FIRE INCIDENT INVESTIGATION REPORT (To be submitted to the HSEQ Corporate Office within 7 days of incident.) 1. Project Information: Project Name: Click here to enter text. Report No.: Click here to enter text. Date of Incident: Click here to enter text. Time of Incident: Click here to enter text. 2. Location of Fire: ☐ Basement ☐ Room ☐ Corridor ☐ Common Area ☐ Offices ☐ Stores ☐ External Area ☐ Workers Rest Area ☐ Podium ☐ Others (Specify): 3. List works or persons in the vicinity of Fire: 4. Area Ownership/ Under: ☐ Cname ☐ MEP ☐ Sub-Contractor 5. Class of Fire Reported: ☐ Class 1: Destructive Fire- Civil Defense extinguished ☐ Class 2: Dangerous Incident , fire and smoke- Civil Defense called ☐ Class 3: Potentially Dangerous incident - Extinguished by Project Team ☐ Class 4: Minor incident , smoldering, smoke or small fire in bin / external are , extinguished immediately 6. Fuel Sources: ☐ Cardboard Boxes ☐ Piles of Waste ☐ Combustible Fuels ☐ Office Documents ☐ Stored Materials (Paint, Chemicals etc.) ☐ Carpets, Furniture and Fittings ☐ Timber ☐ Hessian ☐ Gas Bottles/Cylinders ☐ Others (Specify): 7. Fire Enhancing Factors: (List contributing or subsequent events or fuels which increased the size or duration of the fire) 8. Root Causes: ☐ Damaged Cables ☐ Wires with no Plugs ☐ Overloaded Multiple Sockets ☐ Old Un-Serviced Air conditioners ☐ Overheated Halogen Lamps ☐ Wooden DBs ☐ Non Fire-Rated Buildings ☐ Smoking ☐ Arson ☐ Others (Specify): 9. Building Fire Level: ☐ Level 5: If permanent FLS including smoke and fire detectors , alarms and sprinklers from permanent power and water supplies not operational when at Fire Safety Level 4 ☐ Level 4: Buildings being fitted out with carpets, curtains and furniture, painting on-going ☐ Level 3: Ceiling being closed, Joinery Works on-going, MEP and T&C ongoing ☐ Level 2: MEP installation and Building works commenced ☐ Level 1: Structural Concrete works only 10. Describe the Fire Incident in detail: Answer who, what, why, where, when & how in this section: (Attach additional pages if required) 11. Describe how Fire was extinguished: 12. Describe Fire Incident Root Causes: Describe direct, indirect & root cause: (Attach additional pages if required) 13. Key Corrective Actions taken to Prevent Recurrence of Fires: Describe the corrective actions with timeframe: (Attach additional pages if required) 14. Key Corrections taken Immediately after the Fire: Attach additional pages if more space is required: 15. Witnesses: I declare that I witnessed the fire incident and the information provided above is true, correct and complete. No. Name Designation Signature Date 1. Click here to enter text. Click here to enter text. Click here to enter text. 2. Click here to enter text. Click here to

1. Page 1 of 4 Form # HSEQ-FIIR (Rev 0 – Mar 23)
FIRE INCIDENT INVESTIGATION REPORT
(To be submitted to the HSEQ Corporate Office within 7 days of incident.)
1. Project Information:
Project Name: Click here to enter text. Report No.: Click here to enter text.
Date of Incident: Click here to enter text. Time of Incident: Click here to enter text.
2. Location of Fire:
☐ Basement
☐ Room
☐ Corridor
☐ Common Area
☐ Offices
☐ Stores
☐ External Area
☐ Workers Rest Area
☐ Podium
☐ Others (Specify):
3. List works or persons in the vicinity of Fire:
4. Area Ownership/ Under:
☐ Cname ☐ MEP ☐ Sub-Contractor
5. Class of Fire Reported:
☐ Class 1: Destructive Fire- Civil Defense extinguished
☐ Class 2: Dangerous Incident , fire and smoke- Civil Defense called
☐ Class 3: Potentially Dangerous incident - Extinguished by Project Team
☐ Class 4: Minor incident , smoldering, smoke or small fire in bin / external are , extinguished immediately
6. Fuel Sources:
☐ Cardboard Boxes
☐ Piles of Waste
☐ Combustible Fuels
☐ Office Documents
☐ Stored Materials (Paint, Chemicals etc.)
☐ Carpets, Furniture and Fittings
☐ Timber
☐ Hessian
☐ Gas Bottles/Cylinders
☐ Others (Specify):
7. Fire Enhancing Factors:
(List contributing or subsequent events or fuels which increased the size or duration of the fire)
8. Root Causes:
☐ Damaged Cables
☐ Wires with no Plugs
☐ Overloaded Multiple Sockets
☐ Old Un-Serviced Air conditioners
☐ Overheated Halogen Lamps
☐ Wooden DBs
☐ Non Fire-Rated Buildings
☐ Smoking
☐ Arson
☐ Others (Specify):

2. Page 2 of 4 Form # HSEQ-FIIR (Rev 0 – Mar 23)
9. Building Fire Level:
☐ Level 5: If permanent FLS including smoke and fire detectors , alarms and sprinklers from permanent
power and water supplies not operational when at Fire Safety Level 4
☐ Level 4: Buildings being fitted out with carpets, curtains and furniture, painting on-going
☐ Level 3: Ceiling being closed, Joinery Works on-going, MEP and T&C ongoing
☐ Level 2: MEP installation and Building works commenced
☐ Level 1: Structural Concrete works only
10. Describe the Fire Incident in detail:
Answer who, what, why, where, when & how in this section: (Attach additional pages if required)
11. Describe how Fire was extinguished:
12. Describe Fire Incident Root Causes:
Describe direct, indirect & root cause: (Attach additional pages if required)
13. Key Corrective Actions taken to Prevent Recurrence of Fires:
Describe the corrective actions with timeframe: (Attach additional pages if required)
14. Key Corrections taken Immediately after the Fire:
Attach additional pages if more space is required:

3. Page 3 of 4 Form # HSEQ-FIIR (Rev 0 – Mar 23)
15. Witnesses:
I declare that I witnessed the fire incident and the information provided above is true, correct and complete.
No. Name Designation Signature Date
1. Click here to enter text. Click here to enter text.
Click here to
enter text.
2. Click here to enter text. Click here to enter text.
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enter text.
Applicable Reports: ☐ Police ☐ Civil Defense ☐ Other (Specify)
Click here to enter text.
Attached: ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No
16. Injured Person’s Personal Details (If any):
In case of an incident with more than one injured person, complete the information for each person using
separate forms.
Name: Click here to enter text. Occupation: Click here to enter text.
Company: Click here to enter text. MB / Oracle No.: Click here to enter text.
Nationality: Click here to enter text. Date of Birth: Click here to enter text.
Passport Number: Click here to enter text. Length of Service: Click here to enter text.
Gender: ☐ Male ☐ Female Labour Card No.: Click here to enter text.
17. Incident Cost: (Appropriate/Best Estimate)
No. Item / Area Amount (AED)
1. ☐ Cost of Property Damage due to fire
2. ☐ Injury Cost due to fire (Treatment, Hospital, Transport, Insurance, etc.)
3. ☐
Legal Cost (Compensation claims, judicial prosecutions, etc. – Federal Law
No. 8)
4. ☐
Productivity Cost (Business disruptions, Delays, Production loss/day,
Material, Salaries, etc.)
5. ☐
Asset Cost (Property, machinery, equipment, structure, material, vehicle,
etc. - Repair & Maintenance)
6. ☐
Asset Cost (Property, machinery, equipment, structure, material, vehicle,
etc. - Replacement)
7. ☐ Enforcement Action (Penalty Issued by Authority)
8. ☐ Fire Area restoration Cost
9. ☐ Other cost relevant to / associated with the Fire
10. Total Cost
18. Declaration by Investigation Team:
I declare that all information provided in this document is true, correct and complete.
No. Name Designation Signature Date
1. Click here to enter text. Click here to enter text.
Click here to
enter text.
2. Click here to enter text. Click here to enter text.
Click here to
enter text.
3. Click here to enter text. Click here to enter text.
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enter text.
4. Click here to enter text. Click here to enter text.
Click here to
enter text.

4. Page 4 of 4 Form # HSEQ-FIIR (Rev 0 – Mar 23)
19. Attachments:
☐ Maps / Drawings
☐ Relevant Records (e.g. Training, Risk Assessment)
☐ Written witnesses statements
☐ Others (Specify)
Click here to enter text.
Report Prepared by: Reviewed by PD/PM (Manager In Charge):
Name : Click here to enter text. Name : Click here to enter text.
Designation: Click here to enter text. Designation: Click here to enter text.
Date: Click here to enter text. Date: Click here to enter text.
☐ Acknowledge that this fire incident has been/will be reported to relevant authorities
(if applicable).
☐ Acknowledge that copy of this report will be sent to Admin Dept.
☐ Acknowledge that copy of this report will be sent to Insurance Dept.
☐ For Abu Dhabi projects, copy of this report will be sent to GLA Manager
Signature: Signature:
Corporate Office Remarks:
NOTE: In case of changes in the status/severity of the fire, the Corporate HSEQ Office shall be notified.