CHURCH FIRE RISK ASSESSMENT FORM
ASSESSMENT CONDUCTED BY ASSESSMENT DATE NEXT ASSESSMENT DUE
LOCATION INFORMATION
CHURCH
NAME
CHURCH
ADDRESS
POINT OF
CONTACT
NAME
CONTACT
INFORMATIO
N
BUILDING INFORMATION
NUMBER OF FLOORS SIZE OF FLOOR AREA MAXIMUM OCCUPANCY OF CHURCH
Service Days
and Hours
Construction
Details
e.g., building
and flooring
materials
Other
OCCUPANT INFORMATION
Approximate occupancy rate
during normal services
Approximate occupancy rate
during special services
Approximate occupancy rate
when no services in session
Special occupants at risk (e.g.,
guests with disabilities)
Designated location of at-risk
occupants during service, if any
Location(s) of other personnel in DURING SERVICE:
the building (e.g., janitors, choir
practice, instrumental practice)
OUTSIDE OF SERVICE:
BACKGROUND INFORMATION
Previous fire losses or incidents
Source(s) of previous fire losses
or incidents
What control measures have been
put in place due to previous fire
losses or incidents?
Other relevant information
HAZARD ASSESSMENT CHECKLIST
Yes No N/A HAZARD ASSESSMENT ITEM NOTES
Are heating sources (fixed or portal) kept clear
of combustible materials?
Are multipoint adaptors and electrical
extension leads kept to a minimum?
Is electrical equipment regularly inspected for
faulty or damaged wire?
Is smoking permitted on the premises?
Are combustible materials safely stored away
from sources of ignition?
Are flammable liquids safely stored away from
sources of ignition?
Are procedures in place to minimize the risk of
and protect from arson?
Other
Other
Other
FIRE ALARM AND DETECTION CHECKLIST
Yes No N/A FIRE ALARM AND DETECTION ITEM NOTES
Are smoke detectors tested monthly?
Are smoke detector batteries replaced at least
once or twice a year?
Is the fire alarm audible from all spaces in the
building?
Are the number and locations of fire call points
throughout the building satisfactory?
Are any fire alarms or call points obstructed
from view or access?
Are all personnel in the building aware of how
to raise an alarm?
Are fire alarms tested and serviced in
accordance with BS 5839 standards?
Does the alarm system have a backup battery
in place?
Other
Other
5
SAFE ESCAPE FROM FIRE HAZARDS CHECKLIST
Yes No N/A SAFE ESCAPE FROM FIRE HAZARDS ITEM NOTES
Are there at least two escape routes located in
each space?
Are all escape routes unobstructed and easily
accessible?
Can all escape points be exited quickly without
the use of a key?
Is there sufficient exit signage located in each
space, and does it comply with BS 5499?
Are illuminated exit signs required?
Is emergency lighting in place and properly
functioning?
Are all exit routes sufficiently illuminated?
Is emergency lighting tested and maintained
according to BS 5266?
Other
Other
FIRE FIGHTING EQUIPMENT CHECKLIST
Yes No N/A FIRE FIGHTING EQUIPMENT ITEM NOTES
Is there an adequate number of fire
extinguishers available?
Are fire extinguishers located in higher fire
hazard areas?
Have fire extinguishers been properly serviced
and tested?
Are fire blankets available?
Is a working sprinkler system installed in the
building?
Is there a working gas flooding system in the
building?
Are fixed installations tested according to BS
standards?
Do all protection systems have working
alarms?
Other
Other
STAFF TRAINING CHECKLIST
Yes No N/A STAFF TRAINING ITEM NOTES
Are staff trained on how to report a discovered
fire?
Are staff trained on how to raise the fire
alarm?
Are staff trained on how to use a fire
extinguisher?
Are staff trained on evacuation procedures?
Are staff trained on alerting other staff and
personnel about a fire?
Are team leaders or roles assigned to help
facilitate safe escape?
Are staff trained on where to go for a safe
assembly point?
Are staff trained on specific hazards on the
premises?
Other
Other
EVALUATION
LOW Unlikely to result in injury
MED Likely to result in injury of one or two occupants
HIGH High potential for serious injury or death
LOW MED HIGH EVALUATION ITEM NOTES
Probability of a fire occurring or
igniting on the premises
Severity of consequences if a fire was
to occur
Competency of staff on evacuation
procedures
Other
Other
Other
Other
Other
CONTROL PLAN
PROBABILI
HAZARD LOCATION PARTIES AT RISK TY CONTROL MEASURES OWNER
(H,M,L)
ACTION PLAN
HAZARD ACTION ASSIGNED TO DUE DATE
ADDITIONAL INFORMATION
RISK ASSESSOR NAME RISK ASSESSOR SIGNATURE DATE
RISK ASSESSOR TITLE
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
APPROVING OFFICIAL NAME APPROVING OFFICIAL SIGNATURE DATE
APPROVING OFFICIAL TITLE
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