Ontario Fire Prevention Services Safety Survey

Fire Safety Survey

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

Fire

Carbon Monoxide

Home Invasion

Flood

Freezing Pipes

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

0-3 minutes

4-6 minutes

7-9 minutes

10-13 minutes

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

Children

Pets

Both

Neither

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

Single

Married

Common-law

Live with parents

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* 5. What is your occupation?

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* 6. What is your spouse's occupation

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* 7. What is your age?

18-24

25-34

35-44

45-54

55-64

65-75

75 +

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* 8. Do you own the house where you live

Own

Rent

Neither (please specify)

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* 9. 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

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* 10. Where did you learn about us ( if from a friend please indicate who)

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* 11. Are you Currently interested in learning about part time opportunities.

Yes

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

Yes