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:

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Home Safety Checklist