy type(s):

Hint: Residential tenants/ retailer tenants with public access permitted during opening hours/ professional workshop with restricted access, etc.

Brief description of the building:

A site plan is available:

Site plan If you have a site plan, attach it to your assessment in an appendix.

Yes
No

Existing arrangements

The following measures have been taken to contain/slow the spread of fire, with relation to:

The construction of the building:

Consider elements like: Protection for frame type; Compartment walls and floors; Internal doors; Lift openings.

Furnishings and decoration:

Consider factors like: The flammability of furniture; Combustibility of paint on walls and ceilings.

High risk activities and processes:

Hint: Consider what is in place to prevent, slow and control the spread of a fire in high risk scenarios; e.g. automatic fire extinguishers for machinery or internal fire doors and ventilation for kitchens.

Other/general activities and processes:

Hint: Detail what's in place to contain/slow the spread of a fire in areas with a relatively moderate or low fire risk; e.g. automatic sprinkler systems in a dining area.

Escape routes:

Since the last assessment, the following have been addressed to improve and maintain fire and smoke containment:

Detail and prioritise additional measures that are necessary to improve containment of fire and smoke:

People in the building

Detail the types of people who are likely to be in the building and consider how their knowledge of the building, health/fitness or special needs or vulnerabilities may affect their ability to make a safe escape. Outline what is in place to help them.
(For example: Customers in wheelchairs need a clearly marked step-free exit route.)

Type of people

Type(s):

A safe escape is possible because:

At any one time, the amount of these people likely to be in the building is:

Add another: Type of people

People

Detail what you have considered in relation to the likely reaction (or lack of reaction) of people who might be asleep, are impaired by drink or drugs, or for some other reason might behave in an unexpected or unpredictable manner.

The agreed point(s) of assembly is/are:

Someone who has the right knowledge and experience, and who is equipped with adequate information, has assessed the present arrangements for escape from a fire, wherever it may occur.

They have confirmed that they are acceptable:

Yes
No

Comments/actions:

If the building is shared:

All of the people that share the building with us have been provided with details of any fire hazards that have been identified and which may affect them; and we have therefore:

Appropriately coordinated fire safety arrangements and plans:

Yes
Not applicable

Since the last assessment, the following have been addressed to improve and maintain coordination of fire safety measures:

Detail and prioritise additional measures that are necessary to improve maintain coordination of fire safety measures:

Alarms

When there are people in the building, these measures will ensure any fire will be detected and an alarm will be raised:

Example: Audible and visual (flashing lights - for the hearing impaired) alarms triggered by smoke detectors.

When there isn’t anyone in the building, these measures will ensure a fire will be detected and an alarm will be raised:

To improve and/or maintain arrangements for fire detection and alarms, we are:

Control and safety

For the purposes of controlling and/or fighting a fire, the following arrangements are in place:

Hint: Suppressor/extinguisher equipment and systems appropriate for the materials and potential ignition sources in each area (and people trained to maintain and use them safely).

To improve and/or maintain arrangements for controlling and fighting fires, we are:

To manage fire safety, the following arrangements are in place:

Hint: Information, guidance and training, competent people with designated responsibilities and duties, and drills and record keeping.

To improve and/or maintain the management of fire safety, we are:

Sources of fuel

Considering what’s inside and outdoors, and including stock, raw materials, work in progress, waste, packaging, cleaning and maintenance materials, dusts and powders, liquids, gases, aerosol cans, etc., the following items have been identified as potential fuel sources for a fire:

Flammable/combustible (fuel)

Item details:

This item is a potential fuel source when:

In use
In storage
As waste

Existing controls:

Risk level:

High
Medium
Low

Further action required:

Revised risk level:

High
Medium
Low

Add another: Flammable/combustible (fuel)

Sources of ignition

The following items/processes/hazards have been identified as potential sources of ignition for a fire:

(For example: Electrical installations; Electrical equipment; Battery chargers; Static electricity; Heating; Cooking areas; Cigarette smoking; Manufacturing processes; Welding; Chemicals; Naked flames; Lightning.)

Source of ignition

Item/process/hazard details:

Existing controls:

Risk level:

High
Medium
Low

Further action required:

Revised risk level:

High
Medium
Low

Add another: Source of ignition

Sources of oxygen

The following hazards have been identified as potential sources of oxygen:

Hazard:

Openings not required for ventilation
Ventilation systems (not essential to the function of the workplace)
Storage and use of oxidising materials
Storage and use of oxygen cylinders
Other

Existing controls:

Risk level:

High
Medium
Low

Further action required:

Revised risk level:

High
Medium
Low

Action plan

Use this space to summarise all the required actions identified by your assessment, including notes on when and who the action should be completed by.

Further action

Further action:

Date completed:

Day Month Year

Responsible person:

Sign off:

Add another: Further action

Appendix

Add details of the location(s) of supplementary documents, such as site plans. You can also use this space to expand upon notes made earlier in the assessment.

Note

Note:

Add another: Note