Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
(FIRE STATION LETTERHEAD)

FIRE SAFETY INSPECTION CHECKLIST

SMALL/GENERAL BUSINESS ESTABLISHMENT
Sari-Sari Store, Kiosk, Barber Shop, Beauty Parlor, Water
Refilling, Convenience Store and alike

I. REFERENCE:
Inspection Order No. (IO):_______________________ Date Issued :_________________ Date Inspected :__________________
II. NATURE OF INSPECTION CONDUCTED (Check appropriate box)
[ ] Inspection during construction [ ] FSIC for Certificate of Annual Inspection (PEZA)
[ ] FSIC for Certificate for Occupancy [ ] Verification Inspection for Compliance:
[ ] FSIC for Business Permit (New)
[ ] FSIC for Business Permit (Renewal) [ ] NTC / [of] Disapproval,
Notice NTCV / [ ] Abatement / [of] Occupancy
if Certificate Closure
[ ] Others (Specify):________________________________________

III. GENERAL INFORMATION

Name of Building : _____________________________________________________________________________
Address : _____________________________________________________________________________
Business Name : _____________________________________________________________________________
Nature of Business : _____________________________________________________________________________
Name of Owner/Representative : _____________________________________ Contact No. : ________________________
FSEC No. : ____________________________ / Date Issued : ______________________________
Building/Renovation Permit : ____________________________ / Date Issued : ______________________________
FSIC No. (Latest) : ____________________________ / Date Issued : ______________________________
Business Permit No. : ____________________________ / Date Issued : ______________________________
Fire Insurance Policy No. : ____________________________ / Date Issued : ______________________________

IV. OTHER INFORMATION

Type of Occupancy: [ ] Mercantile [ ] Business [ ] Others (Specify): __________________________
Construction Type: [ ] Timber Framed and Walls [ ] Reinforced Concrete Framed with Masonry Walls
[ ] Steel Framed and Walls [ ] Mixed Construction
Total Floor Area: ________m2 Occupant Load: _________Person/s No. of Stories: ______ Portion Occupied: __________
Building Height: ________m With Mezzanine: [ ] Yes / [ ] No Handrails/Railings provided: [ ] Yes / [ ] No

V. MEANS OF EGRESS
A. EXIT ACCESS
Horizontal components Actual Dim. Passed Failed Remarks / Corrective Action
Doors (m) [ ] [ ]
Corridors / Hallways (m) [ ] [ ]

B. EXITS
Components Clear Width Passed Failed Remarks / Corrective Action
Exits Doors (m) [ ] [ ]
Horizontal Exits (m) [ ] [ ]
Stairs (m) [ ] [ ]
* Min. Width 0.60 m. between Rails of Fire Escape Stairs * Min. New Stair Width (0.915 m.) < 50 persons OL

At least two (2) means of egress for each floor [ ] Yes / [ ] No Exits doors open and close properly? [ ] Yes / [ ] No
Do doors swing in direction of egress? [ ] Yes / [ ] No

VI. SIGNS, LIGHTING, AND EXITS SIGNAGE

A. MARKING OF MEANS OF EGRESS (EXIT)
Components Passed Failed
Minimum letter height, 150 mm; Width of Stroke, 19 mm [ ] [ ]
EXIT signs are posted along Exit access, Exits and Exit discharge [ ] [ ]
EXIT signs are properly illuminated [ ] [ ]

VII. HAZARD
Hazard Classification: [ ] Low [ Ordinary [ ] High Storage Clearance Required? [ ] Yes / [ ] No
Fire Safety Clearance for Storage [ ] Yes / [ ] No Date Issued:_______________ Control No.__________________
Hazard Content: _________________________________ Total Volume: _________________________________________
Location: ______________________________________________________________________________________________

 Low-hazard contents shall be classified as those of such low combustibility that no self-propagating fire therein can occur.

A. OTHER FLAMMABLE LIQUIDS (I.E. ALCOHOL, ETHER, ETC…)

Components Passed Failed
Clearance of Stocks from the Ceiling [ ] [ ]
Gas Detector and Shut Off Device for LPG [ ] [ ]
LPG System provided with Approved Plans, (if 300 kgs./300 GWC) [ ] Yes / [ ] No
Installation Clearance [ ] Yes / [ ] No Date Issued:_______________ Control No.__________________

BFP-QSF-FSED-024 Rev.02 02.09.23)

 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
(FIRE STATION LETTERHEAD)

Stored in sealed metal containers? [ ] Yes / [ ] No Provided with “NO SMOKING” sign? [ ] Yes / [ ] No

VIII. FIRE PROTECTION

A. First Aid Fire Protection (Fire Extinguishers)
Item to Inspect Identification Passed Failed
Minimal sizes of fire extinguishers for the listed grades of hazards
Fire Extinguisher Size [ ] [ ]
shall be provided on the basis of table 7 & 8 of RIRR of RA 9514.
The minimum number of extinguishers shall be sufficient to meet the
Minimum number of Extinguisher [ ] [ ]
requirements of table 7 & 8 of RIRR of RA 9514.
Location All extinguishers are in their proper location. [ ] [ ]
Extinguisher seals and tags are intact and extinguisher was serviced
Seals & Tags [ ] [ ]
in the last 12 months.
Proper marking on extinguisher to indicate the type of fire the
Markings [ ] [ ]
extinguisher can be used on.
Condition No leaks, corrosion or other defects noticed. [ ] [ ]
Pressure Pressure gauge arrow pointing in the “green” area [ ] [ ]

Type: ____________________________ Quantity: ________________________ Capacity: __________________________

B. Emergency Lighting Systems Provided: [ ] Yes / [ ] No Functional: [ ] Yes / [ ] No
Locations: [ ] Hallways [ ] Exit Doors [ ] Stairway Landings Others Specify: _________________________________
C. Fire Detection and Alarm Provided: [ ] Yes / [ ] No [ ] Smoke [ ] Heat [ ] Manual / [ ] Automatic
Functional: [ ] Yes / [ ] No Integrated: [ ] Yes / [ ] No Units per floor: _____ units Adequate: [ ] Yes / [ ] No
Location of Control Panel (if Applicable): ______________________________________________________________________

DEFECTS/DEFICIENCIES
ITEM IV: ___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
ITEM V: ___________________________________________________________________________________________________________

___________________________________________________________________________________________________________
ITEM VI: ___________________________________________________________________________________________________________

___________________________________________________________________________________________________________
ITEM VII: ___________________________________________________________________________________________________________

___________________________________________________________________________________________________________
ITEM VIII: ___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

RECOMMENDATIONS
[ ] Comply the following DEFFECTS/DEFICIENCIES stated above and pay the corresponding Fire Code Fees including the Storage
Clearance Fee , Conveyance Clearance Fee before the issuance of Fire Safety Inspection Certificate (FSIC).
Fire Code Fees to pay: _______________________________________________________________________________________
[ ] For issuance of [ ] Notice to Comply [ ] Abatement Order with Administrative Fine
[ ] Notice to Correct Violation [ ] Closure Order for the non-payment of Administrative Fine
[ ] Closure Order [ ] Notice of Disapproval, if Certificate of occupancy is applied

______________________________________________________________________ ____________________________
Fire Safety Inspector/s Team Leader
ACKNOWLEDGED BY: RECOMMEND APPROVAL:

______________________________________________ ________________________________________________
Signature Over Printed Name of Owner/ Representative CHIEF, FIRE SAFETY ENFORCEMENT SECTION/UNIT
Date & Time: ______________________
APPROVAL:

________________________________________________
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 (BFP Copy)

BFP-QSF-FSED-024 Rev.02 02.09.23)