Fire Safety Certificate Template - Free Download
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Fire Safety Certificate Template
Fire Safety Certificate Template
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Final / Interim Fire Safety Certificate
Environmental Planning & Assessment Regulation 2000 Part 8, Division 3
Certificate No.
Type of Certificate
Type of Certificate issued
Interim Final
Details of Certificate
Name of Owner/Agent
certify that:
(a) each of the essential fire measures listed below:
has been assessed by a person (chosen by me) who was properly
qualified to do so; and
was found, when it was assessed to have been properly implemented
and to be capable of performing to a standard not less than that required
by the most recent fire safety schedule (copy attached) for the building
for which the certificate is issued.
(b) the information contained in this certificate is, to the best of my knowledge
and belief, true and accurate.
Identification of the Building
Side of street
Nearest cross street
House/Unit number
Description of the building
(whole or part)
Date of Assessment
Date of assessment
Essential Fire Safety Measures
Fire Safety Measure
Access panels, doors & hoppers to fire
resisting shafts
AS 1530.42005
Automatic fail safe devices
Automatic fire detection & alarm systems
AS 1670.1 2004
AS 4428.1 1998
Automatic fire suppression systems
AS 2118.1 1999
Emergency lifts
AS 1735.2 2001
Emergency lighting
AS/NZS 2293.1 2005
Emergency warning and intercommunication
AS 1670.4 2004
AS 4428.4 – 2004
Exit signs
AS/NZS 2293.1 2005
Fire alarm monitoring
AS 1670.3 2004
Fire control centres and rooms
Fire dampers
AS 1668.1 1998
Fire doors
AS 1735.11 1986
AS/NZS 1905.1 2005
Fire hose reel systems
AS 2441 2005
Fire hydrant systems
AS 2419.1 2005
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