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Exit Survey
 
 
Do you practice fire prevention and safety in your home?
 
Yes
 
No
 
 
 
How important is fire prevention and safety in your home?
 
Extremely important
 
A little important
 
Neutral
 
Somewhat unimportant
 
Not important at all
 
 
 
Do you have at least one smoke detector in your home?
 
Yes
 
No
 
What is a smoke detector?
 
 
 
How often is the smoke detector in your home tested?
 
Annually
 
Bi-annually
 
Monthly
 
Bi-monthly

 
 
 
Which other methods of fire prevention do you take in your household?
 
Fire extinguisher
 
Know location of fusebox/circuit breaker panel
 
Fire escape plan
 
Properly functioning doors/windows
 
Combustibles stored away from heat/electrical sources
 
Other (please explain below)
 

 
 
 
If there is a fire extinguisher(s) in your home, do all residents know how to use it properly?
 
Yes
 
No
 
 
How comfortable are you at using the following?
Extremely Comfortable Somewhat Comfortable Neutral Somewhat Uncomfortable Extremely Uncomfortable
Fire extinguisher
 
 
 
If there is a household escape plan, how often is it practiced?
 
Daily
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
Does every member in your household have a list of emergency contacts?
 
 
 
Do you have any other suggestions for fire safety?