Exit Home safety survey Question Title * 1. Do your home have working smoke Detector? Yes No Question Title * 2. Do you have a fire extinguisher in your home Yes No Question Title * 3. Have you been trained on how to properly use a fire extinguisher ? Yes No Question Title * 4. Did you know fire extinguisher need to be serviced on a yearly basis to ensure it is operational? Yes No Question Title * 5. Do the family (household) have a fire escape plan in place ? Yes No Question Title * 6. Do you practice your fire escape plan at least twice a year Yes No Other (please specify) Question Title * 7. Do you household have someone that may require assistance in the event of an emergency.? Yes No Other (please specify) Question Title * 8. Does your home have a visible house number ? Yes No Other (please specify) Question Title * 9. Does your home have propane appliances? Yes No Other (please specify) Question Title * 10. Do you have a CO (carbon monoxide) detector or a propane detector install incase of leaks.? Yea No Done