Inspectors Name

Date of Inspection

Hazard

Inspection Elements

Satisfactory

Appliances

Are manufactures instructions and safety precautions followed?

Are product registration cards sent to manufacture's?

Candles

Candles are on study surfaces in places where they cannot be knocked over.

Candles are kept away from combustible objects and out of the reach of children.

Lit candles are never left unattended.

Matches/lighters

Are matches and lighters locked away from reach of children?

Smoking

Are there large, deep, non-tip ashtrays for smokers?

Smokers know NOT to smoke in bed?

Cooking

Food on stove, toaster or oven is never unattended when cooking.

Surfaces of stovetop, range hood and inside of oven are clean and free of residue build-up.

Electrical

Are cords and appliances in good condition?

Outlets and extension cords are not overloaded.

Are extension cords only used for temporary use?

No electrical cords or wires are located under rugs.

Fireplace/Wood Stove

Is chimney cleaned annually?

Does the fireplace have a study screen?

Space Heaters

Is there at least three feet around space heaters or portable heaters?

Item

Inspection Elements

Satisfactory

Smoke Alarm

Is there at least one smoke alarm on every level of your home?

Have you tested your alarms to make sure they all work?

Has the battery been replaced?

Has any smoke alarm of 10 years of age or older been replaced?

Escape Planning

Does your family have a written plan with 2 ways out?

Plan has a safe meeting place?

Does everyone know how to call the fire department by dialing 911?

Has your family practiced the plan?

Escape Route

Is anything blocking doorways or stairs?