FIRE SAFETY ASSESSMENT GENERAL/FIRE SAFETY INSPECTION This inspection checklist is to be completed on a quarterly basis in the months of January, April, July and October and performed jointly by the Supervisor/employer representative and the relevant Health and Safety Representative for this Work Group. A copy is then to be forwarded to the Health and Safety Committee. Conducted by Supervisor (please print) Health and Safety Representative Other staff members involved: Date: Designated Work Group: RATING SYSTEM Please allocate a rating score to each item inspected, scoring from 1 to 4 to clearly identify the status of the respective topic. Comments should be recorded under each item if necessary. If the item being inspected is POOR major improvement required Score 1 – AVERAGE average improvements required Score 2 – GOOD minor improvements required Score 3 – EXCELLENT fully implemented and/or effective Score 4 – FIRE SAFETY ASPECTS Date of last emergency exercise: Please tick Yes or No appropriately Yes No Score
FIRE SAFETY ASSESSMENT GENERAL/FIRE SAFETY INSPECTION This inspection checklist is to be completed on a quarterly basis in the months of January, April, July and October and performed jointly by the Supervisor/employer representative and the relevant Health and Safety Representative for this Work Group. A copy is then to be forwarded to the Health and Safety Committee. Conducted by Supervisor (please print) Health and Safety Representative Other staff members involved: Date: Designated Work Group: RATING SYSTEM Please allocate a rating score to each item inspected, scoring from 1 to 4 to clearly identify the status of the respective topic. Comments should be recorded under each item if necessary. If the item being inspected is POOR – major improvement required Score 1 AVERAGE – average improvements required Score 2 GOOD – minor improvements required Score 3 EXCELLENT – fully implemented and/or effective Score 4 FIRE SAFETY ASPECTS Date of last emergency exercise: Please tick Yes or No appropriately Yes No Score
fireassess.docx