PRELIMINARY ONSITE FIRE ASSESSMENT FORM ASP6.

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TO FACTORY OWNER: Thank you for cooperating with this Phase 1 fire safety assessment of your facility, which is conducted at the request of the named Brand Member. This limited, visual point-in-time assessment will identify and confirm general fire
safety conditions and concerns. It has been conducted in accordance with Assessment Protocols issued as per policy.
Factory Name, Factory Building Number, and Address:

Factory Owner Representative:

BUILDINGS ASSESSED Number in Complex Number Assessed Building Names/Remarks

Name of Assessor Firm:

Main Factory Buildings

Name of Lead Assessor:

Ancillary Buildings

Other Structures

To Factory Owner: Thank you for cooperating with this Phase 1 structural assessment of your facility, which is conducted at the request of the Brand Member. This limited, visual, point-in-time assessment will identify and confirm
general structural condition.
Describe any additional documents received during factory visit:
FIRE SAFETY ITEMS OF CONCERN NOTED
TABLE 1: BUILDING INFORMATION
Height of Additional
Building Floor Area (Floor- Occupancy Type of Slab Thickness Building the Surrounding Building Information (Occupancy Construction Immediate Information
SL Name Designation wise) Type (Floor- Constcution (Floor-wise) Height highest type) with Proximity Distance as per BNBC History Action Required Required Person Responsible
wise) occupied Table 3.2.2
level (describe)

GF A H mm " " Occupancy withing " " ft 2009

1 Building-1 1 B E Type 1, RCC mm p' q' " " Occupancy withing " " ft

2 C G2 mm " " Occupancy withing " " ft

TABLE 2: MEANS OF EGRESS

Number of
SL Building Floor Existing Number of Exit Stair Location Individual Exit Width Individual Exit Stair width
Name Designation Occupants Exit Stair
(Floor-wise)

GF x
3 s1 NE s2 NW s3 SE a b c aa bb cc
1 Building-1 1 y
3 s1 NE s2 NW s3 SE d e f dd ee ff
2 z
2 s1 NE s3 SE l NA n ll NA nn
All assessment-day recommendations are subject to supplement or change. A Factory Fire Corrective Action Plan (FCAP), if required, will be issued at a later date.
Immediate Action items must be implemented within seven days of date, unless noted otherwise.
Additional Comments by Assessor or Exceptions Taken by Factory Owner Representative:
ACKNOWLEDGED
Factory Representative (Printed Names): Fire Assessment Team Leader

Signature Signature
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