Fire risk assessment failures
Systemic failures in fire safety, including inadequate risk assessments and unaddressed actions, posing risks to residents.
129 items
1 source
7 inquiries
Strongest theme matches
Mixed across source types and ranked by classifier confidence plus text match strength.
Inquiry recommendation
82match
50 - Approach to fire and explosion protection
The regulations and related guidance notes should promote an approach to fire and explosion protection:- (i) which is integrated as between - — active and passive fire protection — different forms of passive fire protection, such as fire insulation and platform layout, and — fire protection and explosion protection (paras 19.87-95); (ii) in which the need for, and...
Matched on
terms: assessment, fire
Inquiry recommendation
70match
51 - Fire water deluge survivability
The ability of the fire water deluge system, including the fire pump system, to survive severe accident conditions should be a feature of the Safety Case (para 19.100).
Matched on
terms: fire
Inquiry recommendation
70match
P2-10 - Require fire safety strategy from registered fire engineer at Gateway 2
We therefore recommend that it be made a statutory requirement that a fire safety strategy produced by a registered fire engineer (see below) to be submitted with building control applications (at Gateway 2) for the construction or refurbishment of any higher-risk building and for it to be reviewed and re-submitted at the stage of completion (Gateway 3). Such...
Matched on
terms: fire
Inquiry recommendation
70match
P1-5 - Require building floor plans for fire services
The owner and manager of every high-rise residential building be required by law to provide their local fire and rescue services with up-to-date plans in both paper and electronic form of every floor of the building identifying the location of key fire safety systems.
Matched on
terms: fire
Inquiry recommendation
66match
POPP-A.16 - Fire authorities must inspect stadia and restrict stands with inadequate fire precautions.
Fire authorities should identify and visit all sports stadia in their areas and should prohibit or restrict the use of any stands which, in their view, constitute a risk to spectators because of the inadequacy of the fire precautions.
Matched on
terms: fire
Inquiry recommendation
66match
P1-38 - Require quarterly fire door checks
The owner and manager of every residential building containing separate dwellings (whether or not they are high-rise buildings) be required by law to carry out checks at not less than three-monthly intervals to ensure that all fire doors are fitted with effective self-closing devices in working order.
Matched on
terms: fire
Inquiry recommendation
66match
P1-37 - Urgent fire door inspections required
The owner and manager of every residential building containing separate dwellings (whether or not they are high-rise buildings) carry out an urgent inspection of all fire doors to ensure that they comply with applicable legislative standards.
Matched on
terms: fire
Inquiry recommendation
66match
P1-8 - Require monthly firefighter lift inspections
The owner and manager of every high-rise residential building be required by law to carry out regular inspections of any lifts that are designed to be used by firefighters in an emergency and to report the results of such inspections to their local fire and rescue service at monthly intervals.
Matched on
terms: fire
Inquiry recommendation
64match
4 - Contents of the Safety Case
In furtherance of the objectives set out in para 2 above, the operator should be required to set out the following in the Safety Case:- (i) A demonstration that so far as is reasonably practicable hazards arising from the inventory of hydrocarbons (a) on the installation, and (b) in risers and pipelines connected to the installation both in...
Matched on
terms: assessment, fire
Inquiry recommendation
62match
60 - Immediate assessment of smoke ingress
The regulatory body should ask operators which have not already done so to carry out forthwith an assessment of the risk of ingress of smoke or gas into the accommodation; and to fit smoke and gas detectors and implement ventilation shutdown arrangements as in recommendation 57, without waiting for legislation (para 19.173).
Matched on
terms: assessment
Inquiry recommendation
62match
54 - Immediate fire risk analysis by operators
The regulatory body should ask operators which have not already done so to undertake forthwith a fire risk analysis, without waiting for legislation (para 19.103).
Matched on
terms: fire
Inquiry recommendation
62match
52 - Hydrocarbon fire test interpretation
The regulatory body should work with the industry to obtain agreement on the interpretation for design purposes of its interim hydrocarbon fire test and other similar tests. If in the view of the regulatory body there exists a need for an improved test, such as a heat flux test, it should work with the industry in order to...
Matched on
terms: fire
Inquiry recommendation
62match
49 - Fire risk analysis requirement
Operators should be required by regulation to submit a fire risk analysis to the regulatory body for its acceptance (para 19.90).
Matched on
terms: fire
Inquiry recommendation
62match
FENN-121 - Install comprehensive fire and smoke detection with automatic extinguishing in stations.
Comprehensive fire and smoke detection equipment, providing for remote monitoring and automatic operation of extinguishing devices, shall be fitted in underground stations as appropriate.
Matched on
terms: fire
Inquiry recommendation
62match
FENN-41 - Cease oil and spirit treatment of timber risers; replace missing fire cleats
The treatment of timber risers and step boards with oil and spirit must cease. Missing fire cleats must be replaced.
Matched on
terms: fire
Inquiry recommendation
62match
P2-26 - Establish mandatory fire risk assessor accreditation
We therefore recommend that the government establish a system of mandatory accreditation to certify the competence of fire risk assessors by setting standards for qualification and continuing professional development and such other measures as may be considered necessary or desirable. We think it necessary for an accreditation system to be mandatory in order to ensure the competence of...
Matched on
terms: fire
Inquiry recommendation
61match
FENN-136 - Fire authority and RI to scrutinise new station designs for passenger safety.
The designs for new stations or significant alterations to stations shall be scrutinised by the fire authority and the Railway Inspectorate with special regard to passenger safety and fire precautions.
Matched on
terms: fire
Inquiry recommendation
61match
FENN-123 - Consult LFB and RI on fire safety for future station refurbishments.
London Undergound shall consult the London Fire Brigade and Railway Inspectorate about the means of escape and fire precaution measures in all future station refurbishment schemes.
Matched on
terms: fire
Inquiry recommendation
61match
FENN-86 - Review station staff fire and safety training based on consultant advice
Fire and safety training for station staff shall be reviewed in the light of the advice from consultants.
Matched on
terms: fire
Inquiry recommendation
61match
FENN-85 - Provide fire safety training for cleaning and engineering staff on stations
Fire safety training for cleaning and engineering staff working on stations shall be provided. London Underground must obtain expert advice.
Matched on
terms: fire
Inquiry recommendation
61match
FENN-83 - Provide biannual fire and safety training for non-supervisory and shop staff
Every six months fire and safety training must be provided for non-supervisory staff and booking clerks. Staff must be given site familiarisation training before they are permitted to take part in the running of the station. Specific provision shall be made for the instruction of staff in shops and other premises in Underground stations.
Matched on
terms: fire
Inquiry recommendation
61match
FENN-81 - Establish continuing fire and safety instruction for station staff by supervisors
London Underground shall establish a programme of continuing instruction at work by supervisors for station staff in fire and safety with the assistance of the London Fire Brigade and British Transport Police. At stations equipped with water fog equipment supervisors must be given practical training during the regular testing of the equipment.
Matched on
terms: fire
Inquiry recommendation
61match
FENN-49 - Check station ventilation and issue fire action instructions for contaminated air
Station ventilation systems must be checked to ensure that contaminated air cannot be introduced into the rooms they serve. Instructions must be issued on any action to be taken in the event of a fire.
Matched on
terms: fire
Inquiry recommendation
57match
FENN-127 - Re-examine Code of Practice regarding fire-loadings in escalator shafts and stations.
London Underground shall re-examine its Code of Practice as it relates to the fire-loadings in escalator shafts and other regions of stations.
Matched on
terms: fire
Inquiry recommendation
57match
FENN-122 - Initiate research into paint fire qualities for London Underground Code of Practice.
London Underground shall initiate a programme of research into the fire qualities of paint. The surface to which it is applied and the method of application must be considered. The result of this research must be incorporated in the Code of Practice.
Matched on
terms: fire
Inquiry recommendation
57match
FENN-45 - Regularly examine fire equipment, report defects, and ensure immediate remedy
London Underground shall regularly examine fire equipment and ensure that defects are reported and remedied at once or alternative arrangements made.
Matched on
terms: fire
Inquiry recommendation
57match
FENN-42 - Research escalator shaft fire dynamics using models and computer simulation
Further research shall be undertaken into the dynamics of fires in escalator shafts by London Underground using the available scale models and computer simulation.
Matched on
terms: fire
Inquiry recommendation
57match
FENN-16 - Research air movement and provide criteria for safe train operation during fire
London Underground shall undertake further research into the effect of trains on air movement in the Underground. London Underground should provide criteria by which line controllers, who have received a report of fire, can judge whether it is safe to continue to run trains.
Matched on
terms: fire
Inquiry recommendation
57match
FENN-15 - Modify London Underground fire equipment to London Fire Brigade standards
London Underground fire equipment shall be modified to London Fire Brigade standards and the amount and type of fire equipment in stations agreed.
Matched on
terms: fire
Inquiry recommendation
57match
P1-9 - Require monthly lift control mechanism tests
The owner and manager of every high-rise residential building be required by law to carry out regular tests of the mechanism which allows firefighters to take control of the lifts and to inform their local fire and rescue service at monthly intervals that they have done so.
Matched on
terms: fire
Inquiry recommendation
57match
P1-6 - Require premises information boxes
The owner and manager of every high-rise residential building be required by law to ensure that the building contains a premises information box, the contents of which must include a copy of the up-to-date floor plans and information about the nature of any lift intended for use by the fire and rescue services.
Matched on
terms: fire
Inquiry recommendation
53match
61 - Studies on breathable air in the TSR
Studies should be carried out with the objective of assisting designers in predicting the breathability of air in a TSR where its external fire wall is subjected to a severe hydrocarbon fire (para 19.163).
Matched on
terms: fire
Inquiry recommendation
53match
56 - Protection of accommodation
The regulations and the related guidance notes should promote an approach to protection of the accommodation:- (i) in which external fire protection is provided both to prevent breach of the accommodation and to maintain breathable air within it (para 19.170); and (ii) in which an integrated set of active and passive measures is provided to prevent ingress of...
Matched on
terms: fire
Inquiry recommendation
53match
46 - Studies on riser protection and SSIVs
Studies should be carried out with the following objectives:- (i) To achieve effective passive fire protection of risers without aggravating corrosion (para 19.22). (ii) To improve the reliability and reduce the cost of SSIVs so that it is more often reasonably practicable to install them (para 19.37).
Matched on
terms: fire
Inquiry recommendation
48match
70 - Availability standards for protective systems
Where a regulation imposes a requirement for a major emergency or protective system, such as a fire deluge system, it should be required that the operator should set acceptance standards for its availability (para 19.199).
Matched on
terms: fire
Inquiry recommendation
48match
45 - Studies on inventory and pipeline connections
Studies should be carried out with the following objectives:- (i) To explore the feasibility of dumping in an emergency large oil inventories, such as those in the separators, in a safe and environmentally acceptable manner, so as to minimise the inventory of fuel available to feed a fire (para 19.19). (ii) To minimise the pipeline connections to platforms...
Matched on
terms: fire
Inquiry recommendation
48match
FENN-74 - Prohibit unprotected storage of combustible items at all Underground stations
Combustible items such as paper and card shall not be stored at stations unless properly protected from the risk of fire. This recommendation and the Code of Practice shall apply to all occupiers of premises on the Underground.
Matched on
terms: fire
Inquiry recommendation
48match
FENN-53 - Implement regular cleaning of machine rooms and shafts with safe material storage
All machine rooms and shafts must be specially cleaned by the end of I988 and regularly cleaned thereafter. Essential cleaning materials shall be kept only in small quantities and in correctly marked containers in fire-proof bins.
Matched on
terms: fire
Inquiry recommendation
48match
FENN-21 - LFB to attend construction meetings, register risks, relocate affected equipment
The London Fire Brigade shall attend all pre-start meetings and important later meetings in relation to construction works on the Underground. Details of the works shall be included on the Fire Brigade's central risks register. Fire equipment and London Fire Brigade plan boxes affected must be relocated before work starts.
Matched on
terms: fire
Inquiry recommendation
48match
FENN-20 - Produce and maintain up-to-date station plans in LFB-agreed locations
In agreement with the London Fire Brigade, London Underground shall produce and maintain up-to-date station plans, and place them in boxes it has provided, at locations agreed or specified by the London Fire Brigade.
Matched on
terms: fire
Inquiry recommendation
45match
P1-39 - Require compliant flat entrance doors where unsafe cladding exists
All those who have responsibility in whatever capacity for the condition of the entrance doors to individual flats in high-rise residential buildings, whose external walls incorporate unsafe cladding, be required by law to ensure that such doors comply with current standards.
Matched on
classifier match
Inquiry recommendation
41match
57 - Ventilation intakes and detectors
For the purpose of maintaining breathable air within the accommodation, it should be required by regulation that the ventilation air intakes should be provided with smoke and gas detectors and that on smoke or gas alarm the ventilation and dampers should shut down (para 19.172).
Matched on
classifier match
Inquiry recommendation
41match
FENN-36 - Urgently replace wooden escalator risers due to 'trench effect' discovery
Replacement of the wooden risers must be urgently sought in view of the discovery of the 'trench effect' and the conclusions of the report referred to in Appendix G as Report 4n.
Matched on
classifier match
Inquiry recommendation
40match
5 - Design accidental events and acceptance standards
For the purposes of the demonstration referred to in para (iii) of recommendation 4, the accidental events are to be identified by the operator. A design accidental event is an event which will not cause the loss of any of the following:- — the integrity of the TSR, — the passability of at least one escape route from...
Matched on
classifier match
Inquiry recommendation
36match
FENN-69 - Survey system materials, evaluate risks, and remove hazardous materials programme
London Underground shall survey materials present on the system, evaluate the risks involved from those materials and devise a programme to remove those which constitute a hazard.
Matched on
classifier match
Inquiry recommendation
36match
FENN-52 - Survey VIR cables, improve machine rooms, and waterproof electrical equipment for cleaning
A survey must be carried out of all remaining VIR cable installations and a renewal programme established. The electrical wiring, lighting, decoration, and general state of machine rooms and shafts must be improved. The waterproofing of electrical equipment to permit mechanical cleaning must then be undertaken.
Matched on
classifier match
Inquiry recommendation
36match
FENN-40 - Require station supervisors to inspect escalators and machine rooms every two hours
Station supervisors must personally inspect escalators, and both upper and lower machine rooms, every two hours until wooden parts have been removed.
Matched on
classifier match
Inquiry recommendation
36match
FENN-39 - Implement regular escalator cleaning, improving access and protective clothing for staff
Escalators shall be manually cleaned at least every six months until the rewiring of machine rooms is completed. Thereafter they shall be mechanically cleaned in accordance with the programme determined under Recommendation 38. Escalator steps must be removed as necessary, and the means of access and protective clothing improved for those doing the work.
Matched on
classifier match
Inquiry recommendation
36match
FENN-35 - Replace wooden escalator skirting, balustrade, decking, and panels with metal
The wooden skirting boards and balustrade, decking and advertisement panels of all escalators must be replaced with metal by July 1989.
Matched on
classifier match
Inquiry recommendation
36match
FENN-1 - Install heat and smoke detectors on escalator trusses and machine rooms
All escalator trusses shall be fitted with linear heat detectors and machine rooms with smoke detectors. Priority should be given to escalators with wooden components and consideration given to moving the water fog valves to a protected location outside the machine room. The eventual aim should be for the detection equipment to activate an alarm system, automatic sprinklers...
Matched on
classifier match