Home Safety Survey - Orange County Fire Rescue

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PROGRAMS

Car Seat Checkpoints

Children's Burn Foundation

Children's Safety Village

Citizen CPR

Citizens' Fire Academy

Community Emergency Response Training

Community Events Request

Community Sharps Disposal Program

Explorer Program

Fire Prevention Activities for Schools

Juvenile Fire Setters

Reserve Firefighter Association

Sudden Cardiac Death

Home Safety Survey
Please complete the survey, below.
Personal Information
Name:
Address:
Home Phone:
Email:

Questionnaire
1) The Emergency phone number in this area is 9-1-1. Do you have this number posted by all your phones?
YES NO
2) Is your house number visible from the street or roadway both day and night?
YES NO
3) Is your home equipped with smoke detectors outside of all sleeping areas and on each floor?
YES NO
4) Have you checked your smoke detetctor in the last six months?
YES NO
5) Have you changed the battery in your smoke detector in the last six months?
YES NO
6) Does everyone in the home know the warning sound of the smoke detector?
YES NO
7) Do you practice exit drills in your home?
YES NO
8) Does each family member know at least two exits in case of emergency?
YES NO
9) If someone in your family smokes, are they careful with their smoking materials?
YES NO
10) Are all hazardous materials, such as gasoline stored in proper containers and away from the living and sleeping areas?
YES NO
11) Is your cooking area free of excess grease?
YES NO
12) Are your extension cords in good working condition i.e not cut or damaged, dry rotted or frayed?
YES NO
13) Are any of your electrical outlets overloaded?
YES NO
14) When using a space heater, is there at least 3 feet of open space all around it?
YES NO
15) Do you have at least one updated multipurpose(ABC) fire extinguisher in your home?
YES NO
16) Do you have burglar/security bars over your window/door?
YES NO

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