*Your Name:

Company Name:

Address Line 1:

Address Line 2:

Address Line 3:

Postcode:

Telephone:

*Email:

Survey Address 1:

Survey Address 2:

Survey Address 3:

Survey Postcode:

Nunmber of Staff:

Floors:

1 2 3 4 5 6 7 8 9 10 10+

Total Size/Area (sq ft):

0-1000 1001-2000 2001-3000 3001-4000 4001-5000 5001-6000 6001-7000 7001-8000 8001-9000 9001-10000 10001-15000 15001-20000 20001-30000 30001-40000 40001-50000 50000+

Number of Rooms:

Usage:

shop office industrial leisure residential doctors surgery mixed other

if other please describe:

is the building owned or leased?

unsure owned leased

Do you share the building with other tenants?

yes no

What is your existing fire assessment status?

This will be our first assessment We need an updated assessment

(*Required)