Fire Safety Risk Assessment Form

The Regulatory Reform (Fire Safety) Order 2005
FIRE RISK ASSESSMENT
Employer or other
responsible person
Name of Premises
Address
Post Code Telephone N
o
Name of Assessor(s)
Date of Assessment Date of Review
Building GENERAL INFORMATION
Property Use
N
o
of floors
N
o
of floors below
ground
Approx area in m
2
of footprint
of building
Age of building
Brief details of construction
GENERAL INFORMATION
Building Occupants
Enter range A= <20, B= 20 – 49, C=50-99, D=100-1000, E= >1000
Occupancy Profile:
Maximum Number of persons, in the
most highly occupied compartment
to be effected by an uncontrolled fire
within 30 minutes, assuming no
evacuation.
WEEKDAYS WEEKENDS
0000 to 0400 0000 to 0400
0400 to 0800 0400 to 0800
0800 to 1200 0800 to 1200
1200 to 1600 1200 to 1600
1600 to 2000 1600 to 2000
2000 to 2400 2000 to 2400
Description of Occupants:
Predominant Type
Atypically mobile for this type of occupancy
Average mobility for this type of occupancy
Untypically vulnerable for this type of occupancy
Page 1 of 23
MR/ECFRS/V2/2013
Page 1/23
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