Home Safety Check Request Form

Please complete the below form with as much detail as possible before selecting the 'Submit Form' button. 

Alternatively you can contact 0800 0327777 to arrange a Home Safety Check. 

» Indicates required fields

Home Safety Checks
1. Are there existing WORKING smoke alarms?
2. Does the occupier live alone?
3. Is anyone living in the property aged between 65 and 79?
4. Is anyone living in the property aged 80 or over?
5. Is anyone living in the property immobile, confined to bed or chair?
6. Does anyone have restricted mobility, unable to get out unaided within 5 mins, if a fire occurred?
7. Does anyone in the property receive DAILY domiciliary care from a care agency?
8. Does anyone smoke where they sleep?
9. Does anyone else smoke within the property?
10. Does the occupier use a chip pan?
Please note that we only carry out Home Safety Checks in the Tyne and Wear Area.  If you live elsewhere please contact your local fire and rescue service - a list is available on our links page.