Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
___
_________
District _ _____
Date ___
_____
_______
Premises Information
Premises
Name
Address
Building
Area / Age:
Premises
type:
Occupancy
type:
Commercial
Government
Residential
Owner ship
Constructio
n type:
Building
Design
Leased
Rented
Private
Owned
Other ______________
Other ______________
Multiple Storey
Basement Yes No
Storage
Type:
Non metals
Explosive
Fertilizer
Leather
Chemical
Other
_________
Quantity Of Material:
Low Quantity
Medium Quantity
Bulk Quantity
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General
Safety
Arrangem
ents
Type of wiring
Gas supply Main cutOpen
Underground off valve
Both
Yes No
Alternate power
Circuit breaker for each
supply system Yes
portion Yes No
No
Damaged / tapped
wires Yes No
Electrical Main cutoff switch Yes
No
Building properly
earthed Yes No
Ducting Material
Used
Emergency lighting
Flammable
Yes No
Nonflammable
N/A
Designated smoking
Central air conditioning No Smoking is followed
area
system Yes No
Yes No
Yes No
Proper house keeping
First Aid box
Separate parking
Yes No
Yes No
Yes No
System manned at all
Building insured
times
Other _____
__
Yes No
Yes No
Proper ventilation
ducts
Yes No
Emergenc
y
Arrangeme
nts
Width of
Yes No
Clearly Displayed
Fire
Detection
Systems
Yes No
Functional
Non-functional
Type:
Automatic
Control Panel:
Yes No
points ___ _______
Manual
No. of manual call
Rescue
1122
Functional __ ______ Non-
Functional __ _______
No. of
__ ________
D.C.P CO2
Water
Other _ ______
Status:
System
Functional
Non-Functional
Functional _ ___
Non-Functional ______
Functional _
___
Non-
Functional _______
Yes No
No. of Fire
Conclusion:
Low risk level
Prepared By:
Signature:________________
___
Name:_____________________
_
Date:______________________
_
Rescue
1122
(The building must not be occupied
until the risk
is reduced)
Verified By:
Signature:________________
___
Name:_____________________
_
Date:______________________
_