UNWANTED FIRE SIGNAL REPORT FORM (False Alarms)

(NB: Do not use to report any fire)

Date: ...... Time: …………Incident Duration: ….…mins.

Location Details:

Building: ………………………………Type: …………………………..

………………………………

Ward/Department: …………………………Room: …………………………

______

Device Actuated(tick box):

Manual Call Point / Smoke Detector / Heat Detector
Combined Detector / Other (specify):

Cause of Unwanted Fire Signal (tick box):

Fault - Detector / Fault - Other / Unknown
Cooking Fumes / Steam / Smoking
Insects / Aerosol Spray / Other Environmental
Staff Member Actions / Contractor Actions / Action by Patient, Student, Visitor, Public
Good Intent / Malicious / Other:

______

Fire Response Team Attended? (Yes/No)…..……Number? …….

Fire & Rescue Service Attended? (Yes/No) ……….

If NO, name and position of person authorising non-attendance:

…………………………………………………………………………….…………..

Description of Event/Further Information: …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Name (please print): …………………………………… Position: …………….

Signature: ……………………………………………….Date: …………………...

Send form to: Senior Fire Advisor, Estates Dept., VictoriaHospital, Kirkcaldy

Unwanted Fire Signal Report Form – Guidance Notes

Location Details:

Complete as much information as available. For the field labelled “Type”, insert main use of affected building (or area of larger building). Examples include;

Hospital, Clinic, Kitchen, Laundry, Student Accommodation, DayHospital, Energy Centre

Device Actuated:

Identify which type of device in the fire alarm system actuated the alarm, if possible. If unable to see the device, information should be available from the fire alarm panel screen. Attach any printout from the panel to this form before submitting (not available from some panels).

Cause / Definition / Examples
Fault – Detector / System responded to identifiable fault in detector head / Nothing in area of detector that could cause a signal, but panel indicates fire.
Fault – Other / System responded to identifiable fault elsewhere in system / Visible damage to wiring.
Unsuitable detector position.
Panel shows multiple addresses, no cause in area.
Unknown / Cause of signal cannot be reliably identified / Unable to determine cause after reasonable investigation
Cooking Fumes / System responded to smoke or fumes from cooking / Use of toasters and small cooking equipment.
Steam / System responded to steam or condensation in immediate area / Use of kettles in staff rooms.
Leaks from heating system.
Smoking / System responded to tobacco smoke or e-cigarette vapour / Illicit smoking in toilets etc.
Insects / System actuated by small insects or larvae entering detector / Evidence of insect activity around detector, no other cause apparent.
Aerosol Spray / System responded to particles from aerosol spray entering detector / Strong smell of air freshener or body spray in vicinity.
Witness states aerosol used.
Other Environmental / System responded to other environmental phenomena not included above / Very high temperature in area, no fire.
Condensation on cold day.
Staff Member Actions / Signal caused by action of member of staff / Accidental breakage of manual call point.
Accidental damage to detector.
Contractor Actions / Signal caused by actions of contractor staff on site / Dust entering detector.
Accidental damage to detector.
Hot works without isolation
Actions by Patient, Student, Visitor, Public / Signal caused by actions of person who is not a member of NHS Fife staff or contractor staff, no malicious intent / Accidental breakage of manual call point.
Operating manual call point instead of door control*
Good Intent* / System actuated by person in belief there is a fire, no fire exists / Operation of manual call point after mistaking signs of fire
Malicious* / System actuated by person who is aware there is no fire / Deliberate operation of manual call point to cause disruption
Other / Cause does not fit any definition above / Testing system without prior notification
Evacuating area for other reasons

* Selecting between these causes may depend on whether motive can be established, and can be affected by medical or mental condition of the person.

UNWANTED FIRE SIGNAL REPORT FORM 2014