Reference Document - Bushfire attack level assessment repor (As Published)t · MCU25/0022

                          BUSHFIRE RISK SELF-ASSESSMENT CHECKLIST
                   This basic self-assessment checklist is designed to give you a greater understanding of the bushfire risk
                   level relevant to your property. Information provided in this assessment will assist you when completing
                   your Bushfire Survival Plan.


        Address:

        									                                                                              Postcode:

        Property Owner/Property Name:


        ACCESS/EGRESS                              Road/Street/Driveway PLEASE √ APPROPRIATE BOX

        Clear of overhanging vegetation 		                                Yes                 No

        Unrestricted gate access 		                                       Yes                 No

        Clear of overhead power lines 		                                  Yes                 No

        Able to reverse in 		                                             Yes                 No

        Turning/passing areas 		                                          Yes                 No

        Heavy vehicle access on cattle grid/bridge                        Yes                 No

        Alternative way out 		                                            Yes                 No

        Two wheel drive access 		                                         Yes                 No

        STRUCTURE/S
        Exterior walls – non-combustible 		                               Yes                 No

        Roof ridge capping sealed 		                                      Yes                 No

        Eaves enclosed 		                                                 Yes                 No

        Roofing gutters and valleys clear of leaf litter and fine fuels   Yes                 No

        Underfloor enclosed		                                             Yes                 No

        Vents screened 		                                                 Yes                 No

        Windows – non-combustible finishing 		                            Yes                 No

        Deck/veranda non-combustible 		                                   Yes                 No


        WATER SUPPLY
        Reticulated water supply		                                        Yes                 No

        Tank supply with QFRS access – 50mm male camlock fitting          Yes		No
        so fire figthers can use water if needed

        QFRS accessible external open water supply (dam/pool) 		          Yes                 No

        Firefighting pump and hose connected to water supply 		           Yes                 No


Document Set ID: 24478325
                 23591412
 16 1, Version Date: 19/01/2026
Version:               28/02/2025