Republic of the Philippines

Department of the Interior and Local Government

Bureau of Fire Protection
National Capital Region
Taguig City Fire Station - Fire District IV
Radian St. Arca South Westen Bicutan Taguig City
Tel # (8)356-9423/837-0740/837-4496

____________________
(Name of Owner) DATE

(Name of Establishment)

(Address)

FOR : CITY FIRE MARSHAL

ATTN : CHIEF, FIRE PREVENTION 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) _________________________________________________________________________________

STORAGE 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_________________ F C 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
A. CLASSIFICATION
[ ] Warehouse [ ] Yards [ ] Garage [ ] Hangars [ ] Others, specify _____________________________
Contents ________________________________ Height of Stacks ________________________________________
Any renovations [ ] Yes [ ] No Underground: [ ] Yes [ ] No Windowless: [ ]Yes [ ] No

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 1 of 6

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

B. STORAGE TANKS/CONTAINERS
Installation: [ ] Aboveground [ ] Underground No. of Tanks _____________________
Distance from: Adjoining Bldg. _____________ Property Line ______________ Between tanks _____________
Dikes/Catch Basin Provided? [ ] Yes [ ] No
Tank No./Description Capacity Contents
1. ______________________________ __________________________ __________________________
2. ______________________________ __________________________ __________________________
3. ______________________________ __________________________ __________________________
C. HAZARDOUS MATERIALS
Presence of hazardous materials? [ ] Yes [ ] No Properly stored and Handled [ ] Yes [ ] No
Kind Container Volume Location
1. _________________ __________________ __________________ __________________
2. _________________ __________________ __________________ __________________
3. _________________ __________________ __________________ __________________
V. EXIT DETAILS
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: 30.5 m without AFSS & 46m with AFSS
Any Enclosure Provided? [ ] Yes[ ] No Min of 2-hr fire rating- 4-storey or more, Min of 1 hr, fire rung- less than 4-
MEANS OF EGRESS 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
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
BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 2 of 6
 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection

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 [ j 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

VI. 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
Other, specify _____________________________________________________________________________________

VII. 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: [ ] 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 _______________________________

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 3 of 6

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

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 Head___________________
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

VIII. 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
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

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
Date Last
Conducted:_______________________________________________________________________________________

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 4 of 6

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

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

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:

INSP EDERINO JOHN B REYES, BFP

ACTING CHIEF, FIRE PREVENTION SECTION

APPROVED / DISAPPROVED:

SUPT EDDIE W TANAWAN,DSC, BFP

CITY 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”

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 5 of 6

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

DISTRIBUTION:
Original (Applicant/Owner’s Copy)
Duplicate (BO or BPLO, as the case may be)
Triplicate (BFP Copy)

BFP-QSF-FSED-020 Rev. 01 (07.05.19) Page 6 of 6