Home Fire Safety Survey

Welcome & Thank You for taking this Fire Safety Survery

Please provide your email address if you would like to recieve a copy of your completed survey once submitted

Email Address

Exterior Conditions

House exterior is free from hazardous fire conditions

Yes

N/A

Gas meter has a protective barrier or does not require one

Yes

N/A

Exterior is clear of excessive rubbish and vegetation that may pose a fire hazard

Yes

N/A

House number is visible from the street

Yes

N/A

Is access to your swimming pool / hot tub secured

Yes

N/A

Propane or gas grill is only used outdoors

Yes

N/A

Smoke Alarms

Smoke alarms located inside each bedroom

Yes

N/A

Smoke alarms located outside each bedroom

Yes

N/A

Smoke alarms located on every level of the home

Yes

N/A

All smoke alarms located >10 feet from stove

Yes

N/A

All smoke alarm batteries replaced every six months

Yes

N/A

All smoke alarms work when tested

Yes

N/A

All smoke alarms < 10 years old

Yes

N/A

All smoke alarms tested monthly

Yes

N/A

Carbon Monoxide Alarms

Carbon monoxide alarm is located on each level of the home

Yes

N/A

Carbon monoxide alarm batteries replaced at least annually

Yes

N/A

Carbon monoxide alarm(s) < 7 years old

Yes

N/A

Carbon monoxide alarms work when tested

Yes

N/A

Emergency Escape

The occupants have a fire escape plan

Yes

N/A

Occupants have a designated outside meeting place

Yes

N/A

All occupants know the outside meeting place

Yes

N/A

All occupants know the primary and secondary escape routes from the bedrooms

Yes

N/A

The occupants practice the fire escape plan at least once every 3 months

Yes

N/A

Bedroom windows used as a secondary escape route open easily

Yes

N/A

Security bars on windows used as a secondary escape route have a quick release device and it is operational

Yes

N/A

Exit routes are free from obstructions

Yes

N/A

Doors do not have double-keyed locks

Yes

N/A

Emergency escape ladders provided for bedrooms on upper floors

Yes

N/A

Electrical

Electrical panel is accessible and in good condition

Yes

N/A

Circuit breakers are labeled

Yes

N/A

Outlets and switches have faceplates

Yes

N/A

Power strips/power bars are used with integral over current protection

Yes

N/A

Electrical cords do not run under carpet or rugs

Yes

N/A

Electrical/extension cords are not a tripping hazard

Yes

N/A

Extension cords are not used as fixed wiring

Yes

N/A

Kitchen and bathroom outlets are GFCI

Yes

N/A

Exterior, basement and garage outlets are GFCI

Yes

N/A

Sufficient airspace left around stereos and TVs

Yes

N/A

Small appliances unplugged when not in use

Yes

N/A

Interior Conditions

The home interior is cleared of excessive combustibles

Yes

N/A

Smoking is not allowed in the home

Yes

N/A

If smoking is allowed in the home, large ashtrays are provided and emptied each night

Yes

N/A

Emergency phone numbers are posted in the home

Yes

N/A

There is a solid core door between the garage and the homes interior

Yes

N/A

Matches & lighters are secured from children

Yes

N/A

Lit candles are not left unattended

Yes

N/A

Flammable liquids are properly stored

Yes

N/A

A minimum of one functioning flashlight is in the home

Yes

N/A

Clothes dryer vent duct is made of metal and is cleaned on a regular basis

Yes

N/A

Heating & Cooking Conditions

Fireplace ashes are properly disposed of outside the home

Yes

N/A

Fireplace has a proper screen and hearth

Yes

N/A

A clear 3 feet of space is provided around the fireplace and all space heaters

Yes

N/A

Liquefied Petroleum (LP) gas heaters with self-contained fuel supplies are not used to heat the interior of the home

Yes

N/A

The chimney is inspected and cleaned annually

Yes

N/A

The furnace is inspected and cleaned annually

Yes

N/A

Hot water discharged in the home is < 120 degrees Fahrenheit

Yes

N/A

Cooking Conditions

Combustibles removed from the stovetop

Yes

N/A

Flammable objects, including pot holders, dish towels and curtains are at least 3 feet away from the stove

Yes

N/A

An adult stays in the kitchen when stove is in use

Yes

N/A

Pot & pan handles are turned in while cooking

Yes

N/A

Equipment Installed

Hardwired Smoke Alarm

Yes

N/A

Battery Smoke Alarm

Yes

N/A

Carbon Monoxide Alarm

Yes

N/A

Fire Extinguisher - Please see our online Fire Extinguisher Survey link below

Yes

N/A

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Personal information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act, and will be used for the purpose of fire prevention education. Enquiries regarding the collection of this information may be directed to the Office of the Clerk/Freedom of Information Coordinator, Municipality of Trent Hills, 66 Front Street South, Campbellford, ON K0L 1L0 705-653-1900.