MSA-Safety Survey

Quick 90 Second Survey

Once the survey is complete, qualified respondents will be selected to receive a limited number of Emergency Gifts for viewing fire safety information. By submitting the survey your name will be entered and you may be selected. So lets Get Started!

Question Title

* 1. Check any of the dangers you are concerned about?

Home Fire

Carbon Monoxide

Flooding or Water Damage

Frozen Pipes

Home Invasion

Question Title

* 2. How long do you have to escape a Home Fire?

10-13 minutes

7-10 minutes

4-6 minutes

0-3 minutes

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* 3. Do you have Children, Pets or Both?

Children

Pets

Both

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* 4. Married, Living Together or Single?

Married

Living Together

Single

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* 5. Your Occupation?

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* 6. Spouse Occupation?

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* 7. Age Range

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 8. Do you own or rent?

Own

Rent

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* 9. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Cell Phone Number

Question Title

* 1. Check any of the dangers you are concerned about?

Question Title

* 2. How long do you have to escape a Home Fire?

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* 3. Do you have Children, Pets or Both?

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* 4. Married, Living Together or Single?

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* 5. Your Occupation?

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* 6. Spouse Occupation?

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* 7. Age Range

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* 8. Do you own or rent?

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* 9. Contact Information

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* 10. Who sent you this or whose social media post did you click on?