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Home safety survey
1.
Do your home have working smoke Detector?
Yes
No
2.
Do you have a fire extinguisher in your home
Yes
No
*
3.
Have you been trained on how to properly use a fire extinguisher ?
(Required.)
Yes
No
4.
Did you know fire extinguisher need to be serviced on a yearly basis to ensure it is operational?
Yes
No
*
5.
Do the family (household) have a fire escape plan in place ?
(Required.)
Yes
No
6.
Do you practice your fire escape plan at least twice a year
Yes
No
Other (please specify)
7.
Do you household have someone that may require assistance in the event of an emergency.?
Yes
No
Other (please specify)
8.
Does your home have a visible house number ?
Yes
No
Other (please specify)
9.
Does your home have propane appliances?
Yes
No
Other (please specify)
*
10.
Do you have a CO (carbon monoxide) detector or a propane detector install incase of leaks.?
(Required.)
Yea
No