You are on page 1of 5

Republic of the Philippines

Department of the Interior and Local Government


BUREAU OF FIRE PROTECTION
Region 1
Naguilian Fire Station
(STATION)
Brgy. Ortiz, Naguilian, La Union
(Station Address)

Date: ________________

SUBJECT : Inspection of___________________________________________________________

FOR : CITY/MUNICIPAL FIRE MARSHAL


ATTN: CHIEF, FIRE SAFETY ENFORCEMENT SECTION

REFERENCE: INSPECTION ORDER NO.___________________ DATE ISSUED: __________________

DATE OF INSPECTION: __________________

NATURE OF INSPECTION CONDUCTED: [Check Appropriate Box]


[ ] Building Under Construction [ ] Periodic Inspection of Occupancy
[ ] Application for Occupancy Permit [ ] Verification Inspection of Compliance to NTCV
[ ] Application for Business Permit [ ] Verification Inspection of Complaint Received
[ ] Others (Specify) ________________________________________

INDUSTRIAL OCCUPANCY CHECKLIST

I. GENERAL INFORMATION

Name of Building ___________________________________________________________________________________


Business Name _____________________________________________________________________________________
Address ___________________________________________________________________________________________
Nature of Business __________________________________________________________________________________
Name of Owner/Occupant_______________________________________________ Contact No.___________________
Name of Representative _________________________________________________Contact No. ___________________
No. of Storey ________________ Height of Bldg.___________ m Portion Occupied_____________________________
Area per Flr. _______________________________ sqm Total Flr. Area ____________________________sqm
Building Permit No.____________ Date Issued_________ Occupancy Permit No. ___________ Date Issued__________
Latest FSIC Issued Control No.____________________ Date Issued __________________ FC Fee _________________
Certificate of Fire Drill __________________________Date Issued ___________________FC Fee__________________
Latest Notice to Correct Violations Control No. __________________________ Date Issued ______________________
Name of Fire Insurance Co/Co-Insurer_________________________ Policy No.__________ Date Issued ____________
Latest Mayors/Bus. Permit _____ Date Issued ________ Municipal License No. __________Date Issued ________
Latest Certificate of Electrical Inspection No. _____________________________Date Issued ______________________
Other Information ___________________________________________________________________________________

II. BUILDING CONSTRUCTION

Beams _________________________ Columns______________________ Flooring _____________________________


Exterior Walls ___________________Corridor Walls _________________ Room Partitions_______________________
Main Stair ______________________Windows______________________ Ceiling ______________________________
Main Door _____________________Trusses________________________ Roof ________________________________

III. SECTIONAL OCCUPANCY (Note: Indicate specific usage of each floor, section or rooms)
___________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
_____________________________________________________________

IV. CLASSIFICATION

Occupancy Classification: [ ] General Industrial [ ] Special Purpose Industrial [ ] Open Industrial


Occupant Load: __________________________ Egress Capacity______________________________________
(Requirement: 9.3 square meters per person)
Any renovation: [ ] Yes [ ] No If yes, specify________________________________________________________

V. EXIT DETAILS
Capacity of Horizontal Exit (Corridor/Hallway):_____ ( Requirement:100 persons per unit of exit width per min)
Capacity of Exit Stair:__________________________ (Requirement: 60 persons per unit of exit width per min)

No. of Exits ____________________ Remote? [ ] Yes [ ] No


Minimum Requirement: No. of Exits: Two (2) units per floor
Location of Exits _______________________________________________________________________________
Maximum Travel Distance Requirement from Farthest Room: 31 m without AFSS & 46m with AFSS
Any Enclosure Provided? [ ] Yes [ ] No Min of 2-hr fire rating- 4-storey or more, Min of 1 hr fire rating- less than 4-storey

MEANS OF EGRESS
Readily accessible? [ ] Yes [ ] No Obstructed? [ ] Yes [ ] No
Travel distance within limits? [ ] Yes [ ] No Dead-ends within limits ? [ ] Yes [ ] No
Adequate illumination [ ] Yes [ ] No Proper rating of illumination? [ ] Yes [ ] No
Panic hardware operational? [ ] Yes [ ] No Door swing in the direction of exit? [ ] Yes [ ] No
Doors open easily? [ ] Yes [ ] No Self-closure operational? [ ] Yes [ ] No
Bldg w/ Mezzanine? [ ] Yes [ ] No Mezzanine with proper exits? [ ] Yes [ ] No
Corridors & aisles of sufficient size? [ ] Yes [ ] No

A. VERTICAL EXITS

1. Main stairway: Width ______________Construction ______________________


Are there railings provided? [ ] Yes [ ] No Made of_____________________________________________
Any enclosure provided? [ ] Yes [ ] No Enclosure construction ________________Any opening? [ ] Yes [ ] No
Fire door construction_________________________________ Door equipped w/ Self-closing device? [ ] Yes [ ] No
Door proper rating: [ ] Yes [ ] No Door provided w/ vision panel: [ ] Yes [ ] No If Yes, made of __________________
Door swing in the direction of exit travel (when required)? [ ] Yes [ ] No
Stairways Pressurized? [ ] Yes [ ] No [ ] N/A If pressurized, what type or method? __________________________
Date Last Tested ___________________________________________________________________________________

2. Secondary Stair/Fire Escape: Number______________ Width ______________________


Construction_________________ Are there railings provided? [ ] Yes [ ] No Made of ______________________
Location: [ ] Interior [ ] Exterior Exits accessible? [ ] Yes [ ] No
Any obstruction? [ ] Yes [ ] No Termination/Discharge of Exits __________________________
Any enclosure provided? [ ] Yes [ ] No Enclosure construction ________________________________
Any opening?[ ] Yes [ ] No Opening protected? [ ] Yes [ ] No
Are fire door provided? [ ] Yes [ ] No Width ____________Fire door construction ________________
Door provided with vision panel? [ ] Yes [ ] No If Yes, made of ______________________________________
Door equipped w/ Self-closing device? [ ] Yes [ ] No Doors & enclosure proper rating? [ ] Yes [ ] No
Doors open easily? [ ] Yes [ ] No Self-closing device operable? [ ] Yes [ ] No
Door equipped w/ panic hardware? [ ] Yes [ ] No Operable? [ ] Yes [ ] No
Door swing in the direction of exit travel? [ ] Yes [ ] No Enclosure properly protected? [ ] Yes [ ] No
Fire escape pressurized? [ ] Yes [ ] No [ ] N/A If pressurized, what type or method? __________________________
Date Last Tested ___________________________________________________________________________________

C. HORIZONTAL EXITS
Width of door/s ______________________ Construction________________________ With vision panel [ ] Yes [ ] No
Door swing in the direction of egress travel? [ ] Yes [ ] No With Self-closing device? [ ] Yes [ ] No
Width of corridors or hallways _______________________________Construction _______________________________
Corridor walls extended from slab to slab? [ ] Yes [ ] No Properly illuminated? [ ] Yes [ ] No
Exit readily visible? [ ] Yes [ ] No Clear and unobstructed? [ ] Yes [ ] No
Properly marked w/ illuminated exit sign? [ ] Yes [ ] No With illuminated directional sign? [ ] Yes [ ] No
Properly located? [ ] Yes [ ] No

D. RAMPS
Provided? [ ] Yes [ ] No Type: [ ] Interior [ ] Exterior Width _______________ Class _______________
Railings provided? [ ] Yes [ ] No Height from the floor ______________(Requirement: 91 cm)
Any enclosure provided? [ ] Yes [ ] No Construction________________________________________________
Are fire doors provided? [ ] Yes [ ] No Width ____________________ Fire door construction______________
Door equipped w/ Self-closing device? [ ] Yes [ ] No Door with proper rating? [ ] Yes [ ] No
Door provided w/ vision panel? [ ] Yes [ ] No If Yes, made of _____________________________________________
Door swing in the direction of exit travel (when required)? [ ] Yes [ ] No
Any obstruction? ________________________________ Termination/Discharge of exit _________________________
E. AREA OF SAFE REFUGE
Provided? [ ] Yes [ ] No Type: [ ] Interior [ ] Exterior Location _________________________________
Any enclosure provided ? [ ] Yes [ ] No Construction________________________________________________
Are fire door provided? [ ] Yes [ ] No Width _______________ Fire door construction___________________
Door equipped w/ self-closing device? [ ] Yes [ ] No Door with proper rating? [ ] Yes [ ] No

Door provided w/ vision panel? [ ] Yes [ ] No If Yes, made of ________________________________


Door swing in the direction of exit travel? [ ] Yes [ ] No

VI. LIGHTINGS & SIGNS


A. EMERGENCY LIGHTS
Automatic Emergency Lights Provided? [ ] Yes [ ] No Source of Power [ ] AC/DC [ ] Others _________________
No. of Units per Floor________________ Located at: Hallways _______________ Stairway Landings _______________
Operational: [ ] Yes [ ] No Exit path properly illuminated? [ ] Yes [ ] No
Tested Monthly: [ ] Yes [ ] No Minimum AEL Power Duration : at least one (1) hour

B. EXIT SIGNS
Exit Signs Illuminated? [ ] Yes [ ] No Location _________________________________________________
Source of Power [ ] AC/DC { } Others____________________________________ Readily visible? [ ] Yes [ ] No
Minimum Letter Size _______________________ Min. Requirement: Height of 11.5 cm & width of 19.0 mm
Exit Route Plan posted on: Lobby/Hallways? [ ] Yes [ ] No Rooms? [ ] Yes [ ] No
Directional Exit Signs? [ ] Yes [ ] No Location_____________________________________________________

C. WARNING/SAFETY SIGNS
[ ] No Smoking [ ] Dead-end [ ] Elevator Sign [ ] Keep Door Closed
Others, specify _____________________________________________________________________________________

VII. FEATURES OF FIRE PROTECTION


A. PROTECTION OF VERTICAL OPENINGS
Properly protected? [ ] Yes [ ] No Atrium? [ ] Yes [ ] No Fire Doors good condition? [ ] Yes [ ] No
Elevator opening protected? [ ] Yes [ ] No Pipe Chase opening protected? [ ] Yes [ ] No
Aircon Ducts system with damper? [ ] Yes [ ] No Dumb Waiter opening protected? [ ] Yes [ ] No
Garbage Chute opening protected? [ ] Yes [ ] No Between Floor & Glass Curtain opening protected?[ ] Yes [ ]No
Date Last Tested____________________________________________________________________________________

B. ALARM SYSTEM
Fire Alarm Provided? [ ] Yes [ ] No Type: [ ] Manual [ ] Automatic Centralized? [ ] Yes [ ] No
Location of Central Control __________________________________________________________________________
No. of Bells per Floor __________ Location__________________________________________________________
Coverage: [ ] Building [ ] Air Handling Unit [ ] Portion, specify__________ Monitored? [ ] Yes [ ] No
Type of Initiation Device? [ ] Smoke [ ] Heat [ ] Manual [ ] Water Flow [ ] Others ____________________________
No. of Pull Stations per Floor______Max.. Horizontal Distance Bet. Pull Stations: 61.0 m
Smoke Detectors? [ ] Yes [ ] No No. of Units per Room _______________ Integrated? [ ] Yes [ ] No
Heat Detectors? [ ] Yes [ ] No No. of Units per Room _______________ Integrated? [ ] Yes [ ] No
Power Source of Detectors [ ] AC/DC [ ] Others___________ Total Detectors per Floor ________________________
Date Last Tested ____________________________________________________________________________________

C. STANDPIPE SYSTEM
Type: [ ] Wet [ ] Dry Tank Capacity ____________________Location _______________________________
Siamese Intake Provided? [ ] Yes [ ] No Location _________________________________________________
Size ________________ No. of Units ___________________________ Accessible? [ ] Yes [ ] No
Fire Hose Cabinets Provided? [ ] Yes [ ] No With Complete accessories [ ] Yes [ ] No
Location ___________________________
No. of Units per Floor ____________ Size of Hose ___________________ Length of Hose _______________________
(Note: Min Required Size of Riser & Distribution Pipe: 2 inch and 1 inch in diameter, respectively
Type of Nozzle ______________________________Date Last Tested ________________________________________
Fire Lane Provided: [ ] Yes [ ] No Location of nearest Fire Hydrant ____________________________

D. FIRST AID FIRE PROTECTION EQUIPMENT (PORTABLE FIRE EXTINGUISHERS)


Type _________________________ Capacity ____________________ No. of Units _____________________________
With PS Mark? [ ] Yes [ ] No With ISO Mark? [ ] Yes [ ]No
Properly Maintained? [ ] Yes [ ] No Conspicuously Located? [ ] Yes [ ] No Accessible? [ ] Yes [ ] No
Other Types Provided, if any __________________________________________________________________________
E. AUTOMATIC FIRE SUPPRESSION SYSTEM (SPRINKLER SYSTEM)
Type of Extinguishing Agent Used __________________Jockey Pump Capacity ____________hp____________ GPM

Fire Pump Capacity: ____________hp _____________GPM Tank Capacity?__________________________ gallons


Maintaining Line Pressure ________________________Farthest Sprinkler Head Pressure _________________________
Riser Size _______Type of Heads Installed ______________________________________________________________
No. of Heads per Floor ___________Total___________________ Spacing of Heads _____________________________
Location of Fire Department Connection ________________________________________________________________

Date Last Tested ___________________________ Conducted By?___________________________________________


Plan Submitted? _________________________ Certificate of Installation? ____________________________________
BFP AFSS Certificate payment under Section 13 B(5) and Fund Code No. D2531-151.

F. FIRE WALL
Building required with fire walls? [ ] Yes [ ] No Provided? [ ] Yes [ ] No
Any opening?[ ] Yes [ ] No

VIII. BUILDING SERVICE EQUIPMENT


A. Boiler Provided? [ ] Yes [ ] No No. of Units provided____________________________
Fuel: [ ] Diesel [ ] Kerosene [ ] Coal [ ] Bunker [ ] LPG Capacity ______________________________________
Container: [ ] Above-ground [ ] Underground Location ______________________________________
LPG Installation Covered with Permit? [ ] Yes [ ] No Fuel with Storage Permit? [ ] Yes [ ] No

B. Generator Set Provided? [ ] Yes [ ] No [ ] Automatic [ ] Manual Fuel:[ ] Diesel [ ] Gasoline


Capacity _______________________ Location ______________________ Dikes/Bundwall Provided [ ] Yes [ ] No
Container: [ ] Above-ground [ ] Underground Dispensing System? [ ] By pump [ ] By gravity
Output Capacity __________________kva Mechanical Permit _________________Date Issued________________
Fuel with Storage Permit? [ ] Yes [ ] No Others (specify) _____________________________________________
Automatic Transfer Switch Provided? [ ] Yes [ ] No Time interval ______sec (Requirement- max 10
seconds)

C. Refuse (Garbage) Handling Facility: Provided? [ ] Yes [ ] No


Enclosure provided? [ ] Yes [ ] No Fire resistive? [ ] Yes [ ] No
Fire protection provided? [ ] Yes [ ] No Type ______________________________________________________
Frequency of collection/disposal______________________________ How collected?__________________________

D. Electrical System
Is there any electrical hazard? [ ] Yes [ ] No Specify location_______________________________________

E. Mechanical System
Is there any mechanical hazard? [ ] Yes [ ] No Specify location ______________________________________
No. of elevators provided ___________________
Firemans elevator provided? [ ] Yes [ ] No Firemans key/switch provided? [ ] Yes [ ]No

F. Other Building Service Systems


[ ] Water Treatment Facility [ ] Waste Water/Sewage Treatment Facility

IX. HAZARDOUS AREAS


[ ] Kitchen [ ] Laundry [ ] Windowless Basement [ ] Storage Room Others____________________
Separation Fire Rated? [ ] Yes [ ] No Type of Fire Protection provided_______________________________________
No. of Units ____________________________ Capacity __________________________Accessible? [ ] Yes [ ] No
Fuel Used _____________ Where Stored _____________________ Covered by BFP Permit _______________________
Chimney: Made of ___________________ Spark Arrester __________________Smoke Hood _____________________

Presence of hazardous materials? [ ] Yes [ ] No Properly stored and handled? [ ] Yes [ ] No


Kinds Container Volume Location
1. ___________________________ __________________ __________ ________________________________

2. ___________________________ __________________ __________ ________________________________

3. ___________________________ __________________ __________ ________________________________


Storage Permit for Flammables/Combustibles Covered by BFP Permit? _______________________________________
Clearance of Stocks From Ceiling _____________________________________________________________________
Minimum Ceiling Clearance: 1.0m for Flammable Liquids and 0.5m for Combustible Materials

X. OPERATING FEATURES
Fire Safety Program (Under the supervision of the Chief Local Fire Service)
Fire Brigade Organization? [ ] Yes [ ] No
Fire Safety Seminar [ ] Yes [ ] No
Employees trained in emergency procedures? [ ] Yes [ ] No
Fire/Evacuation Drill [ ] Yes [ ] No
1st ________________ 2nd _________________

XI. DEFECTS / DEFICIENCIES NOTED DURING INSPECTION (Attached pictures, sketches and others)
___________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

XII. RECOMMENDATIONS
___________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

ACKNOWLEDGED BY:

____________________________________________ ____________________________________________
Signature Over Printed Name of Owner/Representative Fire Safety Inspector/s
Date & Time______________________

__________________________________________
Team Leader

RECOMMEND ISSUANCE OF FSIC/NTC/NTCV:

__________________________________________
CHIEF, FIRE SAFETY ENFORCEMENT SECTION

APPROVED/DISAPPROVED:

Original (BFP copy) ____________________________________


Duplicate (BO or BPLO, as the case maybe) City Fire Marshal
Triplicate (Applicant/Owners Copy)