Home Safety Survey

The purpose of this survey is to raise awareness about home fire safety.

Answering "no" to any of the following questions indicates items that are hazardous for you and your family. These items, or lack of, may increase your risk of fire or injury. If all answers are "yes", then you are doing a great job when it comes to fire safety in your home!

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* 1. Please provide contact information below. This information is only used so we can better serve you, and is never shared.

Name

Phone Number

Email Address

Zip Code

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* 2. Does your home have working smoke alarms?

Yes

Make sure you have working smoke alarms installed in the following areas.

Hallways
Bedrooms
Living areas
Basement

According to the US Fire Administration, about 2500 people die each year in fires. The vast majority of these deaths occur where there are no smoke alarms. Most smoke alarms last for about 10 years and should be replaced at that time. If your alarm does not have a sealed battery unit, then batteries should be replaced every six months and the alarms should be tested at least once a month.

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* 3. Do you have an escape plan if there was an emergency such as a fire, in your home?

Yes

Having an escape plan is so important. Please take the time to create one for your home. Remember, your plan should be as simple as possible and everyone needs to know it and practice it on a regular basis. Your plan needs to show two ways out of every room in your home and a family meeting place outside and away from the home. You need to practice your plan with all members of your home to make sure it works as is planned.

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* 4. Can ALL occupants of your home escape without assistance in an emergency?

Yes

If anyone in your home cannot escape on their own in an emergency, they are at a much higher risk of injury or death. A new baby or an elderly relative visiting or moving in may change things for you. Adults with limited mobility should not be above the first floor. Review your plans often to make sure your circumstances have not changed.

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* 5. Do you have a meeting place outside of your residence to meet in the event of an emergency?

Yes

Predetermined meeting spots can help reduce the confusion when there is an emergency. Make sure your identified meeting spot is known by everyone in your home. A large tree, the mailbox, or a neighbors house all make good meeting places. When first responders arrive to help, let them know if everyone is accounted for or if they need to find someone.

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* 6. Cooking is one of the leading causes of home fires. Is your kitchen fire safe?

	Yes	No
Kitchen stove hood is clean and vented to outside	Kitchen stove hood is clean and vented to outside Yes	Kitchen stove hood is clean and vented to outside No
You know how to extinguish a grease fire	You know how to extinguish a grease fire Yes	You know how to extinguish a grease fire No
You have a fire extinguisher and know how to use it	You have a fire extinguisher and know how to use it Yes	You have a fire extinguisher and know how to use it No
Cooking area is free from combustibles (3 foot rule)	Cooking area is free from combustibles (3 foot rule) Yes	Cooking area is free from combustibles (3 foot rule) No

We want you to cook safely in your home.

Be on alert! If you are sleepy or have consumed alcohol don’t use the stove or stovetop.
Stay in the kitchen while you are frying, boiling, grilling, or broiling food. If you leave the kitchen for even a short period of time, turn off the stove.
If you are simmering, baking, or roasting food, check it regularly, remain in the home while food is cooking, and use a timer to remind you that you are cooking.
Keep anything that can catch fire — oven mitts, wooden utensils, food packaging, towels or curtains — away from your stovetop.

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* 7. Do you allow smoking inside your home?

Yes

One of the leading causes of fire deaths in the home is smoking. These objects can smolder for hours unnoticed, often proving deadly. Never allow smoking on any upholstered furniture, carpeted area, or bed. We strongly suggest not allowing any smoking inside of your home. Make sure cigarette butts are completely extinguished before throwing them away.

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* 8. Do you use candles, incense, or other open flame or smoldering objects in your home?

Yes

If you ever use candles, incense, or other open flame or smoldering objects, please be extremely careful. These items at times seem as though they present no risk for a fire, but unfortunately that is simply not true. Make sure there are no other flammable objects within the area or that drapes and clothing cannot come in contact with them. These items are extremely dangerous and someone needs to be supervising them at all times.

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* 9. Do you use a portable space heater or fireplace to heat your home?

Yes

Portable space heaters can be extremely dangerous. They can easily be knocked over by people or pets. They can also be placed too close to flammable objects like curtains, clothes, furniture, etc. If you choose to use one, do not use one while sleeping and always stay in the same room as the heater. Pets and children should not have access to them at any time.

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* 10. Does your home have working Carbon Monoxide (CO) alarms?

Yes

Carbon monoxide (CO) is called the invisible killer because you cannot see it or smell it. This poisonous gas is created when fossil fuels, such as kerosene, gasoline, coal, natural gas, propane, methane or wood, do not burn completely. The only way to detect CO is with a working CO alarm.

CO alarms should be installed in a central location outside each sleeping area and on every level of the home.

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* 11. Graham Fire & Rescue sends out informational emails a couple times a year regarding fire safety tips and fire department updates. Would you like to be added to our e-newsletter list to receive these emails?

Yes