Republic of the Philippines

Department of the Interior and Local

Government
BUREAU OF FIRE PROTECTION
(FIRE STATION LETTERHEAD)
FIRE SAFETY INSPECTION CHECKLIST
SMALUGENERAL BUSINESS ESTABLISHMENT
Sari-Sari Store, Kiosk, Barner Shop, Beauty Parlor, Water
Refilling, Convenience Store and alike

I. REFERENCE:
Inspection Order No. (10 ):_
_ _ _ _ _ _ _ Date Issued : Date Inspected :._ _ _ _ _ _
------
_
II. NATURE OF INSPECTION CONDUCTED (Check appropriate box)
[ ) Inspection during construction [ J FSIC for Certificate of Annual Inspection (PEZA)
[ J FSIC for Certificate for Occupancy [ J Verification Inspection for Compliance :
[ J FSIC for Business Permit (New) [ J NTC I [ J NTCV / [ J Abatement/ [ J Closure
[ J FSIC for Business Permit (Renewal) [ J Notice
of Disapproval, if Certificate of Occupancy
[ J Others (Specify):. _

Ill. GENERAL INFORMATION

Name of Building
Address
Business Name
Nature of Business

Name of Owner/Representative
Contact No.
FSEC No.
I Date Issued
I Date Issued
Building/Renovation Permit
FSIC No. (Latest) I Date Issued

Business Permit No.

I Date Issued

Fire Insurance Policy No. I Date Issued

IV. OTHER INFORMATION

Type of Occupancy: [ J Mercantile [ J Business [ I Others (Specify): _

Construction Type:
[ J Timber Framed and Walls [ ]Reinforced Concrete Framed with Masonry Walls
[ J Steel Framed and Walls [ J Mixed Construction
Total Floor Area:
m2 Occupant Load: Person/s No. of Stories : Portion Occupied: _

Building Height:
m With Mezzanine: [ J Yes / [ J No Handrails/Railings provided: [ ] Yes / [ J No

V. MEANS OF EGRESS
A. EXIT ACCESS
Horizontal components Actual Dim. Passed Failed Remarks I Corrective Action
Doors (m) I I [ l
Corridors I Hallways (m) I I I I
B. EXITS
Components Clear Width Passed Failed Remarks / Corrective Action
Exits Doors (m) [ l [ l
Horizontal Exits (m) [ J [ I
Stairs (m) [ J [ J
• Min . Width 0 . 60 m . between Rails of Fire Escape Stairs • Min. New Stair Width (0.915 m.) < 50 persons OL

At least two (2) means of egress for each floor [ J Yes / [ J No Exits doors open and close properly? [ J Yes I [ ] No
Do doors swing in direction of egress? [ I Yes I [ I No

VI. SIGNS, LIGHTING, AND EXITS SIGNAGE

A. MARKING OF MEANS OF EGRESS (EXIT)
Components Passed Failed
Minimum letter height, 150 mm; Width of Stroke, 19 mm [ l [ l
EXIT signs are posted along Exit access , Exits and Exit discharge [ l [ l
EXIT signs are properly illuminated [ l [ l
VII. HAZARD
Hazard Classi fication: [ J Low [ Ordinary [ J High
Storage Clearance Required? [ ] Yes / [ J No
Fire Safety Clearance for Storage [ J Yes / [ I No Date Issued:. Control No.. _
Hazard Content: _
Total Volume: _

Loca t ion : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
-
•Low-hazard contents shall be classified as those of such low combustibility that no self-propagating fire therein can occur.
• Ordinary hazard contents shall be classified as those that are likely to burn with moderate rapidity or to give off a considerable volume of smoke .
• Hiah./iazard contents shall be classified as those that are likelv to burn with extreme rapiditv or from which explosions are liketv.

A. OTHER FLAMMABLE LIQUIDS (I.E. ALCOHOL, ETHER, ETC... )

BFP-QSF-FSED-024 Rev.02 02.09.23)
 Republic of the Philippines
Department of the Interior and Local
Government
BUREAU OF FIRE PROTECTION
(FIRE STATION LETTERHEAD)
Components Passed Failed
Clearance of Stocks from the Ceiling [ J [ l
Gas Detector and Shut Off Device for LPG [ l I J
LPG System provided with Approved Plans, (if 300 kgs./300 GWC)
[ J Yes I [ J No
Installation Clearance [ J Yes I [ ) No Date Issued:. _ Control No.. _

BFP-QSF-FSED-024 Rev.02 02.09.23)

 Republic of the Philippines
Department of the Interior and Local
Government
BUREAU OF FIRE PROTECTION
(FIRE STATION LETIERHEAD)
Stored in sealed metal containers? [ ] Yes / [ ] No
Provided with "NO SMOKING" sign? [ ] Yes / [ ] No
VIII. FIRE PROTECTION
A. First Aid Fire Protection (Fire Extinguishers)
Item to Inspect Identification Passed Failed
Minimal sizes of fire extinguishers for the listed grades of hazards
Fire Extinguisher Size [ l [ l
shall be provided on the basis of table 7 & 8 of RIRR of RA 9514.
Minimum number of Extinguisher The minimum number of extinguishers shall be sufficient to meet the
requirements of table 7 & 8 of RIRR of RA 9514. [ l [ l
Location All extinguishers are in their proper location. [ l [ I
Seals & Tags Extinguisher seals and tags are intact and extinguisher was serviced
in the last 12 months. [ l [ l
Proper marking on extinguisher to indicate the type of fire the
Markings [ I
extinouisher can be used on. [ I
Condition No leaks, corrosion or other defects noticed. [ I [ I
Pressure Pressure gauge arrow pointing in the "green" area [ I [ l
Type: _ _ _ _ _ _ _ _ _ _ _ _ Quantity : _ Capacity: _
BE.mergency Lighting Systems Provided: [ J Yes / [ ] No
Fuctional: [ ] Yes / [ ] No
Locations: [ ] Hallways [ ] Exit Doors [ ] Stairway Landings
Others Specify: _
C. Fire Detection and Alarm Provided: [ J Yes / [ J No
[ J Smoke [ ] Heat [ ] Manual I [ J Automatic
Functional: [ ] Yes / [ ] No Integrated: [ ] Yes / [ ] No
Units per floor: units Adequate: [ ] Yes / [ J No
Location of Control Panel (if Applicable): _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

DEFECTS/DEFICIENCIES

ITEMIV:

ITEMV:

ITEMVI:

ITEM VII:

ITEM VIII:

RECOMMENDATIONS
[ ] Comply the following DEFFECTS/DEFICIENCIES stated above and pay the corresponding Fire Code Fees including the Storage
Clearance Fee , Conveyance Clearance Fee before the issuance of Fire Safety Inspection Certificate (FSIC).
Fire Code Fees to pay:
[ ] For issuance of [ J Notice to Comply [ ] Abatement Order with Administrative Fine
[ ] Notice to Correct Violation [ ] Closure Order for the non-payment of Administrative Fine
[ ] Closure Order
[ J Notice of Disapproval , if Certificate of occupancy is applied

Fire Safety lnspector/s Team Leader

ACKNOWLEDGED BY: RECOMMEND APPROVAL:

Signature Over Printed Name of Owner/ Representative

CHIEF, FIRE SAFETY ENFORCEMENT SECTION/UNIT
Date & Time: _ _ _ _ _ _ __
_
APPROVAL:

CITY/ MUNICIPAL FIRE MARSHAL

PAALALA: " MAHIGPITNA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O MAGREKOMENDA
NG ANUMANG BRANO NG FIRE EXTINGUISHER"

"FIRE SAFETY IS OUR MAIN CONCERN"

DISTRIBUTION:
Ori r,ln•I (Appiun tlO• n• r's Copy}
Dup,lcate(BFP Co py)

BFP-QSF-FSED-024 Rev.02 02.09.23}