SAFETY SURVEY

QUICK 90 SECOND SURVEY

Once the survey is complete, qualified respondents will be selected to receive a limited number of Emergency Preparedness Kits for viewing valuable free Safety information. By submitting the survey, your name will be entered and you may be selected. Remember there's no purchase necessary, so let's get started.

Question Title

* 1. Check any of the dangers you are concerned about?

Home Fire

Carbon Monoxide

Flooding or Water damage

Frozen Pipes

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* 2. How long do you have to escape a home fire?

10 - 13 Minutes

7 - 10 Minutes

4 - 6 Minutes

0 - 3 Minutes

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* 3. Do you have children, pets or both?

Children

Pets

Both

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* 4. Married, Living together or Single?

Married

Living Together

Single

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* 5. Your Occupation

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* 6. Spouse Occupation

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* 7. Age Range

Under 18

18 - 24

25-34

35-44

45-54

55-64

65+

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* 8. Do you Own or Rent?

Own

Rent

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* 9. Qualified Respondents will be contacted by Telephone! Please put the Phone Number best to Contact you at.

Name

Address

Apartment #

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 1. Check any of the dangers you are concerned about?

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* 2. How long do you have to escape a home fire?

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* 3. Do you have children, pets or both?

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* 4. Married, Living together or Single?

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* 5. Your Occupation

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* 6. Spouse Occupation

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* 7. Age Range

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* 8. Do you Own or Rent?

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* 9. Qualified Respondents will be contacted by Telephone! Please put the Phone Number best to Contact you at.

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* 10. Who sent you this or whose social media post did you click on?