Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
Region 1
Naguilian Fire Station
(STATION)
Brgy. Ortiz, Naguilian, La Union
(Station Address)

Date: ________________

SUBJECT : Inspection of___________________________________________________________

FOR : CITY/MUNICIPAL FIRE MARSHAL

ATTN: CHIEF, FIRE SAFETY ENFORCEMENT SECTION

REFERENCE: INSPECTION ORDER NO.__________________ DATE ISSUED: _______________

DATE OF INSPECTION: __________________

NATURE OF INSPECTION CONDUCTED: [Check Appropriate Box]

[ ] Building Under Construction [ ] Periodic Inspection of Occupancy
[ ] Application for Occupancy 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 Bldg.___________(m) Portion Occupied ____________________
Area per flr. ______________________________ sqm Total Flr. Area ____________________________sqm
Building Permit No._________ Date Issued_______ 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 Cntrl No. __________________________ Date Issued ________________
Name of Fire Insurance Co/Co-Insurer________________ Policy No.__________ Date Issued ____________
Latest Mayors/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. 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 Exits _______________________________________________________________________________
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 rating- 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 ____________________________________________________________________________________

C. 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 hallways _______________________________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

D. RAMPS
Provided? [ ] Yes [ ] No Type: [ ] Interior [ ] Exterior Width _______________
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 _________________________
E. 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
[ ] No Smoking [ ] Dead-end [ ] Elevator Sign [ ] Keep Door Closed
Others, 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? [ ] 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: [ ] Building [ ] 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 inch and 1 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 By?___________________________________________
Plan Submitted? _________________________ Certificate of Installation? ____________________________________
BFP AFSS Certificate payment under Section 13 B(5) and Fund Code No. D2531-151.

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/Bundwall 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) _____________________________________________

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 ____________________
Firemans elevator provided? [ ] Yes [ ] No Firemans key/switch provided? [ ] Yes [ ]No

F. Other Building Service Systems

[ ] Water Treatment Facility [ ] Waste Water/Sewage Treatment Facility

VIII. HAZARDOUS AREAS

[ ] 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 __________________________________ 2nd _______________________________________
X. DEFECTS / DEFICIENCIES NOTED DURING INSPECTION(Attached pictures, sketches and others)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
________________________________________________________

XI. RECOMMENDATIONS

__________________________________________________________________________________________________
__________________________________________________________________________________________________
___________________________________________________________________________________________

ACKNOWLEDGED BY:

____________________________________________ ____________________________________________
Signature over Printed Name of Owner/Representative Fire Safety Inspector/s
Date & Time______________________

__________________________________________
Team Leader

RECOMMEND ISSUANCE OF FSIC/NTC/NTCV:

__________________________________________
CHIEF, FIRE SAFETY ENFORCEMENT SECTION

APPROVED/DISAPPROVED:

____________________________________
Original (BFP copy)
Duplicate(BO or BPLO, as the case maybe) City/Municipal Fire Marshal
Triplicate (Applicant/Owners Copy)