Fire Risk Assessment Form

General Information
Name of Risk / Insured
Date of Inspection
No. of Visits Single / Multiple
Person carried Inspection
Reason for Inspection Prior to Insurance / Renewal
Perils to be covered Fire / Other
Person (s) met
No of Persons Employed
Operating Periods
No. of Entrance(s) or Exit(s)
Name of Main Raw Material
Stored in Open / Godown
Name of Final Product
Stored in Open / Godown
Name of most Hazardous Process
Supply of Electrical Power WAPDA / Self / Both
Supply of Gas
Supply of Water WASA / Self
No. of Boilers
No. of Standby Generators
Genset Type Diesel / Gas / Both
Building Description
Total Area and Covered Area (S ft)
No. of Floors
Year Built (Age of Building)
Class of Construction Class I / Class II / Class III
Roof Status Concrete / Steel / Asbestos
Thickness of Int / Ext Wall
Plinth Level
Machinery Floor Level
Height of Boundary Wall
Partition Walls between different
departments?

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Sr. Description Yes No N/A
No.
Fire Safety – Security
1. Is the site effectively fenced? Yes No N/A
2. Are there any security check posts present? (if yes, give their number)
3. No. of armed / unarmed security guards.
4. Is there effective flood lit? Yes No N/A
5. Are CCTV Cameras installed in the premises? Yes No N/A
Fire Safety – Electric Installations, Appliances, etc.
1. Type of Wiring? Open / Concealed / Conduits / Within False Ceiling
2. Lighting System? Covered / Un Covered / Not Installed
3. Is the entire electrical installation in good working order? Yes No N/A
4. Are the electrical circuits free of any evidence of overloading? Yes No N/A
5. Is electrical equipment (e.g. light bulbs/fittings and any electrical heating Yes No N/A
appliances) kept well away from combustible materials?
Fire safety - Heating Appliances, etc.
1. Are there any Heating/Cooking Appliances available? Yes No N/A
2. Are Heating/Cooking performed in their designated area? Yes No N/A
3. Are all heating appliances safe (e.g. securely fixed in position, suitably Yes No N/A
guarded and with an adequate clear space free from storage of any kind)?
4. Is the entire heating installation in good order? Yes No N/A
5. Are all heating appliances used only for their original intended purpose)? Yes No N/A
Maintenance of Plant & Machinery
1. Machinery maintained in good order or seems untidy?
2. Machinery’s Year of Installation?
3. Fuel of machinery? Electricity / Sui Gas / Diesel / Other
4. Is there any flammable liquid/gas/ignition sources being used? Yes No N/A
5. Specification of such material?
6. Maintenance Schedule/Card Available? Yes No N/A
7. Are there stored any combustible materials for use? Yes No N/A
8. Are combustible materials kept away from ignition sources? Yes No N/A
Fire Safety – Housekeeping
1. What is the General condition of housekeeping? Satisfactory / Good / Fair / Poor
2. Are waste materials stored well away from any buildings? Yes No N/A
3. How is waste and rubbish disposed off? Daily / Per Shift / Weekly

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4. Are goods stored near electric wiring/circuits/boards? Yes No N/A
5. Aisles of at least 6 to 8 ft maintained between stacks? Yes No N/A
6. Congestion in the areas? Yes No N/A
7. Space between Stock and Walls?
Fire Safety – Storage Areas
1. Distance between Storage and Process areas?
2. Separate Godown/Store/Warehouse available for storage? Yes No N/A
3 What is the situation of storage area? Bulk / Palletized / Rack / High Rack
4. Type of Packing? Cartons / Polythene Bags / Paper Bags / Plastic Drums
5. Height of Stacking?
6. Approximate weight of each Pack?
7. Any hazardous goods present in close proximity of storage area? Yes No N/A
8. If Yes, then mention approximate distance?
9. Is the equipments/material sensitive to water damage? Yes No N/A
10. Is there any provision of rain/ flood water entrance inside the finish good Yes No N/A
godown where goods are stored?
11. Is cigarette smoking prohibited in and around storage area? Yes No N/A
12. “No Smoking” signs are properly posted / pasted in the premises? Yes No N/A
13. What is the storage condition of liquid (raw material/finished product)?
U/G tanks / O/H tanks / Drums / open reservoirs / others
Fire Safety – Means of escape
1. Are fire exits available in departments? Yes No N/A
2. Are fire exits sufficient (e.g. a sufficient No. of adequate width) to enable Yes No N/A
the number of people likely to be present in all areas to evacuate safely?
3. Are all final exits sited so that persons can escape safely from the vicinity Yes No N/A
of the building and the effects of fire?
4. Are all fire exits readily available? Yes No N/A
5. Are all escape routes free from obstruction and not used for storage? Yes No N/A
6. Are all escape routes provided with adequate lighting at all times when the Yes No N/A
premises are in use?
7. Are all escape routes clearly and properly marked with 'fire exit' signage? Yes No N/A
Fire Safety – Fire action plan and Firefighting Team
1. Are there clearly defined written fire action and evacuation procedures, Yes No N/A
including provision for a roll call?
2. Are suitable 'Fire Action' notices prominently displayed around the Yes No N/A
premises?
3. Has the staff been trained to promptly react in case of Fire and other Yes No N/A
emergency services?
4. Are any Fire drills carried out by insured? Yes No N/A

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5. How often are the Fire drills carried out? Monthly / Quarterly / Half Yearly / Yearly
6. Is there a private Fire Brigade? Yes No N/A
7. At what distance is the nearest Fire Brigade located?
8. At what distance is the nearest Police Station located?
9. Public Fire Brigade is familiar with plant? Yes No N/A
Fire Safety – Fire detection and Alarm systems
1. Is there fire alarm installed at site? Yes No N/A
2. Type of fire alarm? Manual (Electric) / Automatic
3. Is the fire alarm system in full working order? Yes No N/A
4. Is there fire alarm call points located near to every exit from each Yes No N/A
building?
5. Are all alarm call points unobstructed and clearly visible? Yes No N/A
6. Are the smoke and/or heat detectors installed in the premises? Yes No N/A
Fire Safety – Firefighting Equipment
1. Type of Fire extinguishers present? Cylinders / Trolleys / Sand Buckets / All of these
2. What is the general condition of Fire extinguishers? Satisfactory / Good / Fair / Poor
3. Is there present an efficient Hydrant system? Yes No N/A
4. No. of Water Hydrants?
5. Capacity of Underground Water Tank?
6. Capacity of Overhead Water Tank?
7. Height of Overhead Water Tank?
8. Is there any pressure pump in accordance with Water Hydrant System? Yes No N/A
9. Is there any Diesel Engine pump as a back-up for Water Hydrant System? Yes No N/A
10. No., capacity (HP) and Output Flow Rate (GPM) of each Diesel Engine pump?

11. Are hose / nozzles present near all hydrants? Yes No N/A
Fire Safety – Loss history
1. Past history of flood?
2. Past history of fire?
3. Past history of Earthquake?
4. Any other Claim History?

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Brief description of main process:
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Brief description of immediate Surroundings:

North (Back)

West (Left) East (Right)

South (Front)

Observation / Findings:
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