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2. Home Safety Survey
   This is a home safety survey that will help you determine some possible hazards in and around your home. It is anonymous and for no other purpose than to help you think about the safety of you and anyone in your home. There are about 40 quick questions to consider. We encourage you to fix any hazards you may discover before they lead to problems or injuries.
4. 
6. 1. Do you rent or own your own home?

   1. Rent
   2. Own

   *If you rent, please check your rental agreement so you know if you can service smoke or carbon monoxide alarms or if they should be checked regularly for you.
7. 2. Can your house number be seen clearly from the street?

   1. Yes
   2. No
9. 3. Do you have smoke alarms in your home?

   1. Yes
   2. No
10. 4. How many smoke alarms are in your home?

    1. One
    2. Two or more, but not in the places listed below
    3. Two or more, in all of the recommended locations listed below

    *Smoke alarms should be mounted in every bedroom, outside of every sleeping area, and on every level of the the home.
12. 5. Do you know if your smoke alarms are working?

    1. Yes
    2. No
    3. Not sure
    4. There are no smoke alarms.
13. 6. Do you test the smoke alarm batteries every month?

    1. Yes
    2. No
    3. There are no smoke alarms.
15. 7. Do you clean, dust, or vacuum your smoke alarm at least once a month?

    1. Yes
    2. No
    3. I was not aware this was important.
16. 8. Do you have any fuel burning appliances in your home?

    1. Yes
    2. No
18. 9. Do you have working carbon monoxide alarms in your home?

    1. Yes
    2. No
19. 10. Does your family have a Home Fire Escape Plan?

    1. Yes
    2. No
21. 11. Does your family practice your Home Fire Escape plan a few times every year to make sure everyone knows what to do if there is a fire emergency?

    1. Yes
    2. No
22. 12. Does your plan include how young children or anyone who could not get out of the home by themselves will be assisted in their exit?

    1. Yes
    2. No
24. 13. Is there anyone who is disabled or over the age of 65 in your home?

    1. Yes
    2. No
25. 14. If anyone in the home is disabled or over the age of 65, have you filled out a "Heads Up" form with our Emergency Communications Center?

    1. Yes
    2. No

    *If not, please call 890-3600 for assistance. We will help you get this important information.
27. 15. In a fire, if there were smoke in your home, do you know to get low and crawl under the smoke as you exit?

    1. Yes
    2. No

    *Smoke from a home fire is filled with superheated toxic gases. It is very dangerous. Stay low and go quickly.
28. 16. Are all hallways, doorways, and means of exit unobstructed and clear of clutter?

    1. Yes
    2. No
30. 17. Is your home cluttered with clothes, magazines, newspapers, or other items that can burn?

    1. Yes
    2. No
31. 18. Do you have a charged fire extinguisher in the home?

    1. Yes
    2. No
33. 19. Have you been trained to use a fire extinguisher?

    1. Yes
    2. No

    *If not, do not attempt to use one in an emergency situation. Get out and call 911.
34. 20. Do you routinely clean your clothes dryer lint filter and vent pipe to make sure they are clear?

    1. Yes
    2. No
36. 21. Do you remain in the kitchen the whole time you are cooking food on the stove?

    1. Yes
    2. No

    Distractions happen. If you have to step away from the kitchen while food is cooking on the stove, turn the burner off.
37. 22. Are all cooking surfaces clear of things that can burn?

    1. Yes
    2. No
39. 23. Do you keep your small appliances unplugged when they are not in use?

    1. Yes
    2. No

    *All appliances should be plugged directly into wall outlets. Do not use with extension cords.
40. 24. Is there a minimum of 3 feet between flammable items and any sources of heat or flame?

    1. Yes
    2. No
42. 25. Before use, do you have all heating equipment and chimneys cleaned and inspected every year by a qualified professional?

    1. Yes
    2. No
43. 26. Is the thermostat on your water heater adjusted to a mazimum temperature of 120 degrees Fahrenheit to avoid scald injuries?

    1. Yes
    2. No
45. 27. Do you use extension cords as permanent sources of power?

    1. Yes
    2. No

    *Extension cords are for temporary use only. Use surge protectors or power strips that have internal overload protection instead. Be sure they are listed by a qualified testing laboratory.
46. 28. Are any appliance cords or cables running under rugs or furniture?

    1. Yes
    2. No

    *Avoid putting cords under rugs and carpets, across doorways, or where they can be damaged or pinched by furniture.
48. 29. Are your receptacles in good working order?

    1. Yes
    2. No

    *Outlets should not be overloaded, and all outlets and switches should be covered with wall plates to prevent shock. Electrical work should always be done by a qualified electrician.
49. 30. Are matches and lighters always kept up high out of the reach of children and in a secure location?

    1. Yes
    2. No
51. 31. Do you use candles in your home?

    1. Yes
    2. No

    *Please consider flameless options instead. Never leave burning candles in unattended spaces.
52. 32. Are there any smokers in the home?

    1. Yes
    2. No

    *Never smoke in bed or where medical oxygen is used. Do not smoke if you are sleepy or under the influence of medication or alcohol. Stay alert. Never leave charging e-cigarettes unattended and use with caution.
54. 33. If there are smokers in your home, do they always smoke outside?

    1. Yes
    2. No
    3. No smokers are in the home.

    *Be sure to have deep sturdy ashtrays and confirm that butts and ashes are completely out before they are discarded. Put them out in water or sand. Never throw them into vegetation, mulch, or anything that can catch fire.
55. 34. Do you have an attached garage?

    1. Yes
    2. No
57. 35. Do you store flammable liquids in the home?

    1. Yes
    2. No

    *They should never be stored near sources of heat, sparks, or flame, and should not be used while smoking.
58. 36. Is all gasoline and gas powered equipment in an outside shed or garage that is detached and away form the home?

    1. Yes
    2. No

    *Gasoline should never be brought indoors, even in small quantities.
60. 37. Would you like a home safety visit from your local fire department?

    1. Yes
    2. No
61. 38. Please call the York County Department of Fire and Life Safety at 757-890-3600 for more information or for assistance with a home safety survey, or leave your name and contact information below.
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