Professional Documents
Culture Documents
Department of The Interior and Local Government Bureau of Fire Protection
Department of The Interior and Local Government Bureau of Fire Protection
Department of The Interior and Local Government Bureau of Fire Protection
____________________
(Name of Owner) DATE
(Name of Establishment)
(Address)
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 ________________________ 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
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
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 ____________________________________
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
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 __________________________________
F. FIREWALL
Building required with firewalls [ ] Yes [ ] No Provided [ ] Yes [ ] No
Any Opening [ ] Yes [ ] No
D. Electrical System
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
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)
XII. RECOMMENDATIONS
________________________________________________________________________________________________
________________________________________________________________________________________________
_______________________________________________________________________________________________.
ACKNOWLEDGED BY:
________________________________________ _____________________________________________
Signature Over Printed Name of Owner/ Fire Safety Inspector/s
Representative
_______________________________________________
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”