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