Form No.

___

_________

District _ _____
Date ___

_____
_______

SAFETY AUDIT FORM

Rescue
1122

Premises Information
Premises
Name

Address

Building
Area / Age:
Premises
type:

Occupancy
type:

Owners Name/ Focal Person: ___ ______________________

Contact No. ______________
Plot size: ______________ (Marla / Kanal/Sq.ft) Total covered Area
_____ Sq.ft
Height of Building ____ ft
Age of the building ___ _____ Month / Years
Industrial

Commercial

Government

Residential

Home Apartments/Flats Hotel / Boarding Warehouse

Industry/Factory
Hospital Office /Shop School /College/university Plaza
Restaurant
Cinema/ auditorium
Banquet hall Bus Terminal Railway Station Airport Other
_________
Government Semi Govt.

Owner ship
Constructio
n type:
Building
Design

Leased

Rented

Private
Owned

Other ______________
Other ______________

Fully Framed Semi Framed Steel Framed Wooden Framed

Brick Masonry
Single Storey

Multiple Storey

Basement Yes No

No. of Floors (Above ground Level) ______

No. of Basements _________
Total No. of Floors ________

Occupancy & Storage

No. of
Occupants
Interiors

Storage
Type:

Staff ______ Residents ______ Visitors ____ Others ____________Total= ________

paint Plastic Wood working Partition False ceiling Wallpaper
Carpets
curtains/blinds Glass Other _______
Electrical Appliances Wood
Petroleum Products Paints
Fabrics
Hazardous material Medicines
Paper & board
Metals

Non metals
Explosive
Fertilizer
Leather
Chemical
Other
_________
Quantity Of Material:
Low Quantity

Medium Quantity

Bulk Quantity

{{{

Punjab Emergency Service, Rescue 1122

Page 1 of 3

SAFETY AUDIT FORM

Rescue
1122
Loose Electrical wiring
Yes No

General
Safety
Arrangem
ents

Over loaded socket /

plug
Yes No

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

Clear Vehicle Access to the Building

Yes No
Access Road__________

Emergenc
y
Arrangeme
nts

Width of

No. of Emergency Exits

_____
Functional ____________ Locked __
____________
Obstruction free __ __ ________ Clearly marked ____ ____ Illuminated __ ___
______
No. Emergency Staircases _ ___
External Staircase Internal
Staircase
Near Exit Illuminated
Obstruction Free
Fire Doors
Yes No
No. of Fire Doors
__ ____
__
Emergency Signs
Illuminated

Yes No

Clearly Displayed

Emergency Evacuation Plan Yes No

Clearly Displayed
Building Layout
Fire Plan Emergency Exits Marked Assembly
Area Marked

Fire
Detection
Systems

Fire Detection & Alarm System

Yes No

Functional

Non-functional

Type:
Automatic
Control Panel:
Yes No
points ___ _______

Manual
No. of manual call

Punjab Emergency Service, Rescue 1122

Page 2 of 3

SAFETY AUDIT FORM

No. of Smoke Detector ___ __ ___

Rescue
1122
Functional __ ______ Non-

Functional __ _______

No. of

Heat Detectors _________ Functional ____ _____ Non-Functional

__ ________

Punjab Emergency Service, Rescue 1122

Page 3 of 3

SAFETY AUDIT FORM

Rescue
1122

No. of Portable Fire Extinguishers __ ____ Functional __ ___ NonFunctional _______

Fire Extinguisher Types

D.C.P CO2

Water

Other _ ______

Sprinkler System Yes No

Status:

Wet System Dry

System
Functional

Non-Functional

No. of water Sprinklers

Functional _ ___

Non-Functional ______

No. of Fire Hose Cabinet __ ____ ___

Functional _

___

Non-

Functional _______

Fire Hydrant System

Yes No

No. of Fire

Hydrants ___ _________

Status: Functional Non-Functional Pressure
Maintained (3-5 Bar)
Fire Hydrant Types
Dry Riser Wet Riser
Electric Fire
Pump
Independent Overhead water tank Capacity _
__
Fire Safety
__
Arrangeme
Underground water tank
Capacity
nts
_________
_
No. of Fire Hose Reels __ __ ___ Functional _
_____ NonFunctional __ _______
Fire Suppression System
Yes No
TYPE_ NIL_______
Functional Non-Functional
Firefighting Trainings
Yes No
No. of Trained
Staff:____ _________
Type of Training _______________________________
Safe working practices followed Yes No
Regular Evacuation Drills
Yes No
Record
Maintained Yes No
Regular inspection of Firefighting Equipment Yes No
Maintained Yes No
Availability of local fire service/Team Yes No
Nearest Fire Station/Team __________________________________ Distance:
__________
Nearest Lorry Filling Point _____________________
_______
Distance:
_____
_

Any other information / observation:

Conclusion:
Low risk level

Medium risk level

High risk level

Punjab Emergency Service, Rescue 1122

Page 4 of 3

SAFETY AUDIT FORM

(No major additional control required, there may be
(Considerable resources may have to be
a need for consideration of improvement that
allocated to reduce the risk. If the building is
involved minor cost.)
unoccupied, it should not be occupied until the
risk has been reduced. If occupied, urgent action
should be taken

Prepared By:
Signature:________________
___
Name:_____________________
_
Date:______________________
_

Rescue
1122
(The building must not be occupied
until the risk
is reduced)

Verified By:
Signature:________________
___
Name:_____________________
_
Date:______________________
_

Punjab Emergency Service, Rescue 1122

Page 5 of 3