FIRE SAFETY ASSESSMENT

PARTICIPANT REGISTRATION DETAILS

ALL QUESTIONS WITH AN ASTERISK MUST BE ANSWERED BEFORE THE FORM CAN BE SUBMITTED

Course Name: FIRE SAFETY
(Confine small workplace emergencies)
Code: CFS/FS/EL
First Name*
Last Name*
Date of Birth
Employer*
Division/Area/Location:*
Email Address*
Please ensure the section below is completed.
I authorise the release of my training results to my employer.*
- Yes
- No
(Please consult with your Course Assessor)
Participant signature:
Please upload your scan copy of sign
Commencement Date:*
Completion Date:*
FIRE SAFETY & EQUIPMENT ASSESSMENT
Q1. List 3 methods of fire prevention.*
Method 1* Method 2* Method 3*
Q2. If an extinguisher has the following pictographs on it what type of fire can it be used on?*
Pictograph 1.
Pictograph 2
Pictograph 3
Q3. What type of fires can the following 5 pieces of equipment be used on?*
Dry Chemical Powder Extinguisher* Carbon Dioxide Extinguisher* Wet Chemical Extinguisher* Water Extinguisher/Hose Reel* Fire Blanket*
Q4. What are the colours of the following 5 pieces of equipment?*
Dry Chemical Powder Extinguisher* Carbon Dioxide Extinguisher* Wet Chemical Extinguisher* Water Extinguisher/Hose Reel* Fire Blanket*
Q5. There are 3 faults with this extinguisher, What are they?*

Fault 1 Fault 2 Fault 3
Q6. What do these 3 faults indicate?*
Q7. Fire Extinguisher Safety. What do the letters P-A-S-S mean?*
P A S S.
Q8. What are the 3 elements a fire must have? (Fire Triangle)*
Element 1 Element 2 Element 3
Q9. You need to be SAFE in the event of fire, What does S-A-F-E mean?*
S A F E

FIRE SAFETY ASSESSMENT

PARTICIPANT REGISTRATION DETAILS

Please ensure the section below is completed.

FIRE SAFETY & EQUIPMENT ASSESSMENT

Compliance & Training

Stephen Shaw

Equipment Sales & Service

Scott Shaw

CONTACT CFS