OFPS Fire and Safety Survey

Fire And Safety Survey

Question Title

* 1. Which of the following are you most concerned about?

Fire

Carbon Monoxide

Home Invasion

Flood

Home Renovations

Question Title

* 2. How long do you have to escape a home fire?

0-3 minutes

4-6 minutes

7-9 minutes

10-13 minutes

Question Title

* 3. Do you have children or pets in you home?

Children

Pets

Both

Neither

Question Title

* 4. Are you Single, married , or living common-law?

Single

Married

Common-law

Live with parents

Question Title

* 5. What is your age?

18-24

25-34

35-44

45-54

55-64

65-75

75 +

Question Title

* 6. Contact information( If selected you will be contacted at the phone number listed.)

Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 7. Do you agree to a no obligation home fire and safety evaluation in your home to get your gift?

Yes

No