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.

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Home Safety Checks

Name »

Address 1 »

Address 2

Town/City »

County »

PostCode »

Telephone »

To help us prepare for your Home Safety Check, please complete the following details about your home.

Is your property private or rented? »

How many adults are in the property and what are their ages? »

How many children are in the property and what are their ages? »

Would all people in the property be able to call the emergency services and escape unaided in the event of a fire? »

Do you use a chip pan at the property? »

Does anyone smoke in the property? »

Have you had any previous fires in the property? If yes please give details. »

Do you have existing working smoke alarms in the property? »

When is the best time to visit? »

Languages spoken

Please note that Home Safety Checks are only available to residents of the Tyne and Wear Area.