FORM-IV

[See rule-13(2)]

FIRE PREVENTION AND SAFETY INSPECTION REPORT

Sl. Details of premises Requirement Requirement Provision Deviation/

No etc as per as per the made in Shortfall/
National approved the deficiency
Building plan building if any
Code of
India
(1) (2) (3) (4) (5) (6)
1. Plot area with
dimensions
2. Total covered
/constructed area (at
ground level)
3. No. of buildings, towers,
blocks etc (occupancy
wise)
4. Height of each building,
tower or block etc from
ground level
5. Total number (including
all underground,
basement, stilt,
mezzanine and ground)
of floors in each
building, tower or blocks
etc
6. Total built up area of all
floors (including all
underground,
basement, stilt,
mezzanine and ground)
of each building or
tower or block etc.
7. Total built up area of all
floors (including all
underground,
basement, stilt,
mezzanine and ground)
of all buildings, towers,
blocks etc.
8. No. of underground or
basement floors
(indicate the level below
the ground of each
floor).
9. Area of each
underground or
basement floor
10. Occupancy (usage)
(mention separately for
each underground,
basement, stilt,
mezzanine, ground and
other floors).
11. Details of parking areas
(mention separately
underground, roof-top,
covered and open
parking areas)
12. Width and height of all
boundary gates
provided for entry and
exit.
13. Open spaces and drive
ways around each of the
buildings or blocks or
towers etc within the
premises.
Notes:-
1.If there is no
interconnection at every
floor level between any
two buildings or blocks or
towers, then each of those
buildings or blocks or
towers are deemed to be
separate buildings for the
purpose of open spaces &
drive ways.
2. The requirement of
open spaces or setbacks
for various classes of
buildings, premises and
occupancies shall be as
prescribed in the
respective regulations or
bye-laws of the building
plan approval authority
concerned.

Front
Rear
Left
Right
14. Has drive way been
provided around each
building or tower or
block? If so, indicate its
width, turning radius
and load bearing
capacity.
15. If underground or
basement extends
beyond the plinth line in
to the drive way, please
indicate whether the
roof of basement has
the capacity to bear
minimum forty-five ton
load of fire service
vehicles/appliances.
16. No. of Exits and their
width
17. How many staircases
have been provided in
the building? Please
indicate in each case.
a) Width of stairway
b) Width of treads
c) Height of riser
18. Has “Fire tower” been
provided in all buildings
or towers or blocks?
a) Fire rating of the
walls of fire tower.
b) Fire rating of Exit
doors at each floor of
fire tower.
19. Average peak occupant
load per floor in all
buildings or towers or
blocks.
20. Number and details of
all lifts? Please indicate
in respect of each lift:
a) Floors between which
the lift runs.
b) Type of doors fitted
to the lift car and each
landing.
c) Fire resistance rating
of lift car landing doors.
d)Floor area of the lift
car
e) Load capacity of the
lift car.
f) Type of
communication system
installed in the lift car.
g) Has “Fireman” switch
been installed in the lift
for grounding it in the
event of fire?
21. If more than one lift is
installed adjacent to
each other, whether or
not adjacent lifts
wells/ducts are
separated by fire
resistant walls?
22. Have lift wells/ducts, lift
lobby and stair wells
been pressurized?
23. Have lift lobby and stair
cases been effectively
enclosed to prevent
fire/smoke entering
them from outside at
any floor including
basement(s)?
24. Have all the “Exits” and
“Way to Exits” been
signposted with self-
illuminated sign ages?
25. No. of Wet Riser(s) and
Dry Riser(s) and
internal diameter of
each riser.
26. No. and details of Down
Comer(s)
27. No. of single and twin
outlet internal hydrants
in each floor including
basement(s).
28. No. and details of first-
aid hose reels in each
floor including
basement(s).
b) Bore and length of
hose reel tubing on
each reel drum.
c) Size (Bore) and type
of nozzle fitted to each
hose reel.
d) Is the hose reel
connected directly to
the riser or to the
hydrant outlet?
29. Has fire hose been
provided near each
hydrant in hose box? If
so, please indicate:
a)The type of hose
b)The size of (bore) of
hose.
c)The length of each
hose
d) Total no of hoses
provided to each
hydrant.
30. Have branch pipes been
provided? If so, please
indicate:
a)The type of branch
pipe
b) Size of nozzle of each
branch
31. Are all buildings, towers
or blocks equipped with
automatic fire detection
and alarm system? If
so, please indicate:
a) No. and type of
detectors (smoke or
heat) installed.
b) Whether detectors
provided both above
and below the false
ceiling.
32. Have manual fire alarm
systems been installed
in all floors including
basement(s) of all
buildings, towers or
blocks? If so, give
details.
33. Has public address
system been installed in
all floors including
basement(s) of all
buildings, towers or
blocks?
34. No. and details of yard
hydrants?
35. Details of automatic
sprinkler system
installed both above and
below the false ceiling in
all floors including
basement(s) of all
buildings, towers or
blocks.
36. Have stationary fire
pumps been installed? If
so, please indicate:
a) The number of
pumps
b) Sizes of suction
diameter (mm) and
delivery diameter (mm)
of each pump.
c) The output of each
pump in LPM
d) The maximum head
against which the pump
can operate at the
output mentioned at (c)
above.
e) Is the pump
automatic in action?
37. Capacity and size of the
underground static tank
if any, exclusively for
firefighting purpose and
provisions for
replenishing the same.
38. Capacity and size of the
terrace tank and it’s
connectivity to the wet
riser/down comer/hose
reel.
39. Number and type of fire
extinguishers (bearing
ISI certification)
provided at various
locations in each floor
including basement(s)
building/tower/ block-
wise.
40. Details of stand-by
source of power
provided? If so, please
indicate:
a)The capacity (output)
b)The functions that can
be maintained
simultaneously such as
operating lifts, fire
pumps, emergency
lighting etc.
c) Is the standby source
automatic in action or
has to be started
manually?
41. Details of fire control
room and its location.
42. Is the building centrally
air conditioned? If so,
please indicate.
a) The material used for
construction of ducts
and its fittings.
b) The type of lining
used for ducts
c) Type of legging used,
if any for insulating any
portion of ducts and
indicate how the legging
is secured.
d) Fire resistance rating
of false ceiling material.
e) If plenum is used as
returned air passage,
has it been protected
with fire detectors?
Please give details.
f) Has a separate air
handling unit (AHU)
been provided for each
floor?
g) Is the AHU having
auto shut off system in
case of actuation of
detector?
h) Have fire dampers
been provided inside
ducts? If so indicate the
no. and type of
dampers.
i) Is the ducting for
each floor effectively
isolated or is it
continuous for more
than one floor?
43. Basement ventilation
details:
a) Whether natural
ventilation is relied
 upon? If so, give details
of vents with area for
the stairwell, lift shafts.
b) Whether mechanical
ventilation has been
provided? If so, give
details of the system
indicating the number of
air changes for the
basement and other
floors.
c) Whether mechanical
ventilation is coupled
with automatic
detection system? Give
details of the system.
44. Location of the switch
gear and transformers?
If inside the building,
please indicate.
a) Are the switchgears
and transformers
housed in separate
compartments
effectively? If so, are
they separated from
each other and from
portion of the building
by four hrs fire resistive
wall?
b) What precautions
have been taken to
prevent a possible fire
in transformers from
spreading?
45. Where electric cables,
telephone cables,
dry/wet risers/down
comers pass through a
floor or wall, have the
spaces (apertures)
round the cables/pipes
been effectively sealed/
plugged with non
combustible, fire
resistive materials?
46. Are the occupants of the
building periodically
trained in use and
operation of fire safety
measures and
emergency procedure?
If so, give periodicity
and details of training.
If not, why?
47. Whether, emergency
drills/rehearsals
conducted regularly? If
so, how often and
whether local Fire
 Station is involved? If
not, why?
48. Has a qualified fire
safety supervisor been
appointed for the
premises? If so, his full
details. If not, why?
49. Has the building been
protected against
lightning? If so, indicate
its details including its
periodical testing. If
not, why?
50. Any other information.

Signature of Inspecting
Officer