Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
Region VIII
Norte Leyte Province
Baybay City Fire Station
R. Magsaysay Ave. Baybay City, Leyte
Tel/Fax Number: (053)-335-3998
Email:
[email protected] Date:
Inspection Order No.: Date Issued:
SIMPLIFIED CHECKLIST FOR SMALL/GENERAL BUSINESS ESTABLISHMENT
GENERAL INFORMATION
Name of Establishment/Building: ________________________________________________________________________
Address: ____________________________________________________________________________________________
Nature of Business: ___________________________________________________________________________________
No. of Buildings / Structures: __________________________________ No. of Floors: ___________________________
Portion Occupied: ____________________________________________________________________________________
Area per Floor: ____________________________________ sqm Total Floor Area: _____________________ sqm
Building Permit No.: ________________________________________ Date Issued: _____________________________
Occupancy Permit No.: ______________________________________ Date Issued: _____________________________
Latest FSIC Issued Control No.: _______________________________ Date Issued: _____________________________
Certificate of Fire Drill No.: __________________________________ Date Issued: _____________________________
Latest NTC/NTCV/AO Control No.: ___________________________ Date Issued: _____________________________
Latest Mayor’s / Business Permit: ______________________________ Date Issued: _____________________________
Latest Mechanical Permit: ____________________________________ Date Issued: _____________________________
Latest Certificate of Electrical Inspection No.: ____________________ Date Issued: _____________________________
Type of Occupancy: _________________ Type of Hazard: _____________________ Size of Building: ________________
Other Information: ____________________________________________________________________________________
BUILDING CONSTRUCTION
Beams ________________________________ Columns ___________________________ Flooring ___________________
Exterior Walls __________________________ Corridor Walls ______________________ Room Partitions _____________
Main Stair _____________________________ Windows ___________________________ Ceiling ____________________
Main Door ______________________________ Trusses ____________________________ Roof _____________________
SECTIONAL OCCUPANCY (Note: Indicate specific usage of each floor, section or rooms)
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FACILITY / BUILDING SKETCH
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For Small/General Business Establishment
FIRE SAFETY REQUIREMENTS
1. Means of Egress (Fire Exits)
a. Provided with proper numbers of exits Yes No
(Minimum of 2 exits for 500 or less occupants)
b. Provided with proper exit width?
(1120 mm for stairway, 710 mm for door, 1120 mm for hallways)
c. Exit 1? Yes No
d. Exit 2? Yes No
e. Fire resistive enclosure provided? Yes No
f. Exit 1? Yes No
g. Exit 2? Yes No
h. Terminating/discharging in a public way/safe dispersal area? Yes No
i. Exit 1? Yes No
j. Exit 2? Yes No
k. Door swing in the direction of exit travel? Yes No
l. Not obstructed? Yes No
m. Not padlocked? Yes No
2. Provided with Proper Number of Portable Fire Extinguisher? Yes No
(1 for every 100square meters)
3. Lightings & Signs
a. Provided with adequate number of emergency lights? Yes No
b. Provided with Illuminated Exit Signs? Yes No
c. Provided with Directional Exit Signs? Yes No
d. Provided with Warning/Safety Signs? Yes No
4. Presence of Hazardous Materials? Yes No
Kinds ______________ Volume ___________ Location _____________
5. Properly Stored and Handled? Yes No
6. Provided with Storage Clearance for Flammable/Combustible? Yes No
7. Provided with clearance of stocks from the ceiling? Yes No
(Minimum Ceiling Clearance: 1.0 meter for flammable liquids and 0.5
meters for combustible materials)
8. Storage area made of fire resistive construction? Yes No
9. Provided with “No Smoking” sign? Yes No
10. Is smoking permitted? Yes No
Where? ____________________
11. Is oven/stove used? Yes No
Kind of fuel ___________________
12. Provided with Automatic Kitchen Hood Suppression? Yes No
13. Alarm System
a. Manual Yes No
b. Automatic Yes No
DEFECTS / DEFICIENCIES NOTED DURING INSPECTION (Attached pictures, sketches and others)
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OTHER OBSERVATIONS
1. Occupancy permit/installation/storage/conveyance clearance presented. Yes No
2. Fire safety Inspection Fee (FSIF) receipt presented. Yes No
3. Fire/evacuation drill for the current year. (Hospital, Educational, Hotel, Minimum Yes No
of 50 occupants for Mercantile, Business, Industrial)
4. Fire Brigade organized (Minimum of 50 employees) Yes No
RECOMMENDATIONS
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Acknowledged by: Certified Correct:
_________________________________ _________________________________
Company Representative Fire Safety Inspector
Witness/es
________________________________ __________________________________
Fire Safety Inspector
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For small/General Business Establishment
