Republic of the Philippines
PROVINCE OF AURORA
AURORA MEMORIAL HOSPITAL
Brgy. Reserva, Baler, Aurora
Email: auroramemhos@gmail.com
PhilHealth Accredited Health Care Provider
FIRE SAFETY MAINTENANCE REPORT
A. SHORT DESCRIPTION OF THE BUILDING
I. BUILDING NAME Aurora Memorial Hospital
II.COMPLETE ADDRESS Brgy. Reserva, Baler, Aurora
III.CONTACT NUMBER
IV.CONTACT PERSON
V.EMAIL ADDRESS auroramemhos@gmail.com
VI.GROSS FLOOR AREA
VII.NUMBER OF FLOORS
VIII.TYPE OF USE Institutional Building
B. STATEMENT OF TESTING AND MAINTENANCE STANDARDS USED
C. DISCUSSIONS OF FIRE PROTECTION AND LIFE SAFETY ISSUES
1. The building is equipped with fire safety equipment as follows:
I. FIRE PUMP SYSTEM BRAND TYPE QUANTITY CAPACITY CUT-OUT CUT- IN
II. FIRE DETECTION AND ALARM BRAND TYPE QUANTITY CAPACITY
SYSTEM
III. FIRE EXTINGUISHERS BRAND TYPE QUANTITY STATUS
IV. EMERGENCY LIGHTS BRAND TYPE QUANTITY STATUS
Republic of the Philippines
PROVINCE OF AURORA
AURORA MEMORIAL HOSPITAL
Brgy. Reserva, Baler, Aurora
Email: auroramemhos@gmail.com
PhilHealth Accredited Health Care Provider
V. SMOKE EXTRACTION FAN BRAND TYPE QUANTITY STATUS
2. Life Safety Activities
NR TYPE OF TRAININGS / SEMINARS RESOURCE FREQUENCY DATE CONDUCTED
D. EXITS AND MEANS OF EGRESS
a. Number of active Exits
NR LOCATION TYPE QUANTITY MAKE LOCK TYPE
b. Maintenance records done on egress component such as doors and enclosed stairways
NR LOCATION TYPE QUANTITY MAKE LOCK TYPE
E. FIRE SUPPRESSION
a. Maintenance and testing records done on fire pumps, sprinkler system, portable fire
extinguishers, standpipes and other fire suppression systems
NR EQUIPMENT FREQUENCY OF FREQUENCY OF PMS FREQUENCY DATE LAST
INSPECTION TESTING TESTED
Republic of the Philippines
PROVINCE OF AURORA
AURORA MEMORIAL HOSPITAL
Brgy. Reserva, Baler, Aurora
Email: auroramemhos@gmail.com
PhilHealth Accredited Health Care Provider
b. Result of Annual fire pump tests, annual main drain tests, and water flow test for
standpipe, submit other test results as appropriate
NR DESCRIPTION TEST FLOW IN TEST TESTING DATE LAST
GPM PRESSURE IN FREQUENCY TESTED
PSI
F. FIRE DETECTION, ALARM, COMMUNICATION AND EVALUATION SYSTEM
a. Testing and maintenance records done on components of the Detection and alarm
system including the fire alarm control panel
NR EQUIPMENT FREQUNECY OF TESTING PMS FREQUENCY DATE LAST
INSPECTION FREQUENCY TESTED
G. SMOKE CONTROL MANAGEMENT
a. Maintenance and testing records of the various component of the smoke management
system. Including test records for pressurization fans for flows and fan controls.
NR EQUIPMENT FREQUNECY OF TESTING PMS FREQUENCY DATE LAST
INSPECTION FREQUENCY TESTED
H. EMERGENCY POWER SUPPLY
Republic of the Philippines
PROVINCE OF AURORA
AURORA MEMORIAL HOSPITAL
Brgy. Reserva, Baler, Aurora
Email: auroramemhos@gmail.com
PhilHealth Accredited Health Care Provider
a. Maintenance and testing records of the system components of the emergency power
supply.
NR TYPE QUANTITY TOTAL TESTING DATE LAST
CAPACITY (KVA) FREQUENCY TESTED
I. OTHER TESTING AND MAINTENANCE RECORDS, INCLUDING TEST RESULTS OF
ELEVATOR RECALL SYSTEM.
NR TYPE QUANTITY CAPACITY IN TESTING DATE LAST
PAX FREQUENCY TESTED
Prepared by: Noted by:
_____________________________ _____________________________
(Safety Officer) (Owner / Representative)
**Kindly attach pictures and other records of actual testing and PMS conducted on fire-fighting equipment.
