Name of Home:_______________________ Address:____________________________
Firefighter Performing Survey:________________________________ Date:__________
1. ____ Smoke alarms outside each bedroom, in bedroom, and on each level of home
2. ____ Smoke alarms worked properly when tested
3. ____ Batteries last replaced in smoke detectors on:_________________________
4. ____ Smoke detectors are properly mounted in correct locations
5. ____ Smoke detectors are clean and free of dust build-up
6. ____ Types of smoke detectors in the home ( ) Ionization ( ) Photoelectric
7. ____ Smoke detectors are less than 10 years old
8. ____ Carbon monoxide detector(s) are present and working if needed
9. ____ Doors open properly without excess effort
10.____ No double keyed deadbolts on escape doors
11.____ Windows open without excess effort
12.____ Escape plan posted in home, periodic escape drills performed
13.____ Extension cords not being used as a substitute for permanent wiring
14.____ Electrical outlets and switches have covers in place
15.____ Child proof covers on plug-ins where children are in the house
16.____ Electrical circuits do not appear to be overloaded
17.____ Electrical service panels accessible and appear in good condition.
18.____ Three foot safety zone maintained around all heated appliances
19.____ Gasoline and other flammable / combustible liquids stored properly
20.____ Woodstove or fireplace in good condition. Screens / doors in place.
21.____ Chimney has been cleaned / serviced by contractor
22.____ Light bulbs are correct wattage for the application
23.____ Hot water temperature not over 120 degrees F
24.____ Adequate air space around television and other electronics
25.____ ABC extinguisher is accessible, charged, and chemical not caked up.
26.____ Chemicals – medications stored out of reach of children
27.____ Interior / exterior dryer vents are clear of excess lint build-up
28.____ Furnace filters are routinely changed and reasonably clean
29.____ Gas / Charcoal grills not used under overhangs or near combustibles
30.____ Secondary escape windows not blocked by furnishings. Two means of escape.
31.____ Furnace / hot water heater areas clear of any combustible storage
32.____ Candles are used properly and safely while attended
33.____ Designated escape procedures and outdoor meeting place established.
34.____ Escape ladders available and ready for use in upstairs bedrooms
35.____ Matches and lighters stored properly
List any problems or comments here:
Home Safety Checklist