FIRE SAFETY CERTIFICATE
Issued in accordance with the Environmental Planning and Assessment Regulation 2000, Clause 170 and
173
The owner of a building, or the owner’s agent, needs to provide a fire safety certificate to the certifying authority (a
council or a private certifier) with an application for an occupation certificate. You can use this form to do so. A copy of
the certificate also needs to be given to the Commissioner of New South Wales Fire Brigades, and displayed in the
building in a prominent position. To complete this form, please place a cross in the boxes
and fill out the white
sections as appropriate.
1.
Details of the building being certified
Name of the owner of the building or part of the building
First name
Family name
Address of the building
Flat/street no.
Street name
Suburb or town
Postcode
Nearest cross street
This certificate is for:
part of the building
the whole of the building.
Description of the building or part of the building
2. Assessment of fire safety measures
List of each essential fire safety measure specified in the Fire Safety Schedule for the building.
Measure
Standard of performance required by the fire
safety schedule
Fire resisting structures & exits
BCA Sections C and D
Lightweight construction
BCA Clause C1.8, BCA Specification C1.8
Fire Hazard Properties
BCA Clause C1.10, BCA Specification C1.10 & C1.10a
Perimeter vehicle access for
emergency vehicles
BCA Clause C2.4
Fire rated (or non-combustible)
access panels, doors & hoppers
to fire-resisting shafts
BCA C3.13
Measure
Standard of performance required by the fire
safety schedule
Date of
assessment
Date of
assessment
Fire seals protecting openings in
fire-resisting components of the
building (including fire collars &
fire stopping/mastic)
BCA Clause C3.15, BCA Specification C3.15, AS1530.42005
Fire-rated doors
BCA Part C3, BCA Specification C3.4 (Clause 2), AS
1905.1 -2005
Fire-rated lift landing doors
BCA Part Clause C3.10, AS 1735.11 - 1986
Smoke doors
BCA Specification C3.4 (Clause 3)
Smoke walls
Public Corridors over 40m
BCA C2.14, BCA Spec C2.5
Rising and Descending Stairs
BCA D2.4 BCA Spec C2.5
Health and Age Care Buildings
BCA Clause C2.5, BCA Spec 2.5
Smoke walls
BCA Specification C3.4 (Clause 3)
Solid core doors
BCA Clause C3.4, BCA Specification C3.4, AS1905.12005
Fire windows
BCA Clause C3.4, BCA Specification C3.4 (Clause 5)
Fire shutters
BCA Part C3, BCA Specification C3.4 (Clause 4),
AS1905.2-2005
Exit doors & paths of travel to
exits
BCA Clause 186 EP&A Regulation 2000
Automatic fail-safe devices (ie, to
unlock/open required exit doors)
BCA Clause D2.21 AS 4085-1992 D2.22 (Re-entry from fire
Warning & operational signs
Fire and smoke door signage BCA Clause D2.23
BCA Section D
stairs)
Access to lift pits BCA Clause D1.17
Offences relating to fire stairs
Clause 183 of EP&A Regulation 2000
Fire extinguishers (portable)
BCA Clause E1.6, AS2444 - 2001
Fire control centres & rooms
BCA Clause E1.8, BCA Specification E1.8
Emergency lifts
BCA Clause E3.4, AS1735.2 – 2001
Warning systems associated
with lifts (including signs)
BCA Part E3
Air conditioning & mechanical
ventilation/air handling systems
BCA Clause E2.2, BCA Table E2.2a, BCA NSW Table
E2.2b, AS 1668.1-1998
Automatic Shutdown of AirHandling Systems
BCA NSW Table E2.2b, BCA Specification E2.2a (Clause
5), AS1668.1-1998
Stairwell pressurisation systems
BCA E2.2a, AS 1668.1 - 1998
Zone Smoke Control System
BCA Clause E2.2, BCA Table E2.2a, AS1668.1-1998
Fire/Smoke dampers
BCA Clause C3.15, AS/NZS 1668.1-1998 and AS1682
part 1 and 2 1990
Smoke Exhaust Systems (including
BCA Clause E2.2, BCA NSW Table E2.2b, BCA
Specification E2.2b
system monitoring/brigade connection)
Measure
Standard of performance required by the fire
safety schedule
Smoke and Heat Vents (including
BCA Clause E2.2, BCA NSW Table E2.2b, BCA
Specification E2.2c, AS 2665 -2001
system monitoring/brigade connection)
Date of
assessment
AED A: Suite 3.04, 55 Miller Street, Pyrmont NSW 2009
W: www.aedconsulting.com.au ABN: 15 149 587 495
Page 2 of 5
Automatic fire/smoke/heat
detectors and alarm-systems
General Detection BCA Clause E2.2 (Clauses 3,4,6,7)
BCA table E2.2a, BCA Specification E2.2a,AS1670.12004, AS1668.1-1998, AS3789-1993
Specific Detection for certain Class 6 & 9b Buildings BCA
Clause E2.2, BCA NSW Table E2.2b, AS1670.1-2004, AS
1668.1-1998
Brigade Connection (system
monitoring) System Monitoring is
required for
Smoke Exhaust
BCA Clause E2.2b, BCA Specification E2.2b, AS1670.32004
Smoke & Heat Vents
BCA Clause E2.2b, BCA Specification E2.2c, AS1670.32004
Sprinklers
BCA clause E1.5, BCA Specification E1.5, AS2118.11999, AS1670.3-2004
Smoke Detection in certain Class 3, aged and health care
buildings under Clause 7 of Spec E2.2a)
BCA clause E2.2a, BCA Specification E2.2a (Clause 7)
AS1670.3-2004
Emergency warning and
intercommunication systems
BCA Clause E4.9, AS 1670.4-2004, AS4428.4-2004
Emergency lighting & exit signs
BCA Part E4, AS 2293.1-2005
Fire Hydrants and Mains
BCA Clause E1.3, AS 2419.1 - 2005
Automatic fire suppression
systems (Sprinklers)(Including
BCA Clause E1.5, BCA Specification E1.5, AS2118.11999
brigade connection)
Wall-wetting sprinkler and
drencher systems
BCA Clause C3.4, AS 2118.2 - 1995
Fire hose reel systems
BCA Clause E1.4, AS 2441- 2005
Static Water Storage (Hydrants
&/or Sprinklers)
Automatic Fire Sprinkler
Systems
Wall-wetting sprinkler & drencher
systems (glazed walls)
Smoke Control Systems
Fire Detection& Alarm Systems
Sound Systems & Intercom
Systems
Emergency Power Supply
(Standby Power Systems)
Stair Pressurisation
Alternative Solutions, Fire Safety
Upgrade Reports or Fire Brigade
advice
Hydrants BCA E1.3 AS2419.1-2005
Sprinklers BCA Clause E1.5, BCA Specification E1.5
(Clause 7) AS2118.1-1999
BCA Clause E1.5, BCA Clause G3.8, BCA Specification
G3.8 (Clause 2), AS2118.1-1999
BCA Clause G3.8, BCA Specification G3.8 (Clause 2),
AS2118.2-1995
BCA Clause E2.2a, BCA Table E2.2a, BCA Clause G3,
BCA Specification G3 (Clause 3)
BCA Clause E2.2a, BCA G3.8, BCA Specification G3.8
(Clause 4), AS1670.1-2004
BCA Clause G3.8, BCA Specification G3.8 (Clause 5),
AS1670.4-2004
BCA Clause G3.8, BCA Specification G3.8 (Clause 6)
BCA Clause G3.8, BCA Specification G3.8 (Clause 7),
BCA Clause E2.2, BCA Table E2.2a, AS1668.1-1998
XXXXXXXX
If you need more space, please attach additional pages.
AED A: Suite 3.04, 55 Miller Street, Pyrmont NSW 2009
W: www.aedconsulting.com.au ABN: 15 149 587 495
Page 3 of 5
3.
Type of certificate
This is:
 an interim fire safety certificate
 a final fire safety certificate
Date of this certificate
4.
Certification
I
of
being the owner of the building described above, or the agent of the owner, certify that:


each of the essential fire safety measures listed above:
has been assessed by a properly qualified person, and
was found, when it was assessed by that person, to be capable of performing to
at least the standard required by the current fire safety schedule for the building;
the information contained in this statement is true and accurate to the best of my knowledge and belief.
5.
Information attached to this certificate
The current fire safety schedule for the building
6.
Signature
The owner of the building, or the agent’s owner, must complete and sign the certificate.
Signature
Name
Address
The capacity in which you are signing if you are not the owner of the building
*
*
A copy of this certificate together with the relevant fire safety schedule must be forwarded to the Council and the
Commissioner of the New South Wales Fire Brigades.
A copy of this certificate together with the relevant fire safety schedule must be prominently displayed in the
building.
AED A: Suite 3.04, 55 Miller Street, Pyrmont NSW 2009
W: www.aedconsulting.com.au ABN: 15 149 587 495
Page 4 of 5
Notes for completing Final/Interim Fire Safety Certificate
Note 1:
An interim fire safety certificate or a final fire safety certificate is required before:

an interim occupation certificate can be issued to allow a partially completed new building (including an
altered portion of, or an extension to, a new building) to be occupied or used, or

an interim occupation certificate can be issued to allow a change of building use for part of an existing
building.
A final fire safety certificate is required:

before a final occupation certificate can be issued to allow a new building (including an altered portion
of, or extension to, a new building) to be occupied or used, or

before a final occupation certificate can be issued to allow a change of building use for an existing
building, or

in accordance with a fire safety order given by a Council.
An interim fire safety certificate is issued for part of the building and may deal only with those essential fire
safety measures appearing on the most recent fire safety schedule (see note 3) relevant to the part of the
building for which an interim occupation certificate will be sought.
A final fire safety certificate must deal with all essential fire safety measures appearing on the most recent
fire safety schedule (see note 3), subject to the following.
An interim fire safety certificate or a final fire safety certificate need not deal with those essential fire safety
measures which have been the subject of some other final fire safety certificate or annual fire safety
statement within the previous 6 months, unless the person or authority responsible for determining the
relevant development consent, complying development certificate, construction certificate or fire safety
order, has specified otherwise in the schedule.
(also see note 3)
Note 2:
The person who carried out the assessment:

must inspect and verify the performance of each fire safety measure being assessed, and

in the case of a (interim or final) fire safety certificate for a new building (not an alteration to, or
enlargement or extension of an existing building) must test the operation of each item of fire safety
equipment installed in the building.
Note 3:
The relevant essential fire safety measures are those specified in the most recent fire safety schedule,
attached to one of the following:

development consent for a change of building use.

complying development certificate for the erection of a building or a change of building use,

construction certificate for proposed building work, including building work associated with a change of
building use, or

a fire safety order.
The fire safety schedule will also identify the required standard of performance for each essential fire safety
measure.
AED A: Suite 3.04, 55 Miller Street, Pyrmont NSW 2009
W: www.aedconsulting.com.au ABN: 15 149 587 495
Page 5 of 5