Republic of the Philippines

Department of the Interior and Local Government

Bureau of Fire Protection
(Region)
(District/Province Office)
(Station)
(Station Address)
(Telephone No./Email Address)

____________________
(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) ___________________________________

INDUSTRIAL 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 floor _____________________________sqm Total Floor 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: [ ] General Industrial [ ] Special Purpose Industrial [ ] Open Industrial
Occupant Load:___________________________ Egress Capacity __________________________________________
(Requirement: 9.3 m2/p)
Any renovations [ ] Yes [ ] No if Yes, specify _________________________________________________

BFP-QSF-FSED-014 Rev. 01 (07.05.19) Page 1 of 5

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

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: 31 m without AFSS & 46 m 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-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___________________________________________________________________________________
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
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 _________________________________
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

BFP-QSF-FSED-014 Rev. 01 (07.05.19) Page 2 of 5

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

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 [ ] NoLocation 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_______________________________________________
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

BFP-QSF-FSED-014 Rev. 01 (07.05.19) Page 3 of 5

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

VIII. BUILDING SERVICE EQUIPMENT

A. Boiler Provided [ ] Yes [ ] No No. of Units provided_____________________________________________
Fuel: [ ] Diesel [ ] Kerosene [ ] Coal [ ] Bunker [ ] PG Capacity__________________________________________
Container: [ ] Above-ground [ ] Underground Location ____________________________________________________
LPG Installation Covered with Permit [ ] Yes [ ] NoFuel 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. HAZARDOUS AREA

[ ] 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

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 _____________________________________________

BFP-QSF-FSED-014 Rev. 01 (07.05.19) Page 4 of 5

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

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

Date & Time ____________________________ _____________________________________________

Team Leader

RECOMMEND ISSUANCE OF FSIC/NTC/NTCV:

____________________________________________
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”

“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-014 Rev. 01 (07.05.19) Page 5 of 5