Northwest Harris Volunteer Fire Department is requesting your help in designing a custom plan for an emergency in your home.

Question Title

* 1. Please enter your basic contact information.

Name

Address

Phone Number

Question Title

* 2. How many floors does your home have?

A Single floor

Two floors

Two floors including a Basement

Three floors including a Basement

Other, please specify

Question Title

* 3. If your home has multiple floors, where is your staircase located.

Standing in my front yard, my staircase is on the LEFT side of my home.

Standing in my front yard, my staircase is in the CENTER of my home.

Standing in my front yard, my staircase is on the RIGHT side of my home.

Question Title

* 4. Please select any features located on your property.

Propane Tank

Swimming Pool

Electric Vehicle Charging Station

Home Generator

Finished Attic

Elevator

Boat House

Solar Panels

Question Title

* 5. If you selected a feature in question 4, please describe its' location. You may use our A,B,C,D labeling system shown in the picture at the top of the page if you would like.

Question Title

* 6. Are there other special features on your property? If so, please describe them and their locations.

Question Title

* 7. In many cases, we would like to visit your home to take measurements from the nearest water supply and obtain additional information. May we contact you?

Yes

No