SCHOOL FIRE SAFETY MONITORING FORM SY 2021-2022 SCHOOL DISTRICT: | SCHOOL ID: | SCHOOL NAME: DASOL 300221 MALIMPIN NATIONAL HIGH SCHOOL School (please check one) T and is valid until has Fire Safety Inspection Cerfificate (FSIC) issued on (Attach @ photocopy of the FSIC) Has NO Fire Safety Inspection Cerlificate, (Attach a photocopy of the latest BFP inspection and/or Notice to Comply from the BFP) If the school has no FSIC, please fill out the template below. BFP INSPECTION FINDINGS ACTIONS TAKEN (FOR COMPLIANCE) BY THE SCHOOL a 1. Some unmaintained/ down New fire extinguishers were Accomplished pressure portable fire purchased and installed in extinguishers installed 2. Short railings structure of every room. Expired fire extinguishers were kept in a safe and isolated room, Plan for additional railings on SHS bldg.. #7 in hallway SHS building is included in the Listed in ESIP Prepared and accomplished by: Jayby villa School ‘ordinator Approved by: renee daca ol Head ‘Seanned with CamScannerRepublic of the Phi Department of the Interior and Local Government Bureau of Fire Protection Region 1 DASOL CENTRAL FIRE STATION Dasol, Pangasinan CP no: 0905-898-0737 Number: R1-2020-PANG-03-008E 09 March 2020 Date FERDINAND R BALAOING Principal 4 (Name of Owner) ‘Malimpin National High School (Name of Establishment) Malimpin, Dasol, Pangasinan (Address) NOTICE TO COMPLY SiriMadar This has reference to the Fire Safety Inspection conducted by $EO3 Salvador R Rulla (Ware of Fire Safety Inspector) and FO3 Exequiel R Catahan with Inspection Order No. £1-2020-PANG-03-008E on March 5, 2020 {Wane of Fire Safety inspector) (@ate of inspection) within your premises located at the above address wherein inspector's report revealed the existence of the following defects/deficiencies, in the violation of the Fire Code of the Philippines of 2008 (R.A. 9514), Defects / Deficiencies ~~ Grace Period 7, Some unmaintained/down pressure portable fire 5 Working Days extinguishers installed 2. Short railings structure of SHS bldg. #7 in hallway 18 Working Days In this Regard you are hereby advised to comply /correct the above mentioned deficiencies within the above cited grace period otherwise appropriate Notice to Correct Violation with corresponding order to pay administrative fine shall be issued by this office. Very truly yours, SE vadof R Rulla BEP ‘O1C-Municipal Fire Marshal PAALALA: “MAHIGPIT NA IPINAGBABAWAL NO PANUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWAN! NITO 'ANG MAGBENTA © MAGREKOMENDA NO ANUMANG BRAND NO FIRE EXTINGUISHER” “FIRE SAFETY IS OUR MAIN CONCERN” t ‘ipo BFP com BFP-GSF-FSED-010 Rev. 01 (07.08.19) ‘Seanned with CamScannerRepublic of the Philippines Department of the Interior and Local Government Bureau of Fire Protection Region 1 Dasol Central Fire Station Poblacion, Dasol, Pangasinan Number: 09059890737 INSPECTION ORDER NUMBER: 4 ~2va0 -fPnb -*3-v09 E TO 7] FOS EXaguicl Gafahan BEP Fire Safety Inspector [PROCEED =| Mahim pin Nap hah Schoo] | ‘Malin ‘Shed PURPOSE | Fire Safety Inspection DURATION | | 8Working Days | REMARKS OR : : ADDITIONAL ‘Submit After Inspection Report (AIR) INSTRUCTION/S APPROVED: ACKNOWLEDGEMENT This is to acknowiedge that permission was granted to the above-named Fire Safety Inspector/s accompanied by authorized representative to conduct Fire Safety Inspection within the es in accordance with lav. a ‘py Bayne] jnnstua a)r)m figain Signature ovey Printed Name/Authorized Representative Date/Time BFP-QSF-FSED-009 Rev. 2 (0601.18) ‘Seanned with CamScannerRepublic of the Phil ippines Department of the Interior and Local Government Bureau of Fire Protection 7 Region 1 aso! Central Fire Station Poblacion, Dasol, Pangasinan 09089990737 . . Date_3/r)>0 suBsect: Ins oe Malo FOR — : OIC,MUNICIPAL FIRE MARSHAL ATTN : CHIEF, FIRE SAFETY ENFORCEMENT SECTION REFERENCE: INSPECTION ORDER NO, JU- 2020- fn-03-009¢ p, 3 [S[r DATEOFINSPECTION: 3/S]_ °° SS sree 3 fe _ NATURE OF INSPECTION CONDUCTED: [] Check Aj [] Building Under Construction {] Application for Occupancy Permit [] Application for Business Permit [] Others (Specify) ropriate Box ic Inspection of Occupancy {] Verification inspection of Compliance to NTCV {] Verification inspection of Complaint Received EDUCATIONAL OCCUPANCY CHECKLIST |. GENERAL INFORMATION } Name of Building, Cel, table Business Name, il Address__Malapin Date Nature of Business! Bain Cain a Name of Owner/Occupant_Ferdinand —- balaging PN contact No” Name ot Representative Jayb+ M. Mevilla To. Contact No.<_O TaCEFISF No. of Storey, _Heigt of Bldg. (mn) Portion Occupied ‘Area per fr sqm Total Fi. Area Le} * as sqm Building Permit No Date issue, Occupancy Permit No___Date Issued Latest FSIC Issued Control No. Date Issued FC Fee Certificate of Fire Dril Date Issued FC Fee, Latest Notice to Correct Violations Control No. Date Issued Name of Fire Insurance Co/Co-Insurer______ Policy No,___Datte Issued Latest Mayor's/Bus, Pemit___Dafe Issved___ Municipal License No__ Date Issued Latest Cerlificate of Electrical Inspection No._________Date Issued Other Information, ILBUILDING ConstructION Ac bw\} . Beams Columns, Flooring Exterior Walls Corridor Walls Room Partitions ‘Main Statr Windows Ceiling Main Door. Trusses Roof, Ill, SECTIONAL OCCUPANCY (Note: Indicate specific usage of each floor, section or rooms) “se —aftactcd —Sch—Sife—Dev'f- fla IV. CLASSIFICATION ‘Seanned with CamScannerRepublic of the Philippines of the Interior and Local Government Bureau of Fire Protection Department V. EXIT DETAILS Capac q Tn) AY Of Horizontal Ext (Contdor Hallway): { Requiternent:100 persons per unit of ext width per Capacity of Exit sta (Reaui 1:60 persons ji in Ranecty A _(Requirement: 60 persons per unit of exit width per min) Remote [ ] Yes []No Minimum Re Two (2) units per floor ze mer Location of Ext Prep Maximum travel Distance Re Any Enclosure Provided [ ] quirement from Farthest Room: 46 m without AFSS & 61m with AFSS_ ‘es [ ]No Min of 2-hr fire rating- 4-storey or more, Min of Thr, fire rung- less than 4-storey Exits Accessible [1 Yes [] No. Discharge of Exts Fire Doors Provided [Yes [] No Self-Closing Mechanism —__[] Yes []No_ Panic Hardware [] Yes [] No (Note: For Room Door Fire Rating Require met ‘capacity is §0 persons or more) t: 20 Minutes and shall be self-closing swing out if the MEANS OF EGRESS Readily accessible Letes [] No Obstructed Ll Yes HK Travel distance within imits {Yes [] No Dead-ends within imits I Yes [] No Adequate illumination I] Yes {] No. Properrating oftumination _[] Yes [] No Panic hardware operational [] Yes-{] No Deorswing In the ditection of ext {] Yes [] No Doors open easily [Es [] No Sett-closere operational II Yes [1 No Bldg w/Mezzanine {] Yes [] No. Mezonine with properexts —[] Yes [] No Comidors & aisles of sufficient size | ] Yes ]No Classroom: [] less than 50 students [] more than $0 students Others (specify) Two exit doors are required for more than 50 students or over93 sq.m in floor area, a. No. of Doors, Direction Angle of Swing Width b. Window opening provided [] Yes [] No Width A. VERTICAL EXITS ' Lain stairway: width__A_ Seg! - Construction Ae there ralings provided [ ] Yes [QNo Made of Any enclosure provided [ ] Yet[]No Enclosure consvuction ‘Any opening [] Yes[]No Fite door consttuction Door equipped w/Seltclosing device [] Yes | ] No Door proper rating: [ ] Yes [ ]No Door provided w/ vision panel: [ ] Yes [] NoIf 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 Stgir/Firq Escape: Number. =f. ~—_ wiath_ BS feg'd = Consreetier— Are there ralings provided #7 ves | ]No_- Made of. Location: [ interior tior Exits accessible ¢{¥es | ]No Any obstruction [ 1 Yes | LHaTermination /Discharge of Exits Any enclosure provided T | Yes[ | No Enclosure construction BFP-QSF-FSFN.015 Rev. 3G 106.01.181Paze 2 of 6 ‘Seanned with CamScannerRepublic of the Philippines Department of the Interior and Local Government Bureau of Fire Protection Any opening [] Yes [ ] No Openi pening protected [ ] Yes[ ]No Are fire door provided [ ] Yes[ ]No Width, Fire door construction, Door provided with vision panel [ ] Yes [ ] No IfYes. made of Door equipped w/ Self-closing device [] Yes [] No Doors & enclosure proper rating [] Yes T]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 |] Noenclosure properly protected [] Yes [] No Fire escape pressurized [] Yes [] No [] N/A If pressurized. what type or method = ________-- Date Last Tested, B. HORIZONTAL EXITS With vision panel [] Yes [] No Width of door/s Construction, Door swing in the direction of egress travel [] Yes[]No_ With Seit-closng device [] Yes []No Width of corridors or hall ways Construction Corridor walls extended trom 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 iluminated directional sign [] Yes [] No Properly located [] Yes [] No C. RAMPS Provided [] Yes [] No Type: [ ] Interior [ ] Exterior Width ___ class __ Railings provided [ ] Yes [] NoHeight from the floor (Requirement: 91 cm) Any enclosure provided [] Yes [] No Construction ‘Are fire doors provided [| Yes[]No Width. Fire door construction Boor 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 panel [] Yes [] No IfYes, made of Door swing in the direction of exit travel [] Yes [] No VI LIGHTINGS & SIGNS A. EMERGENCY LIGHTS Automatic Emergency Lights Provided [] weave Source of Power []AC/DC [] Others No. of Units per Floor. Located af: Hallways _Stalway 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 Mh In, Requirement: Height of 11.5. cm & width of 19.0 mm Exit Route Plan posted on: Lobby/Haliways [] Yes []No Rooms [] Yes [] No Directional Exit Signs [] Yes [] No Location ‘Seanned with CamScannerR lions Department epubli of the Philippines the Interior and Lox cal Govern! Bureau of Fire Protection a C. WARNING /SAFETY 1 LI"No Smoking” oe Other. speci U "ead én” 1] elevator sign ke pecify [] Keep Door Closed Vil. FEATURES OF FIRE PROTECTION A. PROTECTION OF VERTICAL OP! Properly protected [] Yes [] No mum Atrium [] Yes [] No Fire Doors good condition [ ] Ye Elevater opening protected. [] Yes [] cl 2 Heotives {7 Na No Pipe Chase open Aircon Duets system with pIWaian opening protected [] 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 SYST Fire Alarm Provided {Yes [JNo Type: Lyfanual [] Automatic Centralized [] Yes {Ne Location of Centraf Control No. of Bells per Floor | Location_ SHS Oda: 4497 Coverage: [ ] Budding [ ] Air Handling Unit [] Portion. Specify J 7 ‘Monitored [] Yes []No Type of initiation Device [] Smoke [] Heat [] Manual [] Water Flow [] Others No. of Pull Stations per Floor ‘Max. Horizontal Dbtance Bet. Pub Stations: 61.0 m Smoke Detectors | ] Yes [] NONO. 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 CC. STANDPIPE SYSTEM Type: [] Wet [] Dry Tank Capacity Siamese Intake Provided [] Yes [] No Location she No. of Units Accessible [] Ye: een [No Fire Hose Cabinets Provided [| Yes[]No With Complete accessories [] Yes [] No Location, 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 I 1/2 inch in diameter, respectively) Type of Nozzle Date Last Tested_ Fire Lane Provided: [] Yes[]No Location of nearest Fire Hydrant D. FIRST AJD FIRE PROTECTION EQUI Type. ‘apacity With PS Mark [Jes [] No With SO Mark [] Yes []No Properly Maintained [] Yes (]No Conspicuously Located |] Yes[]No Accessible [] Yes [] No Other Types Provided, if any, ee E. AUTOMATIC FIRE SUPPRESSION SYSTEM (SPRINKLER SYSTEM) Type of Extinguishing Agent Used. Jockey Pump Capacity. hp_______sPM Fire Pump Capacity: ap GPM Tank Capacily________gallons Maintaining Line Pressure _____~Farthest Sprinkler Head Pressure Riser Size, No. of Heads per Floor Location of Fire Department Connection ENT (PORTABLE FIRE EXTINGUISHERS) No. of units__ Zé Type of Heads Installed Total, Spacing of Heads REP-QSF-FSFD-O15 Rev. 00) 106.01.18\Page 4 of ‘Seanned with CamScannerRepublic of the Philippines Department of the Interior and Local Government Bureau of Fire Protection I pate Last Tested Conducted. | r _ Plan Se Certificate of Installation. — -P AFSS Certificate payment under Section 13 8 (5) and Fund Code No. 2531-151 F. FIREWALL Building required with firewalls [] Yes [] No Provided [] Yes [] N Any Opening [] Yes [] No iu aa VIL. BUILDING SERVICE EQUIPMENT A. Boiler Provided [] Yes [] No No. of Units provided Fuel: [ ] Diesel |] Kerosene [] Coal [] Bunker []LPG Capacity : [] Above-ground [] Underground Locatlon____________ LPG Installation Covered with Permit [] Yes []No Fuel with Storage Permit [] Yes [] No B. Generator Sef Provided []Yes[]No [] Automatic[] Manual Fuel: [] Diesel [] Gasoline Dikes/Bund wall Provided | ]Yes [ JNo Capacity Location. Container: |] Above-ground [ ] Underground Dispensing System [] By pump [] By gravity Output Capacity, kya Mechanical Permit Date Issued _ Fuel with Storage Permit [] Yes []No Others (specify) _ __ i ieomatic Transfer Switch Provided [] Yes [] No. Timenterval___ 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 F.Other Building Service Systems []WaterTteatment Faciity —[] Waste Water/sewage Treatment Facillty Fireman's key/switch provided [] Yes [] No xm RDOUS AREA [kiichen [| Laundry [] Windowless Basement |] Storage Room [] Others Separation Fire Rated [] Yes[]No Type of Fire Protection provided No. of Units Capacity __ Accessible [] Yes [] No Where Stored Covered by BFP Permit Fuel Used, park Arrester smoke Hood Chimney: Made of Presence of hazardous materials, ‘es[] No Properly stored and handled [] Yes [] No Kinds Container folyme Location 1___ Spe 1 Tank jo legs = Cantor 2, 3. Storage Permit for Flammables/Combustibles Covered by BFP Permit Clearance of Stocks From Celling Minimum Celing Clearance: 1.0m for Flammable Liquids and 0.5m for Combustible Materials X. OPERATING FEATURES Fire Safety Progrom (Under the supervision of the Chief Local Fire Service) Fire Brigade Organization [] Yes HR Fire Safety Seminar [1 Yes [4No 26s tro es BFP-QSF-FSFN-015 Rav. H@ (06.01.18)Pave 5 of 6 ‘Seanned with CamSeannerRepublic of the Philippines Of the Interior and Local Government Bureau of Fire Protection Department sketch and others) and Cor NafaceSeemndarvEei/ Fe esene si aie nes eC No/lackof ex route pian = {No /inadeouate defective Emervenyehine stam, Ease ee en ea wes TN cre ~_ ania Foo {d'No/t ark of Povtable whan Fire Futinsuichr ~ — ta eae ae ae ee er ao XY ECOMMENDATIONS ‘Maintain eood housekeening. [Door mustbeswine out C) Constructsscondar ext_C] Provide “EXIT” sens/ ext route oan, 1D Provide Fire Alarm System / Smoke and Heat Detectors. C1 Realacement / Rewiring of ectoous connections 1 Provide unit/s emergency ight/s. C Provide unit/s___lbs. re extingusher ABC type &insall SOcm above the Foor ppliance Derrerigntng units £O Ing. subject fr yeck-up by dy authorized dealer.) For ssuance of FSI non com x Sul ech foe eooplent. Pe fe saps raid. ACKNOWLEDGED B° Tae (inl. inode Fes exclgi dts Chaka Signature Over[Prifted Name of Owner/Representative Fire Safely Inspector/s Jos) We am Date atime 3/5] 2 Team Leader RECOMMEND ISSUANCE OF FSIC(NTOINTCV: i azlien He Dolan CCHIER, FIRE SAFETY ENFORCEMENT SECTION APPROVED / DSAPPROVED: SFOS S fh Rulla (OIC MUNICIPAL FIRE MARSHAL Original (BFP copy) Duplicate (B0/BPLO copy) Triplicate (Applicant copy) BFP-QSF-FSFD-015 Rav. 105 (06.01.18lPase 6 of 6 ‘Seanned with CamScanner