SMALL/GENERAL BUSINESS OCCUPANCY
I. REFERENCE:
lnspection Order No. (lO)
*
Business Identification Number (BIN) / Business Account Number (BAN)
*
Date lssued
*
-
Month
-
Day
Year
Date lnspected
*
-
Month
-
Day
Year
ll. NATURE OF INSPECTION CONDUCTED (Check appropriate box)
NATURE OF INSPECTION CONDUCTED (Check appropriate box)
*
lnspection during construction
FSIC for Certificate for Occupancy
FSIC for Business Permit (New)
FSIC for Business Permit (Renewal)
FSIC for Certificate of Annual Inspection (PEZA)
Verification Inspection for Compliance
NTC
NTCV
Abatement
Closure
Notice of Disapproval, if Certificate of Occupancy
Other
FSI Name
*
FSI Email Address
*
***REMARKS ON ESTABLISHMENT***
*
Please Select
OPEN
PERMANENTLY CLOSED/RETIRED ESTABLISHMENT
CLOSED DUE TO COMMUNITY QUARANTINE GUIDELINES
CANNOT BE LOCATED
BUSINESS TRANSFERRED
NOT OPERATIONAL
NOT EXISTING
CHANGE OF BUSINESS NAME
DOUBLE IO/ALREADY INSPECTED
RESCHEDULED
REFUSED ENTRY
Submit
III. GENERAL INFORMATION
Business Identification Number (BIN) / Business Account Number (BAN)
Name of Building
Address
Business Name
Nature of Business
Name of Owner/Representative
Email Address of Owner/Representative
Phone Number
Ex: 09191234567
FSEC No:
Date lssued
-
Month
-
Day
Year
Building/Renovation Permit
Date lssued
-
Month
-
Day
Year
FSIC No. (Latest)
Date lssued
-
Month
-
Day
Year
Business Permit No.
Date lssued
-
Month
-
Day
Year
Fire lnsurance Policy No.
Date lssued
-
Month
-
Day
Year
IV. OTHER INFORMATION
Type of Occupancy:
Mercantile
Business
Other
Construction Type:
Timber Framed and Walls
Steel Framed and Walls
Reinforced Concrete Framed with Masonry Walls
Mixed Constuction
Total Floor Area:
Numeric only
Occupant Load:
No. of Stories:
Portion Occupied:
Building Height:
With Mezzanine:
Yes
No
Handrails/Railings provided:
Yes
No
V. MEANS OF EGRESS
A. EXIT ACCESS
Actual Dim.
Passed
Failed
Remarks/ Corrective Action
Doors
Corridors / Hallways
B. EXITS
Clear Width
Passed
Failed
Remarks / Corrective Action
Exits Doors
Horizontal Exits
Stairs
Atleast 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)
Passed
Failed
Minimum letter height, 1 50 mm; Width of Stroke, 19 mm
EXIT signs are posted along Exit access, Exits and Exit discharge
EXIT signs are properly illuminated
VIl. HAZARD
Hazard Classification
Low
Ordinary
High
Storage Clearance Require
Yes
No
Fire Safety Clearance for Storage
Yes
No
Date Issued:
-
Month
-
Day
Year
Date
Control Number:
Hazard Content:
Total Volume:
Location:
A. OTHER FLAMMABLE LIQUIDS (I.E ALCOHOL, ETHER, ETC...)
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
lnstallation Clearance
Yes
No
Date Issued:
-
Month
-
Day
Year
Control Number:
Stored in sealed metal container?
Yes
No
Provided with ''NO SMOKING" sign
Yes
No
VIII. FIRE PROTECTION
A. First Aid Fire Protection (Fire Extinguishers)
Passed
Failed
ITEM TO INSPECT: > Fire Extinguisher Size -Minimal sizes of fire extinguishers for the listed grades of hazards shall be provided on the basis of table 7 & 8 of RIRR of RA 9514.
ITEM TO INSPECT: >Minimum number of Extinguisher -The minimum number of extinguishers shall be sufficient to meet the requirements of table 7 & 8 of RIRR of RA 9514
ITEM TO INSPECT: >Location -All extinguishers are in their proper location.
ITEM TO INSPECT: >Seals & Tags -Extinguisher seals and tags are intact and extinguisher was serviced in the last 12 months.
ITEM TO INSPECT: >Markings -Proper marking on extinguisher to indicate the type of fire extinguisher can be used on
ITEM TO INSPECT: >Condition -No leaks, corrosion or other defects noticed
ITEM TO INSPECT: >Pressure -Pressure gauge arow pointing in the "green'' area
Type:
Quantity:
Capacity:
B. Emergency Lighting Systems Provided:
Yes
No
Functional:
Yes
No
Locations:
Hallways
Exit Doord
StairwayLandings
Other
C. Fire Detection and Alarm Provided:
Yes
No
Fire Detection and Alarm:
Smoke
Heat
Fire Detection and Alarm:
Manual
Automatic
Functional:
Yes
No
Integrated:
Yes
No
Units per Floor:
Adequate:
Yes
No
Location of Control Panel (if Applicable):
DEFECTS/DEFICIENCIES
ITEM IV
ITEM V
ITEM VI
ITEM VII
ITEM VIII
RECOMMENDATIONS
FSI Recommendation
Please Select
For Issuance of FSIC
For Issuance of NTC
Recommendation
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 lnspection Certificate (FSIC).
Fire Code Fees to pay:
Please Select
Fire Code Fee
Storage Clearance Fee
Conveyance Clearance Fee
For Issuance of:
Notice to Comply
Notice to Correct Violation
Closure Order
Abatement Order with Administrative Fine
Closure Order for the non-Payment of Administrative Fine
Notice of Disapproval, if Certificate of occupancy is applied
AMOUNT PAID
O.R. NUMBER
Date of Payment
-
Month
-
Day
Year
FIRE SAFETY INSPECTION CERTIFICATE
FOR CERTIFICATE OF OCCUPANCY
FOR BUSINESS PERMIT (NEW/RENEWAL)
Other
THIS CERTIFICATION IS VALID FOR
Please Select
issuance of FSIC for business permit only
issuance of FSIC for occupancy permit only
ADDRESS DESCRIPTION
(ex. ABC Barbershop with 5sqm floor area occupying a 1 storey commercial building)
ACKNOWLEDGE BY:
Name of Owner/Representative
Owner/ Representative Signature
Signature of Owner/Representative
Date
-
Month
-
Day
Year
Fire Safety Inspector(s) NAME
FSI Signature
Fire Satey Inspector
FSI Email Address
C,FSES Email Address (For Recommendation)
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Submit
FOR CHIEF OF FIRE SAFETY ENFORCEMENT SECTION
Please enter verification code
CHIEF, FSES RECOMMENDATION
RECOMMEND ISSUANCE OF FSIC
RECOMMEND ISSUANCE OF NTC
Chief, FSES Signature
CFM Email Address (For Approval)
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FOR CFM/MFM (ISSUANCE OF NTC)
Please enter verification code
APPROVAL(NTC)
APPROVED
DISAPPROVED
Date of Approval(NTC)
-
Month
-
Day
Year
CFM/MFM Signature(NTC)
Preview PDF
Submit
C,FSES Email Address(NTC)
Email Address of Owner/Representative (NTC)
NTC Serial Number
NTC Serial Number Generator
NTC INVALID FSIC
if disapproved(ntc)
FOR CITY/MUNICIPAL FIRE MARSHAL
Please enter verification code
APPROVAL
APPROVED FSIC
DISAPPROVED FSIC
Date of Approval
-
Month
-
Day
Year
Date
CFM/MFM Signature
Preview PDF
Submit
C,FSES Email Address
Email Address of Owner/Representative
Date+1 year
-
Month
-
Day
Year
Date
FSIC Serial Number
FSIC Serial Number Generator
if disapproved
Should be Empty: