Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Bureau of Fire Protection

EVALUATION CHECKLIST FORM

This Checklist shall be used in evaluating application for issuance of

CERTIFICATE OF COMPETENCY

Date of Evaluation:
I. General Company Details:
Company Name: SEC Accreditation No.

Top company head: Position: Date Accredited

Office Address: Validity

Tel Nos. Fax No. Email:

Instructions:
The following items are to be rated based on the assessment of authorized BFP representative/s:
1. The “Rate” column must be accomplished based on the following point system:
“0” absence of or non-compliance with the particular item “3” Adequate
“1” Poor “4” More than adequate
“2” Fair/Average “5” Excellent
2. Equivalent Rating = is the product of “Rate” and Equivalent Weight per column
3. Actual Score = is the product of “Rate” and “Value Factor” per item.
Average Rate = Quotient of Sub-total and totals of equivalent weight.
4. Overall Evaluation Rating = is the sum of Actual Score in all items.
5. PJ = Based on evaluator’s personal judgement. Rate is based on point system establish above.
6. * - Need submission of required documents as proof
7. ** - Need ocular observation
PART I B REMARKS
Rate Equiv. Weight
Equiv. Weight
1. Compliance with Legal requirements (0/5)
A. Company has a valid Business Registration and Permit
- Registration with DTI/SEC/CDA/DOLE which ever is applicable
In case of: Single Proprietor – Business Name from DTI
Partnership/Corp. – Registration with SEC
Cooperative – Registration with CDA
Union – Registration with DOLE
- Business Permit (LGU)
B. Registration with DOLE (Rule 1020 Requirements)
C. BIR Requirements
Value Factor for Item I = 10%
Maximum possible score = Actual Score
Rate Equiv. Weight
Equiv. Weight REMARKS

2. Technical Staff/Resource Speakers*

A. Has under its employ one permanent Fire Safety Practitioner
With valid COC. (0/5)
B. Has under its employ three regular trainers
With valid COC. (0/5)
C. Has at least one technicacl personnel with adequate
related knowledge in the following fields:

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 Name Trainer/ResourceSpeaker
C1. _____ Fire Safety Inspection ____________________________
C2. _____ Fire Investigation and Reporting ____________________________
C3. _____ Fire Hazard Analysis/Evaluation/Control ____________________________
C4._____ Fire Safety Programs ____________________________
C5._____ Fire Protection and Control ____________________________
C6. _____ Training and Safety Educ Technique ____________________________ REMARKS
C7. _____Materials/Equipment
4. Training Personal Protective Equipment
(PJ) ____________________________
A. C8._____
Training Equipment
Other Fire Safety
** related fields ____________________________
a1 Has at least one set each of
overhead projector or LCD, tape recorder
white board or flip chart, effective sound system
D. WithRate:validIfcontract
all of the
ofabove
serviceare
with
available
all speakers/trainers.
=4 (0/5)
E. With at least More5 speakers/trainers issuedwith
than the stated minimum = 5COC
F. With
a2 Has technical
at leaststaff
oneresponsible
sets each ofin thethefollowing
design PPEs:
Implementation
gloves, safetyand evaluation
shoed, of training.
hard hats, goggles,(0/5)
respirator
ear muffs/earplugs, safety belts/body harness or Sub-total
contract with suppliers of said equipment as to its
Value availability
Factor forduring
Item IIthe=35%
Fire Safety Trainings.
Maximum possible scores = 35
B. Training Venue Actual Score
b1 Has a training venue of contract with venue: Rate Equiv. Weight
Equiv. Weight
____ can accommodate at least 15 participants comfortably
3. ____
Office Lighting is adequate
Facilities and Personnel **
____ Ventilation
A. Office is comfortable
is located in a business-like environment
____accessible
Location to is unaffected by adverse
means of public condition of
transportation
environment
and with proper identification.
Rate:All
Rate: Allitems
itemsare
arecomplied
met = 5; = 5; oneonecriteria
item notis not met = 3;= 4
complied
Two items twonotcriterias
compliedare not
= 3 met = 2; three criterias are not met = 1
B. Has at least 3 office tables and chairs. (0/5)
C. C.
Reference
Office hasmaterials
sufficient space for personnel to move
b1 around
Has at comfortably.
least one regular(0/5)subscription to fire
safety related
D. Lighting materials* are
and ventilations (0/5)adequate. (0/5)
E.b2 Has
Maintains an updated
at least one set of setlibrary
of each ofof
fire
thesafety
following items:
materials,fax
telephone, books, standards
machine and related
and other suitablematerials
communication equipment. (0/5)
D. F.
Training
Has at Module/materials
least one set of workingon Fire Safety and prnter. (0/5)
computer
c1.Has
G. Training manualstaff
one regular for avvailable
the 40-hur to training
answer ontelephone
FS
40-hour
calls and training on OSHoffice
queries during is clearly
hours. printed
(0/5) and
updated
Name of person:
c2.Has
H. Scope coversauthorizedto
a person all occupationalissuehealth
companyand safety
field as specified
decisions. (0/5) in the bureau prescribed course
c3.Name
Content is comprehensive can fulfill both general
of person:
and specific
I. Receiving areaobjectives of one
has at least the training
table and course
chairs for
staff and clients. (0/5)
E. J.
With effective
Meeting evaluation
or briefing roomscheme/procedures
can accommodate
thatatcan serve
least as basis
6 persons for further improvement of
comfortably.
theHas
K. training
clean and sanitized comfort room (PJ)
L. Files and equipment are properly stored, labelled
F. Training
and wellCertificate
secured.of Completion*
(PJ) Sub Total
indicates information on Organization’s name
accre, number
Value Factor for , compliance
Item III = 20%statement mentioning
the BWC requirement,
Maximum possible score inclusive
= 20 date/s of training
and signature of two authorized Officials in the org. Actual Score

Sub-total

Value Factor for Item IV 35%

Maximum possible score = 35 Actual
Rate Score
Equiv. Weight
Equiv. Weight
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OVERALL SCORE
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 Value Sub- Actual Score
Equivalent Rating
Factor Total (VF* Sub-total)
1 Legal Requirements 10% Below 70 = Poor
2 Technical Staff/Resource Person 35% 70 - 79 = Fair/needs improvement
3 Office facilities and support staff 20% 80 - 89 = Adequate compliance
4 Training Materials/Equipment 35% 90 - 95 = More than adequate
100% 96 above = Excellent

Recommendations/Comments:

Evaluated by: Reviewed by: Noted by:

Name: Name: Name:
Position: Position: Position:
Date: Date: Date:

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