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) _________________________________________________________________________________

STORAGE 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_________________ F C 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 ________________________ 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
A. CLASSIFICATION
[ ] Warehouse [ ] Yards [ ] Garage [ ] Hangars [ ] Others, specify _____________________________
Contents ________________________________ Height of Stacks ________________________________________
Any renovations [ ] Yes [ ] No Underground: [ ] Yes [ ] No Windowless: [ ]Yes [ ] No

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 1 of 6

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

B. STORAGE TANKS/CONTAINERS
Installation: [ ] Aboveground [ ] Underground No. of Tanks _____________________
Distance from: Adjoining Bldg. _____________ Property Line ______________ Between tanks _____________
Dikes/Catch Basin Provided? [ ] Yes [ ] No
Tank No./Description Capacity Contents
1. ______________________________ __________________________ __________________________
2. ______________________________ __________________________ __________________________
3. ______________________________ __________________________ __________________________
C. HAZARDOUS MATERIALS
Presence of hazardous materials? [ ] Yes [ ] No Properly stored and Handled [ ] Yes [ ] No
Kind Container Volume Location
1. _________________ __________________ __________________ __________________
2. _________________ __________________ __________________ __________________
3. _________________ __________________ __________________ __________________
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 Exit ___________________________________________________________________________________
Maximum Travel Distance Requirement from Farthest Room: 30.5 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 rung- less than 4-
MEANS OF EGRESS storey

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
BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 2 of 6
 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection

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 [ j 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 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
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 _______________________________

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 3 of 6

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

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 Head___________________
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

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. 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
Date Last
Conducted:_______________________________________________________________________________________

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 4 of 6

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

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

XI. 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”

DISTRIBUTION:

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 5 of 6

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

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 6 of 6