HARROW AND COLCHESTER SOUTH FIRE FIGHTER'S ASSOCIATION
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Smoke Detector Survey

Please take a minute to do our smoke detector survey. Before you begin please go around your residents and test all the detectors.

 
Please fill in the following:
Name:
 
Address:
 
Email:
(optional)
 
1- Type of Dwelling ?
    
 
2 - Number of Floors ?
    
 
3 - How many occupants live in the residents ?
    
 
4 - How many smoke detectors are there in the home ?
    
 
5 - Is there at least one on every level of the home ?
  Yes
No
 
6 - If no, which levels do not have an alarm ?
 
Basement
1st Floor
2nd Floor
3rd Floor
other
 
 
7 - How many smoke alarms did you test ?
    
 
8 - How many smoke alarms did not work ?
    
 
9 - If the smoke alarm did not work, indicate the number of alarms with the following probem(s)
Battery Disconneted
Battery dead
Battery Missing
Hardwire Disconnected
Hardwire Power Off
Other
 
10 - How many batteries where replaced ?
      
 
 
 
 
 
         
Harrow Fore Fighter's Association