Republic of the Philippines

Department of the Interior and Local Government

Bureau of Fire Protection
Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna
(049) 511-9111 / binanfirestation@yahoo.com

____________________
(Name of Owner) DATE

(Name of Establishment)

(Address)

FOR : CITY/MUNICIPAL FIRE MARSHAL

ATTN : CHIEF, FIRE SAFETY ENFORCEMENT SECTION

REFERENCE: INSPECTION ORDER NO. ____________________ DATE ISSUED_______________________

DATE OF INSPECTION: __________________________________

NATURE OF INSPECT ION CONDUCTED: [ ] Check Appropriate Box

[ ] Building Under Construction [ ] Periodic Inspection of Occupancy
[ ] Application for 0ccupancy Permit [ ] Verification Inspection of Compliance to NTCV
[ ] Application for Business Permit [ ] Verification Inspection of Complaint Received
[ ] Others (Specify) ___________________________________

DETENTION AND CORRECTIONAL 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 B1dg. ____________ (m) Portion Occupied __________________________
Area per flr __________________________ sqm Total Flr. Area ______________________________ sqm
Building Permit No _____________ Date Issue_________ 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 Mayor's/Bus. Permit _________ Date Issued______ Municipal License No._____ Date Issued________
Latest Certificate of Electrical Inspection No. __________________ Date Issued _______________________
Other Information _________________________________________________________________________________

II.BUILDING CONSTRUCTION
Beams ________________________
Exterior Walls__________________
Main Stair____________________
Main Door____________________
Columns____________________ Flooring ____________________________
Corridor Walls _______________ Room Partitions _____________________
Windows ___________________ Ceiling______________________________
Trusses ____________________ Roof _______________________________

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

IV. CLASSIFICATION
Occupancy Classification: [ ] New [ ] Existing
[ ] 1. Health Care Facilities (Hospitals & Nursing Homes)
[ ] 2. Residential Custodial Care (Nurseries, Home for the Aged, Mentally Retarded Care Institutions, etc)
[ ] 3. Residential Restrained Care (Penal Institutions, Reformaries, Jails, etc)
Occupant Load:_________________(Requirement: 11 sqm/person at Sleeping Dept; eg, restrained care & hospital
OPD ; 22 sq.m./person at in-Patient Treatment Dept. eg. Custodial & Healthcare)
Any renovations [ ] 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

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 1 of 6

 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection

Location of Exit____________________________________________________________________________________
Maximum travel Distance Requirement: (a) 30m from any room door to exit;(b)15m from any point in a sleeping room to
an exit door of that room;(c)46m from any point in a room to a exit;(d) if equipped with AFSS,(a) or (c) may be increased
by 15m.
Any Enclosure Provided [ ] Yes [ ] No Min of 2-hr fire rating- 4-storey or more, Min of 1 hr, fire rung- 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 __________________________________________________________________________________
B. 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 hall ways ________________________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

C. 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 ________________________________

D. 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 pane l [ ] Yes [ ] No If Yes, made of __________________________________
Door swing in the direction of exit travel [ ] Yes [ ] No

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 2 of 6

 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection

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
Other, 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: [ ] Budding [ ] 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 1/2 inch and 1 1/2 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_____________________________________________
Plan Submitted ___________________________ Certificate of Installation __________________________________
BFP AFSS Certificate payment under Section 13 B (5) and Fund Code No. D2531–151

F. FIREWALL
Building required with firewalls [ ] Yes [ ] No Provided [ ] Yes [ ] No
Any Opening [ ] Yes [ ] No

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 3 of 6

 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection

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/Bund wall 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 secs)
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 ____________________________________________________________________________
Fireman's elevator provided [ ] Yes [ ] No Fireman's key/switch provided [ ] Yes [ ] No
F.Other Building Service Systems
[ ] Water Treatment Facility [ ] Waste Water/Sewage Treatment Facility

IX. HAZARDOUS AREA

[ ] 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 _______________________________________

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 4 of 6

 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection

XI. DEFECTS / DEFICIENCIES NOTED DURING INSPECTION (Attached pictures, sketch and others)
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________.

XII. RECOMMENDATIONS
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________.

ACKNOWLEDGED BY:

________________________________________ _________________________________________
Signature Over Printed Name of Owner/ Fire Safety Inspector/s
Representative

Date & Time ___________________________ _________________________________________

Team Leader

RECOMMEND ISSUANCE OF FSIC/NTC/NTCV:

__________________________________________
CHIEF, FIRE SAFETY ENFORCEMENT SECTION

APPROVED / DISAPPROVED:

_________________________________________
CITY / MUNICIPAL FIRE MARSHAL

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG
MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 5 of 6

 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection
DISTRIBUTION:
Original (Applicant/Owner’s Copy)
Duplicate (BO or BPLO, as the case may be)
Triplicate (BFP Copy)

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 6 of 6