Appendix IV: Facility Survey

This section is provided to assist in developing a general understanding of the facility's operations and layout. It is not intended to be a comprehensive report, but rather a tool to aid in gathering data. Basic information, such as the number of employees, purpose of the buildings, process materials, products manufactured, and special hazards, must be identified during this process.

Such information can serve as a general checklist for the survey and can assist in quickly identifying potential fire hazards. The form found in this section is intended as a guide and should be modified to reflect local conditions.


Identify the company, facility, facility manager, surveyor(s), and date of survey. Such information can be used as a record for report development and survey identification. All information should be kept on file for future reference.


Identify the facility's number of employees by shift and department. This information will assist in determining employee risks. Consideration must be given to employees on all shifts by departments and buildings.

Building Information:

Identify the buildings on the premises and the types of operations in each building. This information will provide a checklist of areas to review and assist in identifying any special hazards in the building. Buildings with high numbers of employees, multiple floors, and combustible materials will require more survey time than other areas.

Utility Services:

Identify the utility and heating services. Utilities often provide a fuel and/or ignition source for fires. Fire-prevention controls for fuel and ignition sources should be reviewed during the survey.

Process Materials:

Process materials used to develop the facility's products must be identified and reviewed for fire hazards associated with the materials. Process materials typically contribute to the building's fire load as they may have flammable or combustible characteristics.


Final products, like process materials, must be identified and reviewed. These materials are typically maintained in on-site warehouses, and are considered a major source of fuel for fires. Materials and contents that cause the most concern are explosives, plastics, flammable liquids, combustible dusts, aerosols, and compressed gases. Plastics are considered to be rated as high fire hazards due to their ability to develop extremely high temperatures, high burning rates, and dense smoke.

Building Survey


Company: ______________________________________________
Owner: ________________________________________________
Facility Address: _________________________________________
Facility Phone Number: ____________________________________
Facility Manager: _________________________________________
Date of Survey: __________________________________________
Name of Surveyor(s):______________________________________



Number of

Shift One  
Shift Two  
Shift Three  

Building Information:

Number of Buildings: _____________________

Number of
Number of
Building 1:        
Building 2:        
Building 3:        
Building 4:        

Area of Entire Property: ____________________

Areas Protected by Automatic Sprinklers:

  1. __________________________
  2. __________________________
  3. __________________________
  4. __________________________

Utility Services:

Other _____________

Process Materials Listing:

  1. __________________________
  2. __________________________
  3. __________________________
  4. __________________________

Finished Products:

  1. __________________________
  2. __________________________
  3. __________________________
  4. __________________________
  5. __________________________
  6. __________________________
  7. __________________________
  8. __________________________

Use Additional Pages as Necessary

Back to Table of Contents

Table of Contents

Getting Started
Survey Checklists

Reference Guide

Appendix I
Sources of Information & Assistance

Appendix II

Appendix III
Review of Basic Fire Hazards

Appendix IV
Facility Survey

Appendix V
Selected NFPA Reference Codes

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