Test form

Responsible person (e.g. employer) or person having control of premises:

Email:

Address of premises:

Person(s) consulted:

The premises

Number of floors at ground level and above:

Number of floors entirely below ground level:

Floors on which car parking is provided:

Number of flats:

Approximate gross floor area:

m²

Brief details of construction and approximate age of building:

Occupancy:

The occupants

Approximate maximum number of employees at any one time:

Approximate maximum number of residents and visitors at any one time:

Occupants especially at risk from fire

Sleeping occupants:

Occupants in remote areas and lone workers:

Others:

Disabled occupants (if known):

Fire loss experience

Fires in the past:

Cost of the past fire losses:

Other relevant information

Detail here if required: