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: Baybay_cfs@yahoo.com

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)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

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)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
__________________________________________________________________________________________________

Acknowledged by: Certified Correct:

_________________________________ _________________________________
Company Representative Fire Safety Inspector

Witness/es
________________________________ __________________________________
Fire Safety Inspector

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For small/General Business Establishment