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) ______________________________________________________________________________
BUSINESS 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. EXIT DETAILS

Occupant Load:_______________________________ Egress Capacity___________________________________
(Requirement: 9.3 square meters per person)
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: 61 m without AFSS & 915m with AFSS
Any Enclosure Provided? [ ] Yes [ ] No Min of 2-hr fire rating- 4-storey or more, Min of 1- hr, fire rung- less
MEANS OF EGRESS than 4-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
BFP-QSF-FSED-018 Rev. 01 (07.05.19) Page 1 of 5
 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection
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 panel? [ ] Yes [ ] No If Yes, made of ____________________ ________________
Door swing in the direction of exit travel? [ ] Yes [ ] No

V. 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
BFP-QSF-FSED-018 Rev. 01 (07.05.19) Page 2 of 5
 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection
[ ]”No Smoking” [ ] “Dead End” [ ] Elevator Sign [ ]Keep Door Closed
Other, specify _____________________________________________________________________________________

VI. 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 I ] 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

VII. 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

BFP-QSF-FSED-018 Rev. 01 (07.05.19) Page 3 of 5

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

VIII. 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

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
1st _____________________________________ 2 nd ______________________________________

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

BFP-QSF-FSED-018 Rev. 01 (07.05.19) Page 4 of 5

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

BFP-QSF-FSED-018 Rev. 01 (07.05.19) Page 5 of 5