Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
TALAINGOD FIRE STATION – DAVAO DEL NORTE PROVINCE
Purok 4B, Sto.Nino, Talaingod, Davao del Norte
Contact Number: 09617826626
Email: [email protected]

____________________
(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) ___________________________________

DETENTION AND CORRECTIONAL 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 ________________ 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: [ ] New [ ] Existing
[ ] 1. Health Care Facilities (Hospitals & Nursing Homes)
[ ] 2. Residential Custodial Care (Nurseries, Home for the Aged, Mentally Retarded Care Institutions, etc)
[ ] 3. Residential Restrained Care (Penal Institutions, Reformaries, Jails, etc)
Occupant Load:_________________(Requirement: 11 sqm/person at Sleeping Dept; eg, restrained care & hospital
OPD ; 22 sq.m./person at in-Patient Treatment Dept. eg. Custodial & Healthcare)
Any renovations [ ] Yes [ ] No if Yes, specify ___________________________________________________

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

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 1 of 6

 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
TALAINGOD FIRE STATION – DAVAO DEL NORTE PROVINCE
Purok 4B, Sto.Nino, Talaingod, Davao del Norte
Contact Number: 09617826626
Email: [email protected]

Location of Exit____________________________________________________________________________________
Maximum travel Distance Requirement: (a) 30m from any room door to exit;(b)15m from any point in a sleeping room to
an exit door of that room;(c)46m from any point in a room to a exit;(d) if equipped with AFSS,(a) or (c) may be increased
by 15m.
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 pane l [ ] Yes [ ] No If Yes, made of __________________________________
Door swing in the direction of exit travel [ ] Yes [ ] No
BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 2 of 6
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
TALAINGOD FIRE STATION – DAVAO DEL NORTE PROVINCE
Purok 4B, Sto.Nino, Talaingod, Davao del Norte
Contact Number: 09617826626
Email: [email protected]

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
________________________________
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
BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 3 of 6
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
TALAINGOD FIRE STATION – DAVAO DEL NORTE PROVINCE
Purok 4B, Sto.Nino, Talaingod, Davao del Norte
Building required with firewalls [ ] Yes [ ]Contact
No Number:Provided
09617826626
[ ] Yes [ ] No
Any Opening [ ] Yes [ ] No Email: [email protected]

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. 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-016 Rev. 01 (07.05.19) Page 4 of 6

 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
TALAINGOD FIRE STATION – DAVAO DEL NORTE PROVINCE
Purok 4B, Sto.Nino, Talaingod, Davao del Norte
Contact Number: 09617826626
Email: [email protected]

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:

_ SFO1 Leopoldo B Labajo Jr__ ___

CHIEF, FIRE SAFETY ENFORCEMENT SECTION

APPROVED / DISAPPROVED:

SFO4 Erico E Ganiera _

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”

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 5 of 6
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
TALAINGOD FIRE STATION – DAVAO DEL NORTE PROVINCE
Purok 4B, Sto.Nino, Talaingod, Davao del Norte
Contact Number: 09617826626
DISTRIBUTION:
Original (Applicant/Owner’s Copy) Email: [email protected]
Duplicate (BO or BPLO, as the case may be)
Triplicate (BFP Copy)

BFP-QSF-FSED-016 Rev. 01 (07.05.19) Page 6 of 6