Fire Safety Strategy and Accessibility Statement Form

Site / Building Name

Site Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Respondent Name

First NameMiddle NameLast Name

Job Title / Role

Organization / Company Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Building Use / Type

Occupancy Type

Number of Floors / Storeys

Estimated Maximum Occupancy

Fire Alarm System Present?

Alarm Type / Description

Means of Escape / Evacuation Strategy

Firefighting Equipment Available

Emergency Lighting Present?

Assembly Point Location

Additional Fire Safety Measures / Notes

Entrance accessibility

Step-free access available

Lift or elevator available

Accessible toilet available

Accessible parking available

Hearing assistance provisions

Visual assistance provisions

Accessible route description

Support for wheelchair users

Other accessibility arrangements, limitations, or planned improvements

Declaration of Accuracy

Date of Completion

Date

Name of Person Completing the Form

First NameLast Name

Supporting Documents