Asset Classification Form completed? (MFPE Chapter 1, Annex A)
Criticality Assessment Form completed? (MFPE Chapter 1, Annex A)
Year of construction:
Approximate internal building floor area (square metres):
Has occupancy or the usage of the building changed since last FSS?
If yes, has any change / usage been approved by the Region's Director Estate Services Facilities?
If yes, has a certificate of occupancy or equivalent been provided?
Are there any available fire safety-related alternative solutions / Dispensations. If yes, survey to include assessment of maintenance requirements in 'Report Checklist' at page 13A-3.
Table 3. Characteristic
Table 4. Fire Safety Survey Results
Recommendations from previous survey by status
Outstanding recommendations from previous survey by status
Recommendations from current survey by status
Table 5. Survey Results Summary
Overall current survey status
Date of next survey:
Table 6. Inspecting Officer
Authorized to conduct fire safety surveys?
AIBS Accreditation No:
EEPD file reference:
Company telephone No:
I have inspected the building and found it to be substantially in accordance with the findings noted in this fire safety survey report.
Notes:- the details of the POC for the survey are to be provided in Table 1- when the fire safety survey is outsourced, the information required to populate Table 2 is to be provided by Defence as part of the tender documentation.- A description of the original use and certification of the building is to be given in Table 2. The reference to floor area in this table is to be the internal measurement available in DEMS that includes all room floor areas within the building and excludes the building fabric. It is noted that this is not a BCA defined measurement of areas. - The building characteristics are to be described in Table 3.- The previous, current and outstanding fire safety survey recommendations are to be provided in Table 4. The outstanding column in this table is to list the recommendations that have not been completed from the previous fire safety survey report. - The status of the current fire safety survey is to be shown in Table 5.- The details of the inspecting officer are to be provided in Table 6.
DSG Region: DS-SNSW
S = Satisfactory GS = Generally Satisfactory U = Unsatisfactory XX = Unacceptable Dangerous FA = Further Assessment N = Notes
NOTE: Refer to Report Guidelines at Annex B for further information.
01. Fire rated elements
02. Linings - Floors, wall and ceiling.
03. Compartmentation - Fire
04. Compartmentation - Smoke
05. Bounding construction
06. Essential service separation
07. Protection of external openings
08. Fire rated door-sets
09. Smoke-rated / solid core doors
10. Access panels / service penetrations
11. Number of exits
12. Fire-isolation of exits
13. Travel distances
14. Egress paths
15. Discharge of exits
16. Door swing
17. Door hardware
18. Fire hydrants
19. Booster system / pump sets
20. Fire hose reels
21. Foam / Foam attachments
22. Fire sprinklers
OTHER SUPPRESSION SYSTEMS
24. Gas inert / synthetic
25. Water mist / other
26. Portable extinguishers
27. Fire blankets
28. Fire indicator panel
29. Sub-indicator panel / mimic panel
30. Manual call points
31. Smoke / thermal / flame
Alarm acknowledgement module (AAM)
32. BOWS / SSISEP / EWIS
SMOKE HAZARD MANAGEMENT
33. Fire and smoke dampers
34. Air-handling shutdown
35. Zone / stairway pressurisation
36. Smoke exhaust / smoke and heat vents
37. Fire fan control panel
EVACUATION LIGHTING SYSTEMS
38. Emergency lighting
39. Exit and directional signs
40. Dangerous goods storage
41. Flammable goods storage
42. Gas isolation / storage
43. Hazardous area compliance
44. Alternative solution report / Dispensation
45. Power supply - Essential services
46. Fire vehicle access and response
49. Alternative solution requirements
50. Emergency lighting and exit signs
Evac plans installed? Are the plans AS 3745 compliant?
51. Exit doors and doors in paths of travel
52. Fire and smoke rated elements
53. Fire and smoke dampers
54. Fire detection and alarm systems
55. Fire doors / smoke doors / fire shutters
56. Fire hydrants
57. Fire suppression systems
58. Fire pumps
59. Fire resisting shaft openings
60. Hose reel system / foam attachments (Qty)
61. Lay flat hose
62. Mechanical smoke hazard management
63. Portable fire extinguisher / fire blankets (Qty)
Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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