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| Telephone (Does the home have a working telephone?): |
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| Smoke Detector (Is there a working battery Operated smoke detector located on each level of the home?): |
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| Escape Rooms (Are there at least two ways of escape from each bedroom?): |
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| If one way of escape from the bedroom is through a window, is that window large enough to allow ready exit for every child in the home?: |
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| Are the ways of escape from each bedroom free of object that would prevent easy exit?: |
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| Is there an organized plan for getting all individuals safely and quickly out of the home in the event of a fire?: |
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| Flammables (Are highly flammable items kept away from heating and cooking units?): |
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| Address (Can you clearly see the house number from the street?): |
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