Republic of the Philippines

Department of Health
B i co l C en t er fo r H ea l th D ev e l opm e n t
O F F IC E O F T HE R E G I ON A L D IR E C T O R

Checklist for Virtual Inspection for Operational Permit of

Water Refilling Station

Name of Water Refilling Station: Stream Haven Water Refilling Station

Address: Purok 3 Obaliw – Rinas, Oas, Albay
Date: March 13, 2023

Requirements Compliant Remarks

1. Picture of valid microbiological and physio- ✔
Chemical test.
2. Picture of water source. ✔
3. Picture of exterior of water refilling station. ✔
4. Picture of purification device/machine. ✔
5. Picture of PPEs (face shield, face mask, hairnet,
gloves and waterproof apron) for personnel. ✔
6. Picture of Hot air gun for sealing of cap and ✔
faucet of water container.
7. Picture of Brush or sponge for cleaning the ✔
water containers.
8. Picture of Soap for cleaning of water ✔
containers.
9. Video walkthrough of the water refilling ✔
station, video demonstrating the operation of
purification device/machine and washing,
refilling and sealing of containers.

Inspected By:

ENGR. LEA ANGELA P. ROMERO

Engineer III

AR. JASON JESUS M. LLAMASARES

Licensing Officer I

Received By:
_________________________
Signature over Printed Name

Legazpi City * Trunk line (052) 2040050, 2040040, 2040090, 7421731*

Website: http://www.ro5.doh.gov.ph * email address: records@bicol.doh.gov.ph