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) _________________________________________________________________________________

SMALL/GENERAL BUSINESS ESTABLISHMENT 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. MEANS OF EGRESS

a) No. of Exits________________________ Width ___________________________________________
Exits Accessible [ ] Yes [ ] No Termination of Exits ________________________________
Enclosure provided [ ] Yes [ ] No Enclosure construction ______________________________
Are Fire doors provided [ ] Yes [ ] No Fire Door construction_______________________________

BFP-QSF-FSED-024 Rev. 01 (07.05.19) Page 1 of 2

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

b) Number of Stairs Provided _____________________ Width ____________ Construction ____________________

Enclosure provided [ ] Yes [ ] No Enclosure construction _____________________
Are Fire doors provided [ ] Yes [ ] No Fire Door construction _____________________
Other details: _____________________________________________________________________________________

V. FIRE PROTECTION EQUIPMENT

a) Emergency lights provided [ ] Yes [ ] No Illuminated exit signs provided: [ ] Yes [ ] No
b) No. of fire extinguisher________________________ Type _____________ Capacity ________________________
Accessible [ ] Yes [ ] No Conspicuous Location [ ] Yes [ ] No
c) Is building equipped with Fire Alarm [ ] Yes [ ] No Detectors [ ] Yes [ ] No
Location of Control Panel ____________________ Functional [ ] Yes [ ] No

VI. FLAMMABLES
a) Presence of Hazardous Materials [ ] Yes [ ] No Properly stored and handled [ ] Yes [ ] No

Kind Container Volume Location

1. ________________ __________________ _________________ __________________
2. ________________ __________________ _________________ __________________
3. ________________ __________________ _________________ __________________
Storage Permit for Flammables/Combustibles Covered by BFP Permit ________________________________________
Clearance of Stocks from the Ceiling __________________________________________________________________
Minimum ceiling clearance: 1.0 m for flammable Liquids and 0.5 m for Combustible Materials
“NO SMOKING” Sign Provided [ ] Yes [ ] No is smoking permitted [ ] Yes [ ] No where________________
Storage construction ___________________ Safety Device for LPG tanks Provided [ ] Yes [ ] No

b) Oven/stove used___________________________ Kind of Fuel ___________________________________________

Smoke hood _______________ Spark Arrester _____________ Partition construction_______________________

VII. FINDINGS NOTED DURING INSPECTION

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________.

VIII. RECOMMENDATIONS
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
_______________________________________________________________________________________________.

ACKNOWLEDGED BY:

________________________________________ _____________________________________________
Signature Over Printed Name of Owner/ Fire Safety Inspector/s
Representative
Date & Time ____________________________ ______________________________________________
Team Leader

RECOMMEND ISSUANCE OF FSIC/NTC/NTCV:

SFO2 Linaflor P Villanueva

CHIEF, FIRE SAFETY ENFORCEMENT SECTION

APPROVED / DISAPPROVED:

CINSP RONNIE R BENEDICTO

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-024 Rev. 01 (07.05.19) Page 2 of 2