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) ________________________________________________________________________________

RESIDENTIAL 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: [ ] Hotel [ ] Apartment [ ] Others___________________________
Occupant Load:_____________________________ (Requirement:18.6 sq.m. per person)
(requirement: 0.65 sq.m. per person for concentrated use without fixed seat; 1.4 sq.m. per person for less concentrated
use and 0.28 sq.m. per person for standing room or waiting space)
Any renovations [ ] Yes [ ] No Underground: [ ] Yes [ ] No Windowless: [ ] Yes [ ] No

V. EXIT DETAILS
Capacity of Horizontal Exit (Corridor Hallway): ____________ (Requirement:100 persons per unit of exit width per min)
Capacity of Exit Stair: _____________________________ (Requirement: 75 persons per unit of exit width per min)
BFP-QSF-FSED-025 Rev. 01 (07.05.19) Page 1 of 6
 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection

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 m without AFSS & 46m with AFSS

Min of 2-hr fire rating- 4-storey or more, Min of 1 hr, fire rung- less than 4-storey
Any Enclosure Provided [ ] Yes[ ] No
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 EXIT
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 panel [ ] Yes [ ] No If Yes, made of ___________________________________________
Door swing in the direction of exit travel [ ] Yes [ ] No
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 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 _______________________________________________

BFP-QSF-FSED-025 Rev. 01 (07.05.19) Page 3 of 6

 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection
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. 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 _________________ 3rd __________________ 4th ___________________

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

BFP-QSF-FSED-025 Rev. 01 (07.05.19) Page 4 of 6

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

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-025 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-025 Rev. 01 (07.05.19) Page 6 of 6