Professor Niamh Nic Da's expert presentation on fire science, explaining the origin and cause investigation methodology for the Flat 16 fire at Grenfell Tower.
00:00:00 take matters up from here thank you sir before I start there's a housekeeping announcement there is no plan for alarm today if the fire alarm sounds trained fire wardens on the second floor will
00:00:11 fire wardens on the second floor will direct everyone to evacuate there are two fire exits within this room on the right-hand side facing the Chairman Hoban bar staff and inquiry team who ensure that everyone is evacuated at
00:00:23 ensure that everyone is evacuated at first before they evacuate the building and finally could I ask everyone to turn their mobiles off or to silent and during the course of the hearings I'm certain - today we have a presentation
00:00:36 certain - today we have a presentation from Professor Nev McDade which will cover three essential topics first of all the basic science of fire secondly the elements of fire investigation and finally a summary of Professor McDade
00:00:49 finally a summary of Professor McDade preliminary views on the floors Norwich --an of the initial fire within flat 16 again before I call a professor McDade I should repeat yesterday's warning
00:01:00 should repeat yesterday's warning regarding the content and of presentation it contains not only photographs of flat 16 by the burnt-out compartment but also video images which
00:01:11 compartment but also video images which show the early development of the fire as well as thermal images of the fire fighting within flat 16 itself also they will be playing of mr. Kirby these 999
00:01:23 will be playing of mr. Kirby these 999 calls during the course of the presentation the images and audio may therefore be distressing and with us a man now called professor McDade yes thank you
00:01:45 I do solemnly sincerely and truly declare and affirm thank you thank you
00:02:01 declare and affirm thank you thank you would you prefer to stand or sit I'll purchase stamps thank you first of all what is your name my name is Nia flick date and you are professor of forensic science in the University of Dundee that's correct you are director of the
00:02:12 that's correct you are director of the Leverhulme Research Centre for forensic science that's correct you're a charted chemist yes I am you're the Immediate Past Chair of the European network of forensic science Institute's
00:02:23 network of forensic science Institute's working group on fire and explosion investigation that's correct and you're the Deputy Chair of the scientific advisory board of the International Criminal Court yes I am you're also a
00:02:34 Criminal Court yes I am you're also a fellow of the Royal Society of Edinburgh correct the Royal Society of Chemistry the Institute of chemistry of Ireland yes you're a fellow of the Royal statistical Society and finally your
00:02:46 statistical Society and finally your fellow of the chartered society of forensic science that's correct and it's right that you provided the inquiry with a preliminary report dated March of this year yes I did and you've provided the
00:02:57 year yes I did and you've provided the report in the same way as you would provide a report as if you're in court yes I did and as to the factual matters set out and report they're true to the best of your knowledge and belief they are and finally does your report
00:03:10 are and finally does your report accurately set out your opinion on that as relevant to the inquiry yes it does mr. McDade with that I invite you now to give your presentation thank you thank you and good morning by way of an
00:03:22 you and good morning by way of an initial introduction I have been tasked specifically to address matters relating to the determination of where within Grenville tower on the 14th of June 2017
00:03:35 Grenville tower on the 14th of June 2017 the fire started and how the fire started within this location this is known as an origin and cause determination within the fire
00:03:47 determination within the fire investigation process and it is one of the primary objectives of the examination of a fire scene by fire investigators as an expert witness for the grand full
00:03:59 as an expert witness for the grand full tower public inquiry it is my responsibility to provide to the best of my ability my impartial honest and unbiased opinion based on known and
00:04:12 unbiased opinion based on known and verifiable information relating to the events which occurred in the early hours of the 14th of June 2017 my presentation
00:04:24 of the 14th of June 2017 my presentation will be in four parts firstly I will provide a brief introduction about my terms of reference then some information
00:04:35 terms of reference then some information about how I went about fulfilling these terms of reference as my part of the phase one of the public inquiry secondly I will provide an overview of what is
00:04:48 I will provide an overview of what is fire how a fire starts and how a fire develops inside in a room my reason for providing this information is to try to
00:04:59 providing this information is to try to ensure that everyone can understand what is needed in terms of both the physical evidence and the information obtained from witnesses in order to provide a
00:05:12 from witnesses in order to provide a reliable determination of the area of origin that is the place where a fire started and also to understand the sequence of events that have that have
00:05:23 sequence of events that have that have to be demonstrated scientifically in order to have confidence in the determination of the cause of a fire
00:05:32 next I will provide an introduction to fire scene investigation and to how that process is undertaken this will help in understanding the purpose of a fire
00:05:44 understanding the purpose of a fire investigation the actions of the fire investigators and the potential limitations of their conclusions I will explain how a fire investigation is
00:05:55 explain how a fire investigation is usually undertaken and what fire investigators will do in practice and how they reach their conclusions
00:06:04 finally I'll provide my preliminary interpretation of the available evidence relating to the origin and the cause of the fire that occurred in Granville tower on the 14th of June 2017 this is
00:06:19 tower on the 14th of June 2017 this is based on the information presented in the materials that I have received in my role as an expert witness for the grand full tower of public inquiry experts
00:06:30 full tower of public inquiry experts will often use words that are full of jargon and while these may be understood by other experts they may leave non experts and members of the general public feeling that they do not
00:06:41 public feeling that they do not understand what is being said to them I am going to use as little jargon as possible and I will try and explain the concepts clearly and in straightforward
00:06:52 concepts clearly and in straightforward language so that everybody can follow what I'm saying
00:06:58 during the final part of my presentation I will be speaking about the early stages of the fire in Granville Tower which occurred on the 14th of June 2017 I will play part of the initial 999 call
00:07:11 I will play part of the initial 999 call made by mr. Coe Baden and I will be showing pictures of the fire and its aftermath
00:07:17 aftermath within flat 60 I will also be showing some of the thermal-imaging video footage taken by the first firefighters who entered flat 16 as well as some
00:07:29 who entered flat 16 as well as some videos of the incident from the outside of the building during these early stages of the fires development these will be shown on a spit screen side by side so that the activities of the
00:07:41 side so that the activities of the firefighters are put into context with the development of the fire I will provide a warning to the two prior to playing the audio of the 999 Corps and
00:07:52 playing the audio of the 999 Corps and also to showing the photographs under the video
00:07:59 I was instructed as an expert witness to the Grand Vitara public inquiry on the 6th of November 2017 as an expert witness in this context it is my
00:08:11 witness in this context it is my responsibility to provide an opinion relating to the questions asked of me within my terms of reference and to do so impartially and objectively based
00:08:22 so impartially and objectively based upon the information made available to me by the public inquiry team in this role I have an obligation under duty to provide assistance to the public inquiry
00:08:33 provide assistance to the public inquiry in relation to issues which have been asked of me and which are specifically within my areas of expertise my terms of reference cover two specific questions
00:08:47 reference cover two specific questions firstly I was asked to review where in Grenville tower the fire started and what the cause of the fire was within that area of origin secondly I was asked
00:09:02 that area of origin secondly I was asked to review how the fire spread through the compartment of origin and through the flat of origin at the time of preparation of this presentation and of
00:09:14 preparation of this presentation and of my phase 1 provisional report the police investigations relating to the fire at Grenville tower are still ongoing as such the conclusions I express at this
00:09:27 such the conclusions I express at this stage can only be the provisional and I will update my report as new information is made available to me where the
00:09:38 is made available to me where the evidence that has been made available to me has allowed then my opinions have been made on the balance of probabilities that is where something is more likely than not to have happened if
00:09:51 more likely than not to have happened if I cannot reach a reliable conclusion based on the information provided to me at the point of preparation of my phase 1 provisional report then I have made this care within the report
00:10:05 I undertook two visits to Granville tower as part of my work these visits were facilitated by the Metropolitan Police Service to whom I am very
00:10:16 Police Service to whom I am very grateful the first visit was on the 9th of October 2017 on this occasion I visited Granville Tower with some of the
00:10:27 visited Granville Tower with some of the other experts to the public inquiry and some of the public inquiry legal team I went into many of the flats within Grenville tower and I gained a strong
00:10:39 Grenville tower and I gained a strong perspective of the building and of the level of damage and destruction within the flats on different floors of the building I went from the ground floor of
00:10:50 building I went from the ground floor of the building to the top floor of the building and out onto the rooftop of the tower during this visit I had an opportunity to visit flat 16 specifically and spend some time in the
00:11:03 specifically and spend some time in the remains of that flat my second visit to Granville Tower was on the 9th of November 2017 on this occasion I spent
00:11:14 November 2017 on this occasion I spent time in each of the flats on the fourth floor of Granville Tower and in particular within the remains of flat 16
00:11:24 at the time of both of these visits much of the furnishings and the debris remaining after the fire within flat 16 had either been removed or had been
00:11:35 had either been removed or had been placed in bags awaiting removal all of the electrical appliances and some of the electrical wiring had also been removed by this time as a consequence
00:11:50 removed by this time as a consequence little of the items visible in the photographs that I have used in my phase 1 provisional report were present in flat 16 at the time of my two visits to
00:12:01 flat 16 at the time of my two visits to the property as a consequence of this the photographs and the notes made by the fire investigators who undertook the initial scene investigation became my
00:12:14 initial scene investigation became my primary source of information these initial investigation investigators were members of the London Fire Brigade investigation team who were
00:12:25 Fire Brigade investigation team who were the first team on site they were subsequently joined by fire investigators from bureau veritas which is a company which supplies scientific
00:12:36 is a company which supplies scientific support to London Fire Brigade and they were also accompanied by fire investigators from key Forensic Services Limited which is a private company which
00:12:48 Limited which is a private company which supplies forensic science services to police forces and to other clients I was provided with fire investigation reports notes and photographs prepared by the
00:13:01 notes and photographs prepared by the bureau veritas and key Forensic Services fire investigators I was also provided with witness statements from the occupants of flat 16 and from London
00:13:13 occupants of flat 16 and from London Fire Brigade personnel I also viewed videos provided by members of the public and by the London Fire Brigade
00:13:23 undertaking a review of a fire investigation is not an ideal circumstance in such a circumstance the methodology followed by the initial
00:13:36 methodology followed by the initial investigation team becomes very important as does the quality and the completeness of the information recorded specifically through notes photographs
00:13:48 specifically through notes photographs and witness statements of what the investigators saw and what actions they took such records and information are
00:13:59 took such records and information are needed so that all relevant evidence was identified was correctly recorded in its original position was correctly
00:14:10 original position was correctly recovered and is accounted for in the examiner's notes of their observations and their actions
00:14:19 the actions of the fire investigators their observations and how they undertook their investigation are recorded in their investigator notes these are called contemporaneous notes
00:14:32 these are called contemporaneous notes which means that they were made at the time of or shortly after the time that the activities occurred they are often handwritten notes as well
00:14:43 they are often handwritten notes as well as photographs and sometimes video materials in this second part of my presentation I will provide some
00:14:54 presentation I will provide some background information about what a fire is about how things burn and what needs to be in place in order for that burning to occur this will include the steps
00:15:08 to occur this will include the steps needed so that a fire can start and how once started a fire develops within a contained space such as a room in a flat
00:15:20 understanding how fires start and how they develop is underpinned by robust chemical physical and engineering principles and there is much
00:15:31 principles and there is much peer-reviewed scientific literature and ended engineering literature textbooks and other materials that are devoted to this topic this provides an accepted
00:15:43 this topic this provides an accepted rigor and confidence in the understanding of the conditions that are required for materials to ignite and for any resultant fire to develop and to
00:15:54 any resultant fire to develop and to spread such processes are well accepted and considered reliable across the experts in the field and are described generally as fire dynamics
00:16:09 my explanation of these processes will be very general so as to simply provide an overview some of my fellow experts may explain some of the concepts that I
00:16:20 may explain some of the concepts that I introduced to you in greater depth and detail during their evidence when a fire occurs there will often be physical
00:16:32 occurs there will often be physical materials remaining after the event and I will explain some of the common types of fire damage that can occur and what hypotheses can be inferred from the
00:16:44 hypotheses can be inferred from the damaged by the fire investigators
00:16:53 in order for solid or liquid materials to burn they must first be turned into a gas and this process requires the material to be heated materials contain
00:17:08 material to be heated materials contain atoms which are linked or bonded together to other atoms to make molecules and all combine together to make up the material itself the most
00:17:20 make up the material itself the most common materials are called hydrocarbons and they contain atoms of carbon and of hydrogen as well as a variety of other elements depending on the material itself I have represented this in this
00:17:34 itself I have represented this in this diagram the white circles and red circles represent the atoms and the black lines represent the bonds between the atoms when hydrocarbons are heated
00:17:49 the atoms when hydrocarbons are heated energy is transferred to the material and this energy causes the bonds are the links between the atoms to break or to decompose this decomposition process is
00:18:03 decompose this decomposition process is called pyrolysis and it requires a source of heat in order to occur materials will then change chemically when they are heated in a process that
00:18:16 when they are heated in a process that is called thermal decomposition the methey materials can also change physically for example a liquid is turned into a gas or a solid is turned
00:18:28 turned into a gas or a solid is turned into a gas leaving behind a solid residue and ash
00:18:36 the pyrolysis process is complicated and the composition of the gases coming from the materials and the mixtures can as a result also be a complex and sometimes
00:18:48 result also be a complex and sometimes toxic mixture this mixture will depend on the heat of material and what it was made of and also the temperature to which it was heated the pyrolysis
00:19:02 which it was heated the pyrolysis process is fundamentally related to the temperature that the materials are exposed to and to the amount of heat energy required for the pyrolysis to occur which is different for different
00:19:14 occur which is different for different materials for example plastics tend to paralyze at higher temperatures than materials such as wood pyrolysis and the
00:19:27 materials such as wood pyrolysis and the generation of pyrolysis products is the first step in the combustion or the burning process when the gas is produced
00:19:38 burning process when the gas is produced as a consequence of the pyrolysis process are mixed with oxygen which I have represented in blue in the diagram this oxygen comes from the air when this
00:19:50 this oxygen comes from the air when this mixture is in the right percentages then combustion can occur combustion is a chemical reaction which generates heat which is represented by the downward
00:20:02 which is represented by the downward yellow arrows in my diagram combustion also generates light and it generates combustion products there are different
00:20:13 combustion products there are different types of combustion which include smoldering combustion where a flame is not visible and flaming combustion where flames are visible pyrolysis and
00:20:26 flames are visible pyrolysis and combustion typically also produce smoke which is formed by small airborne particles of soot of ash and of liquid and these products move away from the
00:20:40 and these products move away from the material that is burning and that produces them as they cool down they can settle onto vertical and her on ttle surfaces as black deposits
00:20:57 flaming combustion which is what we recognize as a fire has a number of essential requirements firstly there
00:21:08 essential requirements firstly there must be a localized heating of a combustible material where a combustible material otherwise known as a fuel is one that can ignite and can burn
00:21:21 secondly this localized heat must have enough energy so that the fuel undergoes pyrolysis and generates gases thirdly
00:21:36 pyrolysis and generates gases thirdly oxygen must be present in the environment of the gases such that it mixes with the gas in some cases the gases from the fuel and oxygen air and
00:21:47 gases from the fuel and oxygen air and oxygen are pre-mixed but more often the oxygen moves into the gaseous fuel in a process which is called entrainment not
00:21:58 process which is called entrainment not all gaseous fuel and air mixtures can sustain a flame and those which can are called flammable mixtures fourthly some
00:22:10 called flammable mixtures fourthly some means of ignition needs to be present in the environment of this fuel-air mixture which has enough energy to ignite the mixture and finally the fuel and oxygen
00:22:23 mixture and finally the fuel and oxygen interact in a self-sustaining heat producing chain reaction which facilitates further pyrolysis of nearby combustible materials and so prolongs
00:22:34 combustible materials and so prolongs burning
00:22:38 these requirements are often referred to as the fire triangle or fire Dimond all three elements of the fire triangle that is heat oxygen and fuel must be present
00:22:53 is heat oxygen and fuel must be present for the fire to be sustained and if any of these elements are removed then the fire will simply extinguish fires can
00:23:04 fire will simply extinguish fires can switch between smoldering and flaming combustion and in many circumstances flaming fires will follow an initial period of smoldering combustion and a
00:23:15 period of smoldering combustion and a smoldering combustion phase will occur towards the end point of a fire ignition is the start of a sustained burning
00:23:26 is the start of a sustained burning event there are two types of ignition piloted ignition where an external ignition source such as an independent flame is used and auto ignition where
00:23:42 flame is used and auto ignition where the fuel air mixture is raised to sufficient temperature that it will ignite of its own accord
00:23:54 small flames such as those associated with candle are called laminar flames where a high temperature zone usually exists generally around 800 to 1400
00:24:08 exists generally around 800 to 1400 degrees centigrade and it exists around the flame and can be maintained this allows for the almost complete combustion of the small particles of
00:24:21 combustion of the small particles of carbon or soot generated as byproducts of the pyrolysis process and this almost complete combustion produces the color that has seen in the candle flame and it
00:24:33 that has seen in the candle flame and it is why candles do not produce very much smoke as the flame begins to become larger or more disrupted the soot
00:24:45 larger or more disrupted the soot particles begin to escape unburned from the high temperature zone around the flame and form a large part of the smoke that scene during flaming combustion
00:24:57 these larger and more ragged flames are known as turbulent flames with an average temperature of approximately a thousand degrees centigrade to
00:25:11 thousand degrees centigrade to understand how an initial material on fire
00:25:13 fire leads to the development of a fire in for example a room we need to think of how the heat generated by the initial fire begins to affect the materials that
00:25:24 fire begins to affect the materials that are nearby and the development of fires relies upon the movement of movement or transfer of heat from one material to another this will be determined by the
00:25:38 another this will be determined by the ability of the material once it is on fire to release heat energy and this ability is called a heat release rate
00:25:49 the rate at which heat energy can be transferred to a material is called the heat flux more formally the heat release rate is defined as the amount of heat
00:26:01 rate is defined as the amount of heat energy that is released by a material per unit time which is usually a second when that material is on fire and the
00:26:12 when that material is on fire and the heat flux is the rate at which heat energy can be delivered to a material per unit area per unit time
00:26:27 the transfer of the heat energy released from a material when it burns on to nearby materials can occur in a number of ways
00:26:38 understanding the methods of heat transfer are very important so that the way in which a fire can move between nearby materials can be explained heat
00:26:51 nearby materials can be explained heat transfer explains how a fire can move from one item to the next and how a fire grows and develops within for example a compartment there are three heat
00:27:03 compartment there are three heat transfer mechanisms firstly conduction is the transfer of heat energy between adjacent chemical molecules and electrons within a material an example
00:27:17 electrons within a material an example would be holding the handle of a pot that is heating on a stove the handle you're holding becomes hot and that is because heat is being conducted through the metal of the pot secondly convection
00:27:32 the metal of the pot secondly convection convection is the transfer of heat through the movement of heated liquid or gas so an example of this would be the water in the pot rooting up and thirdly
00:27:45 water in the pot rooting up and thirdly radiation radiation is the transfer of heat in the form of electromagnetic radiation and an example would be the heat that you feel coming from the hot
00:27:56 heat that you feel coming from the hot plate that the pot is resting upon heat can also be transferred directly through a flame interacting with a surface and this is called direct flame impingement
00:28:11 this is called direct flame impingement this is where a flame comes into direct contact with a new fuel source and provides both the heat source for pyrolysis to occur and the ignition
00:28:22 pyrolysis to occur and the ignition source for those pyrolysis products once they mix with oxygen to ignite
00:28:32 the sequence required for a material to burn follows a very defined pathway firstly there needs to be localized heat
00:28:44 firstly there needs to be localized heat focused for long enough in an area where the there there are materials that can combust so as to generate the pyrolysis products secondly the generated gases
00:29:01 products secondly the generated gases needs to mix with oxygen in the air and an ignition source is required so that the ignition can occur and the material then burns this generates more heat pi
00:29:14 then burns this generates more heat pi realizing further fuel so that the combustion reaction becomes self-sustaining as a fire burns it
00:29:25 self-sustaining as a fire burns it creates a rising column of gases which are called a fire plume hot gases are buoyant which means that they rise upwards into the air the fire plume can
00:29:38 upwards into the air the fire plume can generally rise quickly and it can rise to considerable heights above the flame this is why if you hold your hand some distance above a candle a candle flame
00:29:49 distance above a candle a candle flame you can still feel the heat from the candle what you feel or the buoyant hot gases of the candle flame
00:30:00 cooler air will circulate into the flame and replace the hot gases and this is a process that's called air entrainment
00:30:10 when the hot gases produced by a fire meet a horizontal surface such as a ceiling these gases can spread out along that surface in what are called ceiling
00:30:22 that surface in what are called ceiling Jets the resultant ceiling Jets act themselves as a source of further heat they radiate heat back into the room and
00:30:33 they radiate heat back into the room and this heat will now begin to affect nearby materials by transferring heat energy into those materials causing pyrolysis and the thermal decomposition process to occur as the pyrolysis gases
00:30:49 process to occur as the pyrolysis gases begin to emerge mixing with air to form a flammable gas mixture they are readily ignited by nearby flames and the fire begins to grow and begins to develop
00:31:02 begins to grow and begins to develop within a compartment this process occurs in the same way a localized heat source will produce pyrolysis combustible
00:31:14 will produce pyrolysis combustible materials these will release gases which mix with air and are ignited this creates a fire plume of buoyant gases
00:31:26 creates a fire plume of buoyant gases which rises to the ceiling and spreads out along the horizontal surface
00:31:33 err will in train into the buoyant gases
00:31:39 from this point fire development within a compartment if left unchecked will follow also a well defined series of stages once flaming combustion has been
00:31:52 stages once flaming combustion has been established in the early stages of a fire the sequence of events for each item of fuel within a compartment to begin to burn are essentially the same
00:32:06 begin to burn are essentially the same once combustion of the first fuel item begins the fire plume increases in height and begins to have an effect on combustible materials nearby through the
00:32:17 combustible materials nearby through the different heat transfer mechanisms the buoyant hot gases in the fire plume begin to spread out at ceiling level creating a level ey're of hot gas and
00:32:29 creating a level ey're of hot gas and smoke in the room which radiates heat back into the entire room as this layer spreads out horizontally and begins to descend vertically this causes other
00:32:44 descend vertically this causes other combustible materials to thermally decompose to produce pyrolysis products to mix with available oxygen and to ignite direct flame impingement may also
00:32:56 ignite direct flame impingement may also occur
00:33:01 the hot gas layer in the room begins to get bigger as more materials become involved in the fire and start to burn the main heat transfer mechanism in the
00:33:14 the main heat transfer mechanism in the room becomes radiant heat from the gas layer this radiated heat energy will begin to be transferred to all of the combustible materials within the
00:33:25 combustible materials within the compartment raising the temperature of these materials so that pyrolysis will begin the boundary between the hot gas layer and the lower portion of cooler
00:33:38 layer and the lower portion of cooler air in the room is known as the neutral plane and it can change and descend as the fire progresses and creates more hot gases and smoke if flames reach up into
00:33:52 gases and smoke if flames reach up into the hot gas layer then the temperature of the gas layer can increase and so the amount of heat energy transferred into the room via radiated heat will also
00:34:04 the room via radiated heat will also increase and there may come a point where all of the exposed combustible material surfaces within the compartment will begin to produce enough gaseous
00:34:15 will begin to produce enough gaseous products such that they will ignite and becomed involved in the fire this event is called flashover and flashover can be
00:34:28 is called flashover and flashover can be thought of as the point in a fire where a room becomes fully involved and we're all combustible materials within that
00:34:39 all combustible materials within that room our burning
00:34:43 after flashover the fire will burn steadily and will begin to decay as the fuel is used up or upon intervention by for example the fire brigade
00:34:57 very many things will affect how fires develop within enclosed spaces and the speed of this development these include but are not limited to what the
00:35:10 but are not limited to what the combustible materials present are made out of and how quickly they go through the process of pyrolysis production of gas mixing of that gas with air and then
00:35:22 gas mixing of that gas with air and then ignition that heat energy that they transfer into the space once ignited the presence of oxygen the position of the
00:35:33 presence of oxygen the position of the fuel in the compartment and the dimensions and the characteristics of the compartment as well as many other factors are important as a result fires
00:35:46 factors are important as a result fires and compartments once ignited can develop across a wide range of timeframes the early stages of a fire are considered to be fuel controlled
00:35:58 are considered to be fuel controlled that means that the size of the fire is controlled by how much fuel is burning and how much heat energy that fuel releases and the position of that fuel
00:36:10 releases and the position of that fuel in the compartment assuming that sufficient oxygen is present if the rate of burning begins to exceed the amount of air coming into the room then the
00:36:22 of air coming into the room then the fire becomes ventilation controlled in my next slide I am going to show some photographs of an item that is on fire
00:36:33 photographs of an item that is on fire these images are not associated with the fire at rental Tower and I am using them only to illustrate the importance of the location of fuel within a compartment
00:36:44 location of fuel within a compartment and the effect that this location can have on the speed to flatter
00:36:54 the location of materials for example if an item is located in the middle of a room or against a wall or in a corner can have a significant effect on the
00:37:05 can have a significant effect on the speed with which a fire can develop within that compartment when a fire is confined against a wall or in a corner then the flame associated with the
00:37:18 then the flame associated with the combustion of the item will extend in its height to ensure that enough oxygen can entrain into the flames in order that the material can combust and combustion can be sustained the
00:37:32 combustion can be sustained the photographs I'm going to show you are of a fire test where the same item the cushion is placed in the middle of the room in the first test and against the wall in the second test and in the
00:37:43 wall in the second test and in the corner for the third test in the first situation the flames are relatively small in height and that is because the
00:37:55 small in height and that is because the air can come in to every side of the exposed flame to support the combustion of the fuel in the second test the
00:38:06 of the fuel in the second test the cushion is now up against a wall the air flow as a consequence is more restricted and as a consequence the flame grows in height so that the combustion can be
00:38:18 height so that the combustion can be maintained when the air flow is restricted even further by placing the fuel in a corner the flames now extend
00:38:30 fuel in a corner the flames now extend right up into the ceiling which in turn heats up the gas layer to a greater extent and more quickly this will increase the amount of radiant heat
00:38:41 increase the amount of radiant heat energy coming back into the space so that other materials nearby would be expected to become involved in the fire more quickly
00:38:52 this shows that even though the material which is burning is essentially the same the location of the fuel can have a significant impact on the fires development generally speaking the
00:39:07 development generally speaking the movement of smoke and hot gases through a compartment will dictate the movement of the fire as the hot gases and smoke transfer heat to nearby materials when
00:39:24 transfer heat to nearby materials when fires occur there can be a significant impact to the structures and materials within the environment of the fire and beyond understanding the physical effect
00:39:36 beyond understanding the physical effect of a fire on materials is critically important and it is this understanding that is used in interpreting the damage after a fire has occurred this enables
00:39:49 after a fire has occurred this enables fire investigators to try and to reconstruct the story of the early stages of the event most materials will respond to a fire in a predictable way
00:40:02 respond to a fire in a predictable way this will depend upon the physical and chemical properties of the material on what the material essentially is made out of for example different types of
00:40:13 out of for example different types of plastics wood glass concrete metals and so on we'll all experience heat differently
00:40:25 the effects of fire on materials may include also for example the damage to the structure of the material such as melting of glass or metal or the
00:40:38 melting of glass or metal or the breaking apart of concrete or brick which is a process called spalling the way in which the soot and smoke is deposited on vertical or horizontal surfaces or areas where deposition is
00:40:52 surfaces or areas where deposition is absent is important the effect of heat on some surfaces which can lead to changes in the color and the texture of those surfaces for example the removal
00:41:04 those surfaces for example the removal of water from gypsum wallboard as a result of heat a process called calcination causes a physical change in color and composition of that material
00:41:17 color and composition of that material the oxidation of surfaces can also cause their color to change so for example copper can turn red or black a change in color can also occur because
00:41:30 a change in color can also occur because the fire has removed corrosion protection such as paint on a material and so the materials underneath will oxidize or otherwise known rust the
00:41:42 oxidize or otherwise known rust the melting of materials which would occur at known temperatures or known temperature ranges the charring or burning of materials can generate
00:41:53 burning of materials can generate specific patterns which are called burn patterns these are patterns which can provide indications of an area that was burning for longer than others or where
00:42:04 burning for longer than others or where burning was more intense because of the type of material present or because of its location or because of other effects such as ventilation the combination of
00:42:16 such as ventilation the combination of these different indicators that I have mentioned and others form the fire patterns within a fire scene
00:42:31 a fire pattern is a general term which describes many different types of physical evidence that may be observed within a fire scene the effects of the
00:42:42 within a fire scene the effects of the fire of materials present in the fire scene are used to define these fire patterns as such they are formed by heat by smoke deposition and by the burnings
00:42:53 by smoke deposition and by the burnings of materials fire investigators will use these patterns combined with a knowledge and understanding of the relevant scientific engineering and fire science
00:43:05 scientific engineering and fire science literature as one of the tools to help them to attempt to understand the history of the fire so as to identify the area of origin and to contribute to
00:43:17 the area of origin and to contribute to the determination of the cause of a fire if indeed this is possible as such fire patterns in part act as a narrative for
00:43:30 patterns in part act as a narrative for the fires origin and development
00:43:34 patterns are analyzed by the fire investigators in combination with each other and with other information available for example from witness statements or from the electrical system
00:43:45 statements or from the electrical system in a property fire patterns can occur sequentially one after the other and as a consequence they can overlap each other as the fire develops this is
00:43:58 other as the fire develops this is particularly true in the latter stages of a fires development or where a fire may have flashed over as the early fire patterns can be destroyed or can become obscured fire patterns can also be used
00:44:14 obscured fire patterns can also be used to identify areas where the fire was burning intensely as well as providing information that might explain how the fire moved from one place to another
00:44:28 when the fire plume interacts with vertical and horizontal surfaces one of the types of fire patterns that can result is known as a V or a u-shaped
00:44:39 result is known as a V or a u-shaped pattern and these are patterns created when soot or smoke condenses onto a vertical surface to leave marks in the shape of a V or over u after the fuel is
00:44:53 shape of a V or over u after the fuel is ignited and a flaming fire develops the fire plume comes into contact with the wall and as this is a cooler surface
00:45:04 wall and as this is a cooler surface soot and smoke will condense onto that surface this can form visible black patterns on the wall in the shape of a V or a U as I said the shape of the
00:45:18 or a U as I said the shape of the patterns can change if there are openings such as windows which can change the direction of the smoke these patterns form in a true
00:45:30 patterns form in a true three-dimensional space and often a pattern will also form on the ceiling to give the shape of a cone in three dimensions if the fire continues in this
00:45:43 dimensions if the fire continues in this area then the deposited smoke can also be burnt back off to leave a clean area within the original pattern for example in this case on the ceiling and this is
00:45:55 in this case on the ceiling and this is called a clean burn v-shaped patterns can sometimes indicate areas where the fire has been burning for longer which
00:46:06 fire has been burning for longer which can provide some evidence of a possible area of origin of a fire
00:46:16 other fire patterns can be built up as a combination of both the burning of materials and of smoke deposition areas
00:46:28 materials and of smoke deposition areas where the damage to materials are more pronounced can indicate where a fire has been burning for longer periods of time or more intensely this is very dependent
00:46:39 or more intensely this is very dependent on the types of materials and so such physical evidence should be and considered cautiously low level burning or charring for example on floors or on
00:46:52 or charring for example on floors or on skirting boards can indicate an area where the fire may may have burnt lower than elsewhere and can possibly be indicators to a potential area of origin
00:47:04 indicators to a potential area of origin in this example there are three fire effects that make up the fire pattern firstly the v-shaped mark which is a
00:47:15 firstly the v-shaped mark which is a smoke pattern on the wall which occurs as smoke condenses onto the wall as the fire plume develops secondly a burn pattern on the floor where the fuel
00:47:28 pattern on the floor where the fuel which was burnt was located and finally a burn mark on the skirting board all three of these marks combined together
00:47:39 three of these marks combined together suggest a fire that may have been at floor level and burning for long enough to create the damage to the floor and to the skirting board this finishes the
00:47:54 the skirting board this finishes the first part of my presentation
00:47:59 convenient space to say yes hey well well then we'll have a short break now resume at five past eleven is 5 plus 11
00:48:21 you
01:08:43 [Music]
01:08:47 thanks a professor McDade will continue with her presentation yes when you were there
01:08:51 there thank you I now want to turn to the
01:09:02 thank you I now want to turn to the third part of my presentation which is relating to the process of how a fire scene is investigated fire investigations are by their nature
01:09:14 investigations are by their nature destructive of the fire scene that is being investigated and will often involve the removal of debris in layers where items and materials are moved or
01:09:25 where items and materials are moved or in some cases removed from the scene for further examinations as the investigation progresses as a consequence the investigation of a fire
01:09:37 consequence the investigation of a fire scene should be a plat should be planned it should be systematic and it should be methodical evidence within fire scenes
01:09:49 methodical evidence within fire scenes can be misinterpreted there can be lost or destroyed if the process is not undertaken carefully in the UK we have a
01:10:01 undertaken carefully in the UK we have a code of practice for investigators of fires and explosions for the criminal justice system which provides details of the objectives and the mechanism of fire
01:10:12 the objectives and the mechanism of fire scene investigation all observations and actions
01:10:24 all observations and actions should be comprehensively recorded both photographically and in contemporaneous notes written at the time of the
01:10:35 notes written at the time of the examination materials and items within the scene should be documented in place where they are found so that their exact location is recorded and is known
01:10:49 knowing the exact position of items relative to each other prior to the fire helps in piecing together the sequence of events which may have occurred fire
01:11:03 of events which may have occurred fire patterns for example burning charring or discoloration that may be associated with the different items present in the scene should also be noted and should be
01:11:15 scene should also be noted and should be documented and only when the scene has been initially documented should items begin to be moved around once the item
01:11:26 begin to be moved around once the item has been documented where it was found the item can be carefully moved placed into appropriate packaging and the packaging sealed before removal from the
01:11:37 packaging sealed before removal from the scene the recovery and removal of items should be undertaken in such a way as to preserve the item as much as possible
01:11:49 preserve the item as much as possible this can be challenging particularly with fire damage to objects as they can be very fragile as a consequence of the fire event timely recovery of materials
01:12:03 fire event timely recovery of materials is also important as materials can deteriorate considerably if left with in a fire scene for prolonged periods of time sometimes items recovered from fire
01:12:17 time sometimes items recovered from fire scenes are taken to a laboratory for further examination this is often the case for electrical items or for electrical appliances or for fire debris
01:12:29 electrical appliances or for fire debris which is thought might contain a liquid accelerant for example such laboratory examinations should be undertaken in a clean laboratory space
01:12:40 undertaken in a clean laboratory space following standard procedures again items should only be examined systematically and all examinations must be fully documented laboratory
01:12:55 be fully documented laboratory examinations usually involve an initial non-destructive visual examination this can sometimes involve using a microscope to look at fine details are using other
01:13:07 to look at fine details are using other techniques such as x-rays and again these laboratory examinations should involve recording in detail the damage observed on the items there are other
01:13:21 observed on the items there are other examinations as well that can be undertaken which provide more in-depth understanding of what might have happened to the item and this depends
01:13:32 happened to the item and this depends upon the investigative need these other examinations can be destructive of the materials that are being tested the main
01:13:44 materials that are being tested the main objectives of ferrocene investigation include one identifying where the fire started this is the area of origin this
01:13:56 started this is the area of origin this is an assessment made by a fire investigator based on the available evidence and can involve some subjective assessment of that evidence to
01:14:08 assessment of that evidence to identifying the specific cause of the fire if it is possible to do this and three fire investigations also often involve determining how the fire might
01:14:20 involve determining how the fire might have spread both within a compartment and from that compartment to elsewhere in the building
01:14:30 the way in which a fire develops what materials become involved the location of these materials at the time of the fire how the smoke and combustion
01:14:41 fire how the smoke and combustion products move within a component and between compartments whether doors and windows are open or are shut and many other factors within a fire scene can be
01:14:53 other factors within a fire scene can be hypothesized upon based on the physical evidence that survives the fire and remains at the scene after the fire has been extinguished it is generally
01:15:06 been extinguished it is generally accepted within the fire investigation community that the determination of the area of origin of a fire involves the interpretation of information derived from four main elements and these are
01:15:21 from four main elements and these are firstly the fire patterns this involves the systematic examination of the various physical evidence and patterns that remain within the structure which
01:15:33 that remain within the structure which occur as a consequence of the interaction of the fire with that structure and with the materials that may be present secondly Electrical
01:15:44 may be present secondly Electrical surveys this involves the examination of the physical damage within and to electrical items occurring as a result
01:15:55 electrical items occurring as a result of heat and direct attack by the fire this involves understanding how electrical systems work and understanding how electrical appliances
01:16:06 understanding how electrical appliances work what common faults may occur in different appliances and whether these faults are themselves capable of causing a fire such examinations may require the
01:16:20 a fire such examinations may require the expertise of a specialist fire electrical engineer three fire dynamics this is an understanding of how fires
01:16:31 this is an understanding of how fires start how they spread and how they develop within a fire scene and is informed by laboratory experiments and the scientific and engineering literature textbooks and so on relating
01:16:44 literature textbooks and so on relating to fire science and fire engineering for witness statements and materials which can provide vital early information
01:16:55 can provide vital early information about for example where items were located at the time of the fire who called the Fire and Rescue Services whether any sights sounds or smells were
01:17:07 whether any sights sounds or smells were observed prior to the fire or during the early stages of the fire what video or CCTV material may be available and so on in some fire scene
01:17:23 available and so on in some fire scene investigations portions of the scene may be gridded off so that different areas can be examined systematically and sequentially in these situations the
01:17:36 sequentially in these situations the recovered debris within each grid would be searched independently of all other gridded areas and the work undertaken would be recorded and fully documented
01:17:47 would be recorded and fully documented it would not be unusual for the materials within a gridded area to be recovered together and searched more carefully within for example a
01:17:58 carefully within for example a laboratory in some cases where the use of an ignitable liquid for example petrol are suspected in efforts to
01:18:09 petrol are suspected in efforts to accelerate the fire samples may be recovered from the fire scene and subsequently analyzed in a laboratory for the presence of those chemicals which would possibly indicate the
01:18:20 which would possibly indicate the presence of such an ignitable liquid hydrocarbon detection dogs trained in the detection of residues of ignitable liquids may also be used during the fire
01:18:31 liquids may also be used during the fire scene investigation
01:18:36 once a room has been cleared of fire debris
01:18:40 debris it is often valuable to relocate some items back into the positions that they were in at the time of the fire in many cases this can be done quite
01:18:51 cases this can be done quite successfully using the fire patterns within the scene as a guide by reviewing witness statements and other evidence
01:19:02 witness statements and other evidence for example CCTV footage as well as fire patterns and physical evidence evidence including if appropriate the relocation of items into their original positions
01:19:14 of items into their original positions at the scene it may be possible to identify the area of origin of that fire
01:19:24 it is often stated that fire scene investigation should follow what is called a scientific method this presents a systematic data collection and data
01:19:36 a systematic data collection and data analysis process followed by the development of various hypotheses which are tested against that data and a final hypothesis is chosen initially the
01:19:51 hypothesis is chosen initially the purpose of the fire scene investigation needs to be identified as this allows for the initial strategy to be developed in terms of setting the priorities for
01:20:03 in terms of setting the priorities for the investigation
01:20:07 fire scene investigation is primarily a subjective process where the investigators will collect data using their experience their knowledge and
01:20:18 their experience their knowledge and their understanding to interpret the physical evidence that's provided through fire patterns and if relevant the electrical evidence remaining at the
01:20:31 the electrical evidence remaining at the fire scene this is then placed in the context of other information presented to them by the witnesses investigators may also use fire dynamics and various
01:20:44 may also use fire dynamics and various resources within the relevant scientific and engineering literature relating to for example how materials identified as being present within the scene will burn
01:20:57 being present within the scene will burn this is so as to understand the specific context of the fire under investigation
01:21:07 the investigators may also undertake experiments and tests to determine the composition and the combustion properties of materials within the fire scene and in some cases small or large
01:21:21 scene and in some cases small or large scale reconstructions are carefully planned and undertaken so as to generate scientifically valid and correctly measured test data which can then be
01:21:33 measured test data which can then be analyzed alongside the data already collected all of this relates to the data collection and analysis part of the scientific investigation at all points
01:21:46 scientific investigation at all points it is important that the examination is undertaken following a scientific process so that there is confidence in the data that is derived the information
01:21:59 the data that is derived the information from witnesses and fire patterns at the scene the knowledge of fire dynamics and the electrical systems combined with the results of examinations in the laboratory are all used to test various
01:22:12 laboratory are all used to test various hypotheses relating to what might have occurred in the event
01:22:18 this hypothesis testing should be unbiased and should be undertaken on the basis of the facts that are derived from the investigation as this process
01:22:31 the investigation as this process develops further tests and data may be required in order to answer further questions that arise as the hypotheses are themselves tested a consensus can be
01:22:46 are themselves tested a consensus can be derived through dialogue between fire investigators in light of the systematic and scientific examination of materials recovered from the farm however it may
01:22:57 recovered from the farm however it may be that insufficient information is available to determine either the area of origin or the cause of a fire conclusively
01:23:14 by reviewing witness statements and other evidence including fire patterns and other physical evidence including if appropriate the relocation of items back
01:23:25 appropriate the relocation of items back into their original positions at the fire scene it may be possible to identify the area of origin of the fire the success of such an identification
01:23:36 the success of such an identification will be very dependent upon what physical evidence survives the fire and on the quality and systematic nature of the investigation that has been carried
01:23:47 the investigation that has been carried out determining the specific cause of a fire can be more challenging and will often and will more often than not require in-depth laboratory testing
01:24:00 require in-depth laboratory testing including possibly destructive testing of items recovered from the fire scene and testing occasionally of exemplar products and equipment to determine
01:24:12 products and equipment to determine whether specific fire caused scenarios are possible in determining the cause of a fire the specific conditions required for combustion that I've outlined must
01:24:25 for combustion that I've outlined must be met and should be supported by the physical evidence recovered from the scene these conditions are a source of localized heat is present for sufficient
01:24:38 localized heat is present for sufficient duration and in the environment of combustible materials such that pyrolysis can occur that the evolved pyrolysis products can mix with
01:24:50 pyrolysis products can mix with sufficient oxygen to initiate either smoldering combustion or flaming combustion given an appropriate ignition source that the initial fire can grow
01:25:02 source that the initial fire can grow and can develop it is quite possible given the destructive nature of a fire that the area of origin and specific
01:25:13 that the area of origin and specific cause of the fire may not be determined
01:25:21 in the final part of my presentation I will provide detail of my review of the information provided to me in relation to the fire investigation
01:25:33 in relation to the fire investigation that was carried out to determine the origin and the cause of the fire at Grenville tower on the 14th of June 2017 this is my review of the fire scene
01:25:45 this is my review of the fire scene investigation which was carried out by others who were on the ground at the fire scene in the immediate aftermath of the fire and on subsequent occasions the
01:25:58 the fire and on subsequent occasions the review of the circumstances leading up to the fire and the timelines and activities of those involved are based exclusively upon information provided to
01:26:09 exclusively upon information provided to me so far as the expert to the ground for our public inquiry as the proceedings of phase one of the inquiry unfold and the witnesses will tell their
01:26:21 unfold and the witnesses will tell their stories some of this information may be updated and new information may come to light this will provide me with the opportunity to further evaluate the
01:26:32 opportunity to further evaluate the findings of my review and to update my provisional report in due course I have used a selection of the videos and
01:26:43 used a selection of the videos and photographs I was provided with to illustrate this part of the presentation and indeed to illustrate my provisional phase one a report I intend to cover in
01:26:55 phase one a report I intend to cover in this part of my presentation the information relating to the circumstances of the discovery of the fire and the information relating to the actions of the first responders and in
01:27:06 actions of the first responders and in particular the first fire fighters who entered and attended the fire in flat 16 on the fourth floor of Grenville tower
01:27:18 the information provided to me allows a provisional timeline of the early event of the fire to be established the information also established as far as is possible at this stage the
01:27:32 as far as is possible at this stage the early intervention activities of the firefighters the activities of the fire scene investigators who attended Grenville tower also form part of this
01:27:44 Grenville tower also form part of this information gathering phase once this information has been gathered it can be used to test a series of hypotheses relating to the determination of the
01:27:56 relating to the determination of the area of origin of the fire and the cause of the fire at the end of this process a series of provisional conclusions have
01:28:07 series of provisional conclusions have been reached I intend to start with the information gathering part of my work which has come from witness statements
01:28:18 which has come from witness statements from photographs and the notes of the investigators as well as the reports and videos that have been provided to me I will begin this part of the presentation
01:28:29 will begin this part of the presentation with some orientation to the scene and to flat 16 and then work through a sequence of events from discovery the firefighter attendance and the fire
01:28:40 firefighter attendance and the fire scene investigation during this first session I will be showing some photographs of the outside and of the inside of Granville tower these
01:28:52 inside of Granville tower these photographs include pictures of the interior of flat 16 taken very shortly after the fire I will also be playing part of the initial 999 call to the Fire
01:29:04 part of the initial 999 call to the Fire & Rescue Service and I will be playing some video footage taken by the first firefighters who entered flat 16 as well as external video footage from outside
01:29:16 as external video footage from outside of Granville tower taken on the night of the fire
01:29:23 this is the East face of rental tower flat 16 is on the fourth floor of the tower and is illustrated by the red box both on the photograph and in the plan
01:29:38 this is the North Face of rental tower where flat 16 again is illustrated in red this is a close-up image of the east
01:29:52 red this is a close-up image of the east face of Granville tower indicating flat 16 the kitchen window of flat 16 is indicated by the red arrow
01:30:09 flat 16 was a two-bedroom apartment with a living room and a galley-style kitchen the available evidence suggests that three people lived in the flat mr. Cobb
01:30:22 three people lived in the flat mr. Cobb a day slept in the living room on a mattress of the flat miss Kim foo occupied bedroom number one and miss after the affair work II
01:30:33 and miss after the affair work II occupied bedroom number two the kitchen was next to the living room and directly connected to it via a sliding door which was shot on the night
01:30:45 sliding door which was shot on the night of the fire the living room was also connected to the hallway via another door and immediately opposite this store was the main door into the kitchen
01:31:05 the existing evidence suggests that in the early hours of the 14th of June 2017 mr. kebaya had been sleeping on a mattress in the living room of his flat
01:31:17 mattress in the living room of his flat number 16 in Granville tower the other two occupants of flat 16 miss Kim foo and miss Ave working were also asleep in their respective bedrooms mr. Kapadia
01:31:32 their respective bedrooms mr. Kapadia was woken up by the sound of his smoke alarm which as stated an interview with the Metropolitan Police Service he believed to be the smoke alarm that was in the kitchen of his flat mr. Kapadia
01:31:47 in the kitchen of his flat mr. Kapadia got out of bed and went out of his living room using the door into the hallway he opened the door into the kitchen from the hallway and he looked
01:31:59 kitchen from the hallway and he looked inside for a few seconds in his most recent statement I note that mr. Cobb ADA states that when he looked into the
01:32:10 ADA states that when he looked into the kitchen he saw light colored smoke which seemed to be coming from behind the toll fridge/freezer located in the south east part of the kitchen the smoke was
01:32:25 part of the kitchen the smoke was observed as being about two-thirds the height of the fridge freezer
01:32:35 the existing evidence suggests that mr. Kabaddi went back into the living room to get his mobile phone and he dialed 999
01:32:46 he woke both of the other occupants of the flat by banging on their bedroom doors and by telling them that there was a fire in the flat he ran out of his
01:32:59 a fire in the flat he ran out of his flat and made efforts to wake his neighbors in the other flats on the fourth floor he did this by banging on their front doors and by shouting that
01:33:11 their front doors and by shouting that there was a fire mr. Cobb a day then returned to his flat to grab a pair of trousers and stated that he switched off
01:33:22 trousers and stated that he switched off the electricity supply to the flat at the fuse box as he exited the flat for the second and last time this is
01:33:33 the second and last time this is important information in terms of the fire investigation because it means that any physical evidence that relates to the interaction of the electrical system
01:33:44 the interaction of the electrical system of flat 16 and the fire must have occurred at the very early stages of the fire and prior to when the electricity
01:33:55 fire and prior to when the electricity was switched off
01:34:01 I'm going to play the first part of the call that mr. cuvee day made to the London Fire Brigade in a few moments at
01:34:14 London Fire Brigade in a few moments at 54 minutes and 29 seconds on the 14th of June 2017 a call was received at the London Fire Brigades Stratford fall back
01:34:25 London Fire Brigades Stratford fall back control the time of the call was recorded by the London Fire Brigade and this was the first call received relating to the incident this call was
01:34:39 relating to the incident this call was made by mr. kovaydin and within which he provided valuable early evidence in relation to the fire within the call he indicated to the controller that there
01:34:53 indicated to the controller that there was a fire at Granville tower that the fire was in flat 16 on the 4th floor of the tower and that the fire was associated with a fridge which was
01:35:05 associated with a fridge which was mentioned by mr. Cobb a day during the call I'm now going to play the coal fire brigade yeah hello hi in the 5/16
01:35:16 brigade yeah hello hi in the 5/16 graffito sorry of fire where you just let 16 feet are flat 16 and what's the
01:35:27 let 16 feet are flat 16 and what's the policy hold the ww1 cg w 11:1 - yeah kind of quick please yeah would you just I have to get the address okay claims for that 16 briefing for the
01:35:40 okay claims for that 16 briefing for the 11 once eg the fabricator on their way are you have your height yeah come on said yeah well the four inches are on their way just tell me how many floors you've got there it's forceful
01:35:52 floors you've got there it's forceful right quick quick quick quick yes I know it's burning but they are on their way you've only just called as long as you're okay yeah okay yeah as
01:36:04 long as you're okay yeah okay yeah as long as it's pretty so yeah pagin there's the three so doc you can eat food yes you wait out during that call mr. cuvee dimensions
01:36:15 during that call mr. cuvee dimensions twice that the fire was by the fridge side I am only going to focus on the initial deployment of resources to
01:36:26 initial deployment of resources to Granville tower by London Fire Brigade on receipt of mr. cavaties phone call and this is because these early actions provide information which directly
01:36:37 provide information which directly address my terms of reference in relation to the origin and cause determination of the fire for fire engines were deployed by London Fire
01:36:49 engines were deployed by London Fire Brigade to Granville tower in response to the initial 999 call two fire engines with resource codes G 2 7 1 and G 2 7 2
01:37:01 with resource codes G 2 7 1 and G 2 7 2 were deployed from North Kensington they were mobilized at 0 0 55 and 14 seconds and they arrived at Granville Tower at 0
01:37:13 and they arrived at Granville Tower at 0 0 59 and 28 seconds and 0 0 59 and 24 seconds respectively one fire engine
01:37:24 seconds respectively one fire engine with resource code G 3 3 1 was deployed from Kensington it was mobilized at 0 0 55 and 14 seconds and arrived at
01:37:37 55 and 14 seconds and arrived at Granville tower at at 8 minutes past one and 33 seconds in the morning one fire engine with resource code g36 2 was
01:37:51 engine with resource code g36 2 was deployed from Hammersmith it was mobilized at 0 0 59 and 12 seconds and arrived at Granville tower at 108 and 27
01:38:02 arrived at Granville tower at 108 and 27 seconds next I'm going to show a provisional timeline of the initial London Fire Brigade response as far as
01:38:14 London Fire Brigade response as far as it can be determined from the existing evidence
01:38:19 this is the initial 999 call made at zerozero 54 and 29 seconds g27 1 and G 2
01:38:31 zerozero 54 and 29 seconds g27 1 and G 2 7 2 were deployed from North Kensington and arrived at this at almost the same time approximately 5 minutes after the
01:38:44 time approximately 5 minutes after the initial call G 3 3 1 was deployed from Kensington at the same time as G 2 7 1 &
01:38:55 Kensington at the same time as G 2 7 1 & 2 7 2 and arrived at Granville tower approximately 14 minutes after the initial 999 call g36 2 was deployed from
01:39:10 initial 999 call g36 2 was deployed from Hammersmith approximately 4 and a half minutes after the initial call and its time of arrival at Granville tower almost coincided with the arrival of G 3
01:39:22 almost coincided with the arrival of G 3 3 1
01:39:29 on arrival at Granville tower the firefighters undertook various tasks and activities in preparation to enter the building and to tackle the firemen -
01:39:41 building and to tackle the firemen - firefighters from G 271 work tasked as the initial team to enter flat 16 on the 4th floor of the tower these were crew manager butterbeans and
01:39:54 these were crew manager butterbeans and firefighter Brown
01:40:02 these two firefighters carried with them a thermal-imaging camera which can be used to visualize the interior of rooms where a fire is in progress and to
01:40:14 where a fire is in progress and to indicate areas of increased temperature within those rooms and compartments when it is used in this way the timer on the
01:40:25 it is used in this way the timer on the thermal-imaging camera used by crew manager battery and firefighter firefighter Brown was incorrect analysis by the Metropolitan Police Service suggests that an additional 56 minutes
01:40:38 suggests that an additional 56 minutes and 42 seconds needed to be added to the time on the camera the timings therefore of the video footage I have used have been made on
01:40:51 footage I have used have been made on the basis that the Metropolitan Police Services analysis is correct I will show the video footage of the thermal-imaging
01:41:02 the video footage of the thermal-imaging camera next this footage is extracted from sections of the thermal-imaging camera footage taken by crew manager battery and firefighter Brown it shows
01:41:16 battery and firefighter Brown it shows their progression through the flat and also shows footage externally taken outside of Grenville tower this external
01:41:27 outside of Grenville tower this external footage where it was available shows the development of the fire at the same time as the firefighters were inside the flat so that a comparison of the external
01:41:39 so that a comparison of the external fire development of the fire which was occurring at the same time that the firefighters were making their way through the flat can be made the video
01:41:51 through the flat can be made the video footage is shown on a split screen with the thermal-imaging camera footage appearing on the left and the videos from mobile phone fatigue footage appearing on the right in order to aid
01:42:03 appearing on the right in order to aid visualization the footage is going to play at approximately half speed so that we can follow the activities
01:42:13 the timings in the footage have been corrected based on the suggested correction provided by the Metropolitan Police Service and that corrected time runs at the bottom of the video clip I
01:42:27 am going to show this video footage twice the first time I will show it all of the way through without commentary and the second time I will show it again
01:42:40 and the second time I will show it again all the way through but this time I will provide some commentary as to the activities of the firefighters from the information available to me so that we
01:42:51 information available to me so that we can understand what it is that we're seeing the video runs for approximately four minutes and I'm going to show that video footage now
01:43:09 [Music] [Applause]
01:43:44 [Music] [Applause]
01:43:56 [Music]
01:44:08 [Music] [Applause] [Music]
01:44:17 [Applause]
01:47:38 I'm now going to run that video again and this time I'll talk through some of the items that we're seeing on the video to contextualise so I'm going to be talking as the video
01:47:50 so I'm going to be talking as the video is playing at about seven minutes past one firefighters entered a flat here you see the first firefighter door the door
01:48:03 see the first firefighter door the door is closed from there arrived now you see the firefighters moving around the entrance hole as they start to make an entrance into the first bedroom [Music]
01:48:15 [Music] externally the fire can be seen through the kitchen window [Music]
01:48:26 [Music] the firefighters are now entering the first pheasant and the thermal-imaging camera is reflecting some of the items that are present within them
01:48:37 that are present within them [Music]
01:48:48 [Music] the firefighters are now progressing down hallway of the flat and here in the image from the thermal-imaging camera
01:49:00 image from the thermal-imaging camera you're seeing on the bottom of the hallway with the living room door to the left and the kitchen door to the right
01:49:08 [Music] externally you can see the level of the fire development here is where the firefighters enter the kitchen for the first time the yellow glow that you see
01:49:21 first time the yellow glow that you see is the fire that is down at the window end of the kitchen
01:49:27 the firefighters attempt to put water on the fire and you can see there where the hose reel is spraying water on the fire
01:49:37 they close the door
01:49:47 and then they open the door again to see that the fire is still present
01:50:04 at this point the firefighters are spending some time discussing what tactics they can use in order to tackle the fire that is within the kitchen
01:50:39 but approximately 20 minutes past 1:00 the firefighters enter the kitchen go right into the kitchen and they extinguish the fire that was in and around the fridge freezer directly at
01:50:50 around the fridge freezer directly at that point the final portion of the video that you are seeing and shows the
01:51:02 video that you are seeing and shows the kitchen once the firefighters have extinguished the fire that was in the kitchen some of the items that you can see are recognizable such as kitchen cupboards
01:51:24 and over to the left hand side the washing machine the countertops of the kitchen so again that's the washing machine and there's the bin beside the
01:51:39 machine and there's the bin beside the washing machine there's an item on the floor that is hotter than the items around it which is presumably some fire debris the camera now
01:51:53 debris the camera now swings around and looks out of the window of the flat and you can see aspects of the cladding that are coming down outside of the window
01:52:05 that's the cooker the fridge freezer can be seen with the top door missing and the bottom door open that's the toaster a knife set some of
01:52:19 that's the toaster a knife set some of the materials that were left on the draining rack beside the sink these images from a fire investigation point of view are very valuable and they're
01:52:31 of view are very valuable and they're valuable because they provide factual evidence about the condition and the position of items within the kitchen immediately after the fire was extinguished I'm going to highlight
01:52:44 extinguished I'm going to highlight again some of these key findings within that perspective of the fire scene investigation
01:52:55 when the firefighters arrived at the fourth floor of Granville Tower the door to flat 16 was closed firefighter Brown broke down the door of the flat
01:53:10 broke down the door of the flat according to the thermal-imaging camera this occurred at around 107 and 23 seconds
01:53:20 seconds firefighter Brown stated that black smoke billowed out of the flat once the door had been opened crew manager batter
01:53:35 door had been opened crew manager batter be entered flat 16 first with the fire hose and firefighter Brown followed him behind with the thermal-imaging camera the firefighters initially searched the
01:53:47 the firefighters initially searched the bedroom directly opposite the front door of flat 16 this was the bedroom that according to evidence miss Kim foo occupied the firefighters
01:54:00 miss Kim foo occupied the firefighters then moved through the flat to check the other rooms including the second bedroom which according to the evidence was occupied by Miss a fire key and then
01:54:12 occupied by Miss a fire key and then they moved to the living room they reported no sign of the fire in any of these rooms and they reported no sign of the fire in the hallway
01:54:25 the fire in the hallway this diagram suggests the possible routes that the firefighters took through the flat based on their notes and statements and they swapped around
01:54:36 and statements and they swapped around their roles during their journey through the flat on a number of occasions
01:54:45 this image shows clearly the whole way of the flat with the living room door to the left and the kitchen door to the right and both of these doors were closed this image was taken at just
01:54:59 closed this image was taken at just after 12 minutes past 1:00 in the morning
01:55:09 the evidence available from the occupants of flat 16 as well as the photographs and notes of the fire investigators allow a diagram of the kitchen to be prepared suggesting the
01:55:22 kitchen to be prepared suggesting the most likely positions of various items within the kitchen at the time that the fire occurred these include a microwave the positioning of the sink beside and
01:55:36 the positioning of the sink beside and that bin I beg your pardon the positioning of the sink and beside that beneath of the kitchen counter a washing machine beside this is an electric
01:55:48 machine beside this is an electric cooker and finally the tall fridge freezer
01:55:52 freezer there was also an old freezer unit and a small fridge unit reported to be positioned near to the window with the smaller fridge reportedly placed on top
01:56:04 smaller fridge reportedly placed on top of the old freezer the materials present to the left that is the east side of the tall fridge freezer were not at this point known however recent evidence from
01:56:18 point known however recent evidence from mr. cuvee day may clarify what these items are and I will review this prior to the preparation of my final report for Phase one of the inquiry photographs
01:56:31 for Phase one of the inquiry photographs of the early stages of the fire captured by mr. kabiri on his mobile phone show how the fire in the kitchen of flat 16
01:56:42 how the fire in the kitchen of flat 16 it showed the fire in the kitchen of the flat 16 in its early stages these photographs were taken at around a 5 minutes past 1:00 and 39 seconds and
01:56:54 minutes past 1:00 and 39 seconds and provide evidence that the fire appears to be on the south side of the kitchen which is the side where the majority of the kitchen appliances were positioned the firefighters had not entered em flat
01:57:07 the firefighters had not entered em flat 16 when these photographs were taken
01:57:16 when crew manager Bartleby and firefighter Brown opened the door to the kitchen at about 14 minutes past 1:00 in the morning they immediately saw a fire to the top-left corner of the room as
01:57:29 to the top-left corner of the room as they looked in through the kitchen door
01:57:37 this was in the end of the kitchen where the window was and approximate positions of the tall fridge freezer and the washing machines have been illustrated in the photograph the firefighters
01:57:51 in the photograph the firefighters sprayed the fire with water and closed the door they reopened the door about 15
01:58:02 the door they reopened the door about 15 seconds later and saw that the fire was still burning they again tried to extinguish the fire from the doorway but without success
01:58:19 the fire was still burning after they opened the door for a third time at about 15 minutes past 1:00 the
01:58:31 about 15 minutes past 1:00 the firefighters finally entered the kitchen at approximately 20 minutes past 1:00 and extinguished the fire that was within the kitchen at that point this
01:58:47 within the kitchen at that point this sequence of photographs are still images taken from a mobile phone video and were taken from outside of Granville Tower showing the fire developing and growing
01:59:00 the first embers can be seen falling from the kitchen window of the flat flat 16 at about 8 minutes past 1:00 approximately this is approximately one
01:59:13 approximately this is approximately one minute after the firefighters had entered the flat the fire begins to extend out of the kitchen of flat 16 by
01:59:25 extend out of the kitchen of flat 16 by approximately nine minutes and thirty seconds past one o'clock this is around five minutes before the firefighters entered the kitchen for the first time
01:59:37 entered the kitchen for the first time which is at 14 minutes past 1:00 in the morning
01:59:45 it is now possible to add some further information to the timeline of the early activities relating to the fire at 107
01:59:57 activities relating to the fire at 107 and 23 seconds the firefighters entered flat 16 Granville Tower having arrived on site around 8 minutes earlier this was
02:00:08 around 8 minutes earlier this was approximately 13 minutes after mr. cuvee Dee's initial phone call to the London Fire Brigade by 109 the fire was
02:00:21 Fire Brigade by 109 the fire was emerging from the kitchen of flat 16 this was approximately 15 minutes after mr. kuberdas initial phone call to the London Fire Brigade the firefighters
02:00:37 London Fire Brigade the firefighters opened the kitchen door of flat 16 for the first time at approximately 14 minutes past 1:00 in the morning and this was about five minutes after the
02:00:48 this was about five minutes after the fire had emerged from the building the firefighters extinguished the fire in the kitchen of flat 16 Grenville tower at about 20 minutes past 1:00 in the
02:01:00 at about 20 minutes past 1:00 in the morning which was approximately 25 minutes after the first call to London Fire Brigade and approximately 11 minutes after the fire had exited the building
02:01:15 I'm now going to turn to the fire scene investigation which was carried out in flat 16 within Grenville tower which occurred over a number of days and which
02:01:28 occurred over a number of days and which involved a number of different investigators and organizations this table that you're looking at summarizes the dates of the various investigations
02:01:40 the dates of the various investigations which were undertaken and the items recovered from fat16 during those investigations in total there were three periods of fire investigation activities
02:01:53 periods of fire investigation activities undertaken within flat 16 which resulted in the collection of items for further investigation the first of these occurred during the 14th and the 15th of
02:02:06 occurred during the 14th and the 15th of June 2017 the second was between the period of at the 11th and the 14th of July 2017 and finally there were some
02:02:19 July 2017 and finally there were some visits to flat 16 in November 2017
02:02:26 what you're seeing on the second column of the table that you're looking at or the various items that were recovered by the fire investigators from the scene
02:02:37 the fire investigators from the scene and then moved to the laboratory for further investigation the initial fire scene investigation was carried out by
02:02:49 scene investigation was carried out by London Fire Brigade fire investigators on the 14th of June 2017 and they were joined by fire investigators from bureau veritas
02:02:58 veritas and key forensic services on the 15th of June 2017 in order to complete the initial fire scene investigation of flat 16 the first fire investigators all
02:03:12 16 the first fire investigators all arrived between 158 and 223 on the 14th of June so in the morning time they began their work by interviewing the
02:03:24 began their work by interviewing the fire the firefighters who initially entered flat 16 and extinguished the fire within the kitchen of the flat at around 9 o'clock in the morning of the
02:03:36 around 9 o'clock in the morning of the 14th of June 2017 the first fire investigators entered flat 16 of Granville Tower and began their investigation at this point they began
02:03:49 investigation at this point they began by documenting the scene using contemporaneous notes and recording the scene photographically once they had
02:04:00 scene photographically once they had completed these tasks they left the flat and the building
02:04:06 the scene was reentered by the fire investigators later that day this now included colleagues from bureau veritas who provided the scientific support
02:04:18 who provided the scientific support services to the London Fire Brigade the fire investigators continued to their scene investigation on the 15th of June 2017 and at this point some staff from
02:04:31 2017 and at this point some staff from key forensic services were now also present as well as some of the original fire investigators some of the original fire investigators were also no longer involved in the scene investigation
02:04:47 during these two initial days the fire scene investigation was focused primarily on the east end of the kitchen and various items and materials were
02:04:58 and various items and materials were recovered packaged and removed to the laboratories of bureau veritas for further examination between the 11th and
02:05:10 further examination between the 11th and the 14th of july 2017 fire investigators from bureau veritas and key forensic services revisited the scene and
02:05:21 services revisited the scene and recovered many of the other electrical items which had been previously in the kitchen at this time the dividing wall between the living room and the bedroom
02:05:32 between the living room and the bedroom bedroom number two had either collapsed or had been knocked down and many of the electrical items previously located in
02:05:43 electrical items previously located in the kitchen were now in various parts of the living room or located within the remains of bedroom to a wide range of
02:05:55 remains of bedroom to a wide range of other electrical items were also recovered from elsewhere in the flat and some electrical items that were in the flat were not recovered finally a further set of items were
02:06:08 finally a further set of items were recovered from flat 16 on various dates in November 2017
02:06:17 focusing now on the fire scene investigation which was undertaken on the 14th and the 15th of June in 2017 the fire investigators took various
02:06:29 the fire investigators took various photographs of the scene and documented their activities as they undertook their work this photograph is taken looking into the kitchen from the living room and would have been taken as part of the
02:06:43 and would have been taken as part of the early recording of the fire scene and before too many of the materials and fire debris had been moved about by the investigators the button at the top of
02:06:57 investigators the button at the top of the photograph is associated with the sliding doors and is visible at the ceiling of the interface between the kitchen and the living room starting
02:07:08 kitchen and the living room starting from the left hand side of the photograph closest to me this is the east side of the room you can see the window opening which is visible and in
02:07:19 window opening which is visible and in front of it the remains of an old freezer and a small fridge neither of which according to mr. cuvee day were plugged in at the time of the fire mr.
02:07:32 plugged in at the time of the fire mr. kubilay also stated that the old fridge freezer no longer worked behind this and along the south wall is a gap between
02:07:43 along the south wall is a gap between the window and the remains of the tall fridge freezer when moving along the south wall towards the right-hand side which is the west side of the room there
02:07:55 which is the west side of the room there are an electric cooker and the remains of the kitchen counter with the bin and the washing machine underneath that counter there are some other appliances
02:08:07 counter there are some other appliances on the counter one of which may be the toaster next is the remains of the sink which has been pulled upwards and then some cupboards and what may be a kettle
02:08:20 some cupboards and what may be a kettle and finally a microwave on the counter of
02:08:23 of the cupboards at some point during this initial investigation the investigators gridded off areas
02:08:35 the investigators gridded off areas around the cooker and in front of the remains of the old freezer and small fridge and recovered samples from these areas the area in front of the cooker
02:08:47 areas the area in front of the cooker looks to have been gridded twice and at different times the samples that were recovered from these gridded areas were placed in separate sample bags and were
02:08:59 placed in separate sample bags and were removed from flat 16 the following day on the 15th of June 2017
02:09:07 [Applause]
02:09:11 as the investigators undertook the scene investigation they began to move some of the appliances from the kitchen to elsewhere in the flat as they focus their activities in and around the
02:09:24 their activities in and around the remains of the toll fridge/freezer and the kitchen window it is not certain at this point as to where the other appliances were moved to but it is
02:09:36 appliances were moved to but it is thought that most removed into the living room
02:09:40 many of these appliances that were originally in the kitchen were recovered from the living room and some from bedroom two during the scene investigation that was undertaken in
02:09:51 investigation that was undertaken in July of 2017 the fire investigators also cleared away the materials to the east side of the toll fridge/freezer
02:10:03 side of the toll fridge/freezer that's the side closest to the window the exact nature of these items and materials has not yet been established however the recent evidence from mr.
02:10:15 however the recent evidence from mr. kubilay
02:10:16 kubilay may clarify what these items are what appears to be a large electric cooking pan later identified as an Ethiopian
02:10:27 pan later identified as an Ethiopian cooking pan was removed from this location and it was later recovered from the living room of flat 16 during the subsequent visit by the fire
02:10:38 subsequent visit by the fire investigators in July of 2017 the fire investigators moved the toll fridge/freezer exposing some of the wiring behind the appliance which they
02:10:51 wiring behind the appliance which they removed and packaged for further examination the fire investigators also recovered parts of the fridge freezer namely the top topper door and the
02:11:04 namely the top topper door and the compressor unit as well as some wiring believed to be associated with the fridge freezer all of which was packaged and removed from the scene on the 14th
02:11:15 and removed from the scene on the 14th of June 2017
02:11:19 the investigators also exposed the flooring underneath the fridge freezer which was burnt and they packaged the flooring material from this area and
02:11:30 flooring material from this area and removed it from the scene on the 15th of June 2017 the fire investigators also packaged and removed the remains of a
02:11:41 packaged and removed the remains of a supply flex associated with the fridge freezer and debris from the window area of the kitchen which contained the remains of the extractor fan of the kitchen these were all removed from the
02:11:53 kitchen these were all removed from the scene on the 15th of June the items that were recovered that I have listed from flat 16 that were recovered by the fire
02:12:06 flat 16 that were recovered by the fire investigators on the 14th and 15th of June were examined on the 19th and 20th of June 2017 at the bureau das bureau
02:12:17 of June 2017 at the bureau das bureau veritas laboratories these were non-destructive visual examinations this means that the items were removed from their packaging they were viewed they
02:12:29 their packaging they were viewed they were photographed and any damage described and noted measurements of some of the exact some of the items were taken some of the items were examined
02:12:40 taken some of the items were examined under magnification and some were examined using x-rays
02:12:49 mr. Cobb 8a stated that he switched off the electrical supply as he left flat 16 and these images are of the fuse box within flat 16 one of the miniature
02:13:03 within flat 16 one of the miniature circuit breakers within the fuse box for the circuit which supplies electricity to the kitchen had operated or tripped
02:13:14 to the kitchen had operated or tripped the operation of the miniature circuit breaker must have occurred before the main electricity supply to flat 16 was switched off by mr. Khiladi this means
02:13:28 switched off by mr. Khiladi this means that if electrical if evidence of electrical activity as a result of fire attack or an appliance failure was found within the kitchen of flat 16 in an
02:13:42 within the kitchen of flat 16 in an identified area of origin then it would have occurred within the very early stages of the development of the fire when the kitchen circuit and appliances still had electricity available to them
02:13:56 still had electricity available to them this means that evidence of electrical activity within an appliance or associated with electrical wiring would provide specific physical evidence
02:14:09 provide specific physical evidence linked to the very early stages of the fires development and this would greatly assist in narrowing the area of origin of the fire as defined by the electrical
02:14:20 of the fire as defined by the electrical system bureau veritas and key Forensic Services staff undertook non-destructive visual examinations of the electrical
02:14:31 visual examinations of the electrical items recovered from the initial fire scene examination of the kitchen on the 14th and 15th of June as a result of these examinations they suggested that
02:14:44 these examinations they suggested that there was no electrical evidence I beg your pardon there was no evidence of electrical activity associated with the items which were recovered from the southeast area of the kitchen
02:14:55 southeast area of the kitchen a flat 16 however it is clear that given the kitchen miniature circuit breaker had operated that electrical activity did indeed occur this suggests the
02:15:09 did indeed occur this suggests the further examination of the electrical items which were known to be plugged in as well as the electrical wiring recovered from the southeast area of the kitchen of flat 16 are needed and this
02:15:22 kitchen of flat 16 are needed and this further work led by the inquiries forensic Electrical Engineering expert is now continuing the investigation of
02:15:35 is now continuing the investigation of the origin and the cause of a fire is a primary aim of the fire investigation process the first step is to determine the area of origin and that normally
02:15:47 the area of origin and that normally involves the evaluation of evidence and factual information derived from the following witness information from all
02:15:58 following witness information from all relevant parties a systematic and careful physical examination of the fire scene and materials and items remaining
02:16:10 scene and materials and items remaining after the fire as well as fire patterns that may exist careful removal of items such as for example fire debris samples
02:16:21 such as for example fire debris samples and/or electrical appliances for subsequent laboratory based examinations the removal of such items should be traceable so that where they were taken
02:16:32 traceable so that where they were taken from when and by whom is known and their relevance in the context of the scene can be correctly established through
02:16:43 can be correctly established through such a systematic investigation process the room of origin can often be identified quickly this then allows the fire investigators to narrow down the
02:16:54 fire investigators to narrow down the focus and eliminate items that are not relevant to the question of where the fire started
02:17:02 the determination of the origin of a fire should be based upon the evaluation of a series of hypotheses or propositions which can be tested and evaluated based on available information
02:17:15 evaluated based on available information and physical evidence there are three hypotheses to address in relation to the area of origin of the fire in Grenville tower on the 14th of June 2017 firstly
02:17:31 tower on the 14th of June 2017 firstly that the fire in Granville Tower started in the kitchen of flat 16 as opposed to any other flat in Granville Tower
02:17:41 secondly that the fire started in the southeast end of the kitchen of flat 16 in Granville town as opposed to anywhere else
02:17:52 else in the kitchen and thirdly that the fire start started in the southeast corner in or around the area of the toll
02:18:03 or around the area of the toll fridge/freezer as opposed to any other appliance or item in the southeast corner of the kitchen of flat 16
02:18:16 in assessing hypothesis one that the firing Grenville's tower started in the kitchen of flat 16 as opposed to any other flat in the tower the following
02:18:27 other flat in the tower the following evidence was considered the witness statements from the occupiers of flat 16 Granville Tower and in particular the statements of mr. kovaydin the
02:18:39 statements of mr. kovaydin the statements of the first attending firefighters the thermal-imaging camera footage from those firefighters the external footage taken in the early
02:18:51 external footage taken in the early stages of the fire all of these pieces of evidence when considered together place the fire within the kitchen of
02:19:02 place the fire within the kitchen of flat 16 and taking all of this into consideration it is my view and that it can be concluded with confidence that the fire which occurred in Granville
02:19:13 the fire which occurred in Granville Tower on the 14th of June started in the kitchen of flat 16 on the fourth floor of Granville Tower in assessing
02:19:24 of Granville Tower in assessing hypothesis to that the fire started in the south east part of the kitchen of flat 16 as opposed to elsewhere within the kitchen the following was considered
02:19:35 the kitchen the following was considered the most read the most recent witness statement from mr. kovaydin states that he saw light smoke coming from behind
02:19:47 he saw light smoke coming from behind the turn fridge/freezer the statements of crew manager Butterbean and firefighter Brown positioned the fire in the southeast part of the kitchen the
02:20:03 the southeast part of the kitchen the thermal-imaging camera images provide evidence that there was a lack of fire damage to the appliances to the right side or the west side of the toll
02:20:14 side or the west side of the toll fridge/freezer this is the thermal imaging camera footage of the cooker here is a toaster and what looks to be a sandwich maker and here is the
02:20:26 sandwich maker and here is the thermal-imaging camera of the items that were beside the sink all of these items survived the early stages of the fire
02:20:37 survived the early stages of the fire and this means that the damage observed to these items subsequently by the fire investigators during their scene investigation is not related to the area
02:20:48 investigation is not related to the area of origin of the fire as they were not involved in the early fire development
02:20:57 when reviewing this evidence together it places the area of origin of the fire within the southeast part of the kitchen which is now highlighted in the drawing
02:21:10 in the photograph that we saw before the evidence together places the area of origins of fire within the southeast part of the kitchen highlighted now in
02:21:22 part of the kitchen highlighted now in red on the photograph
02:21:32 in assessing hypothesis three that the fire started in the southeast corner in or around the area of the toll fridge/freezer as opposed to any other
02:21:45 fridge/freezer as opposed to any other appliance or item in the southeast corner of the kitchen the following was considered early external images of the
02:21:57 considered early external images of the fire indicate that the fire started on the southeast side of the kitchen rather than the north side where the old fridge freezer and small fridge were reported as being located this is one of those
02:22:10 as being located this is one of those images both the old fridge freezer and the small fridge were plugged out at the time of the fire this was confirmed by
02:22:23 time of the fire this was confirmed by fire investigators juror there during their examination of the scene and by bureau veritas in their examinations on the picture closest to me which is the
02:22:34 the picture closest to me which is the old freezer the red circle and highlights where the plug to the appliance is that's clearly hanging down beside the appliance rather than being plugged in the witness statement of mr.
02:22:49 plugged in the witness statement of mr. kabadi and the contemporaneous notes of firefighter Brown also suggests that the initial fire was not in the old fridge the old freezer and the small fridge mr.
02:23:03 the old freezer and the small fridge mr. cuvee stated that he saw light smoke coming from behind the tall fridge freezer and that the old freezer was definitely not working firefighter Brown
02:23:16 definitely not working firefighter Brown stated that crew manager batter be pointed out that it was a fridge that he had put out this was towards the right-hand side of the back wall on the
02:23:28 right-hand side of the back wall on the basis of this evidence the old freezer and small fridge were not within the area of origin of the fire although although these appliances were clearly
02:23:39 although these appliances were clearly involved in the fire later point this narrows the area of origin further down to the southeast corner of the kitchen this area includes
02:23:53 corner of the kitchen this area includes a portion of the window that contains the extractor fan and the corner of the room including the fridge freezer and the materials that were in between the
02:24:05 the materials that were in between the fridge freezer and the window the fire investigators recovered several items from this southeast corner of the kitchen during their examination of the
02:24:17 kitchen during their examination of the scene on the 14th and the 15th of June 2017 and these items included the tall fridge freezer the door of the fridge
02:24:28 fridge freezer the door of the fridge compartment at the top of the fridge freezer which had become detached the compressor unit of the tall fridge freezer wiring from in or around the
02:24:39 freezer wiring from in or around the base of the tall fridge freezer electrical wiring from behind the tall fridge freezer parts of the laminate flooring from underneath the tall fridge
02:24:51 flooring from underneath the tall fridge freezer debris recovered from the window area and the debris recovered from the gridded areas that I previously described exactly what materials were
02:25:04 described exactly what materials were present in the area between the window and the tall fridge freezer is a point that continues to be investigated although the large hot plate also
02:25:17 although the large hot plate also described as the electric electric cooking device was noted and is visible in the photograph this item was later recovered on the 11th of July 2017 from
02:25:29 recovered on the 11th of July 2017 from the living room of flat 16 the item was examined in the laboratory and no evidence was found to suggest that it had been plugged in at the time of the
02:25:41 had been plugged in at the time of the fire or that it had a causative role
02:25:47 the fire investigators from bureau veritas and key forensics services state that they carried out a visual examination of the extractor fan recovered from the debris on the window
02:25:59 recovered from the debris on the window the window sill of the kitchen window of flat 16 and that they found no evidence of electrical activity within this device the photographic evidence of the
02:26:13 device the photographic evidence of the early stages of the fire also appeared to indicate that the fire was not positioned in the extractor fan panel in the early developmental stages based on
02:26:26 the early developmental stages based on this evidence it is more likely than not that the extractor fan was not involved in the initial stages of the farm the
02:26:38 in the initial stages of the farm the toll fridge/freezer which you're seeing in these images the image closest to me shows the left-hand side of the fridge freezer the image on the middle shows the right-hand side of
02:26:50 the middle shows the right-hand side of the fridge freezer and the image to the right of the screen shows the front of the tall fridge freezer with the top door put back in its original position
02:27:01 door put back in its original position the tall fridge freezer has been exposed to fire damage from the top from the bottom to the top which resulted in a fire pattern and corrosion running the
02:27:12 fire pattern and corrosion running the height of the appliance there is a greater degree of corrosion in evidence towards the rear of the appliance to the front this is shown in the first fire
02:27:23 front this is shown in the first fire pattern which i've illustrated here
02:27:29 this pattern is approximately mirrored on both sides of the of the appliance
02:27:36 each side of the toll fridge/freezer also reveal a second fire pattern which runs across the sides and the front of the appliance which is pattern B there
02:27:52 the appliance which is pattern B there was a fire pattern observed on the door of the top of the compartment of the toll fridge/freezer and this may suggest that the unknown materials in the corner and to the left or the east side of the
02:28:04 and to the left or the east side of the appliance may also have become involved in the fire at the early stages of its development equally the fire pattern observed on the door of the fridge
02:28:15 observed on the door of the fridge freezer may have arisen as a result of ventilation effects from the nearby window
02:28:25 this is the laminate flooring from underneath the tole freezer fridge freezer the laminate flooring from underneath the tol fridge freezer was
02:28:36 underneath the tol fridge freezer was also examined and it revealed a burn pattern within this area that was not present on the laminate flooring err on either sides of where the fridge freezer was positioned this burn pattern this is
02:28:51 was positioned this burn pattern this is adhere provides physical evidence to suggest that the area of the laminate flooring directly beneath the tol fridge freezer was exposed to a heat source or
02:29:02 freezer was exposed to a heat source or direct flame to a greater extent than the laminate on either side of the tol fridge freezer the skirting board
02:29:14 fridge freezer the skirting board illustrated here in this area also appears to be burnt away Panther is also melting in a straight adhere to the
02:29:25 melting in a straight adhere to the socket and the conduit to the side that the fridge freezer was positioned on
02:29:35 this photograph was taken during my visit to Granville Tower in October 2017 and this is a photograph of flat 16
02:29:46 and this is a photograph of flat 16 looking into the kitchen from the living room
02:29:52 you can see that most if not all of the contents of the flat had been removed by this stage the fire patterns within this photograph illustrate physical evidence
02:30:04 photograph illustrate physical evidence associated with the combustion of the materials within the east side of the living room of the flat of flat 16 there is a large fire pattern extending into
02:30:17 is a large fire pattern extending into the living room which is here and this large pattern is most likely associated with the combustion of the old freezer
02:30:29 with the combustion of the old freezer and small fridge which would be would have been located here these items were not involved in the area of origin but
02:30:41 not involved in the area of origin but they clearly became involved in the fire at a later point creating the observed fire pattern the other fire patterns suggest that the area of origin of the
02:30:53 suggest that the area of origin of the fire is within the southeast corner of the kitchen and these fire patterns include the lowest area of burning at
02:31:04 include the lowest area of burning at the skirting board in the southeast part of the kitchen which corresponds to the position of the tall fridge freezer the burn pattern on the laminate flooring
02:31:17 burn pattern on the laminate flooring corresponding to the position of the tall fridge freezer and the position of melting on the socket and conduit on the wall next to where the tall fridge freezer was positioned this would have
02:31:32 freezer was positioned this would have been the position of that tall appliance
02:31:37 the combination of witness statements the thermal-imaging camera footage the fire patterns on the toll fridge/freezer itself and on the laminate flooring beneath the fridge/freezer
02:31:49 beneath the fridge/freezer the skirting board at the back of the fridge freezer and the melting to the sockets adjacent to the fridge freezer suggests that it is more likely than not that the area of origin of the fire was
02:32:03 that the area of origin of the fire was located at the southeast corner of the kitchen in or around the toll fridge/freezer located along the south facing wall this
02:32:15 located along the south facing wall this area of origin at this time also extends to the space between the tall fridge freezer and the window where the exact nature of the materials in this space
02:32:26 nature of the materials in this space are still being investigated it is my view the further electrical examination of all of the items recovered from this
02:32:37 of all of the items recovered from this part of the kitchen should be undertaken
02:32:43 once the identity of the materials in the space to the east of the Tal fridge freezer become known and the findings of the further electrical electrical examination are available I will be able
02:32:56 examination are available I will be able to further consider this and to update my provisional report accordingly
02:33:08 in order to establish the coals of the fire which occurred within flat 16 Granville Tower it is my view that until further analysis is undertaken so that
02:33:21 further analysis is undertaken so that the chain of events needed for a fire to start can be demonstrated and this may include for example tests that the
02:33:34 include for example tests that the sequence required for viable heating the generation of pyrolysis products and ignition of those products can be demonstrated until that is done and up
02:33:47 demonstrated until that is done and up until this point only visual non-destructive examinations of the electrical items removed from flat 16 by the fire investigators have been undertaken and reported this includes
02:34:01 undertaken and reported this includes some examinations where some samples have been examined using a microscope and some examinations where some samples have been x-rayed however at this time
02:34:13 have been x-rayed however at this time no in-depth analysis of the electrical system or combust ability analysis of the Tal fridge/freezer and its components have been undertaken and reported by any fire investigator
02:34:26 reported by any fire investigator involved in the investigation of the origin and the cause of the fire as a consequence it is my opinion that the cause of the fire remains undetermined
02:34:38 cause of the fire remains undetermined until further analysis of the toll fridge/freezer and other electrical components recovered from the southeast corner of the kitchen of the flat 16 can be undertaken this work led by the
02:34:52 be undertaken this work led by the inquiries forensic electrical expert is now continuing
02:35:03 the initial fire in flat 16 started in the kitchen in the southeast corner and then spread out of the building the fire
02:35:14 then spread out of the building the fire patterns within the kitchen with in the flat 16 Granville Tower have been interpreted by the fire investigators from Bureau Veritas and key Forensic Services who all concluded that the
02:35:27 Services who all concluded that the initial kitchen fire I beg your pardon that after the initial kitchen fire the fire re-entered flat 16 Granville Tower at a later point in time and I agree
02:35:38 at a later point in time and I agree with these conclusions at some point the fire re-entered flat 16 through the window of bedroom 2 causing that room to
02:35:50 window of bedroom 2 causing that room to flashover and subsequent fire to spread out of bedroom 2 and into the hallway re-entering the kitchen this caused a
02:36:03 re-entering the kitchen this caused a second set of fire patterns within the kitchen primarily to the west end of the kitchen the initial fire investigators
02:36:15 kitchen the initial fire investigators took a range of photographs during their initial examination of the fire in flat 16 these photographs illustrate that there remains a flat 16 and the fire
02:36:28 there remains a flat 16 and the fire damage within the various rooms of that flat much of the damage to the hallway looking towards the first bedroom is due
02:36:39 looking towards the first bedroom is due to smoke and to heat bedroom one shows does not show much fire damage although
02:36:50 does not show much fire damage although there does appear to be some evidence of burning around the window in bedroom one
02:36:58 bedroom two has been fully involved in the fire
02:37:02 the fire and looks to have flashed over this must have happened after the fire in the kitchen was extinguished as the first firefighters to enter flat 16 checked
02:37:13 firefighters to enter flat 16 checked this room when they entered the flat and found no sign of fire within this room
02:37:24 the fire damage to the hallway looking towards the kitchen and living room shows fire damage at a high level which must have occurred after the fire
02:37:35 must have occurred after the fire re-entered the flat and that is because the thermal imaging footage from the first firefighters did not show any evidence of fire in this hallway there
02:37:51 evidence of fire in this hallway there is little evidence of direct burning to either the bathroom or the toilet except at high level and similarly the fire
02:38:04 at high level and similarly the fire damage in the living room with the exception of the east wall is relatively superficial and that's what these photographs show
02:38:18 to my conclusions the fire which occurred on the 14th of June 2017 at Grenville tower started in the kitchen
02:38:29 Grenville tower started in the kitchen of flat 16 which was on the 4th floor on the basis of the available evidence it is more likely than not that the area of
02:38:42 is more likely than not that the area of origin of the fire was in or around the toll fridge/freezer in the south-east part of the kitchen at
02:38:54 in the south-east part of the kitchen at this time the area between the toll fridge/freezer and the window is also included within this area of origin as the identity of the materials within
02:39:05 the identity of the materials within this space are still being investigated
02:39:16 the cause of the fire remains undetermined in my view the originating fire within flat 16 extended out of the
02:39:29 fire within flat 16 extended out of the kitchen window of the flat at some point re-entering through the window of the bedroom next to the living room of flat 16 causing further damage to that flat
02:39:45 this further damage would not have prevented determination of the area of origin or the cause of the initial fire
02:39:58 further electrical examination undertaken by a forensic electrical engineer is required of the materials recovered from flat 16 and this as I've said is now underway
02:40:15 once the identity of the materials in the space between the toll fridge/freezer and the window become known and the findings of the electrical examination are available these will be
02:40:26 examination are available these will be further considered prior to the preparation of my final report for phase one of the public inquiry and that's all I have to say well thank you very much indeed that concludes our business for
02:40:41 indeed that concludes our business for today thank you all very much we'll break now and resume tomorrow morning at ten o'clock please
02:40:58 you