Home Fire Safety Education and Smoke Alarm Request Form

Know what to do before, during, and after a fire. A 20-minute call could save your family!

The American Red Cross is preparing families to act quickly through our Home Fire Campaign. Red Cross educators will provide tailored information on how to protect your home and reduce fire risks. During your virtual appointment, Red Cross-trained volunteers will:

Provide guidance in testing your current smoke alarms
Help you develop a personalized fire escape plan to include: identifying two ways to safely escape and a meeting place
Provide valuable fire safety tips and training for your household
Discuss an additional hazard specific to your area (i.e. flooding, hurricanes, tornados)

Did you know that if a fire starts in your home you may have as little as two minutes to escape? During a fire, early warning from a working smoke alarm, plus a regularly practiced fire escape plan can save lives. Learn what else to do to keep your loved ones safe!

*Safety is our top priority. Due to the COVID19 pandemic, we have postponed in-home visits and will resume FREE smoke alarm installations once it is safe to do so. Please note that all education will be conducted over the phone. For additional details, please call your local Red Cross office.

ENTER CONTACT DETAILS

First Name

Last Name

Email Address

Phone Number (XXX) XXX-XXXX

Street Address

Apartment or Unit Number

City

State

Zipcode

Preferred Appointment Time?

Weekday morning (between 9:00 a.m. and 12:00 p.m.)

Weekday afternoon(between 1:00 p.m. and 4:00 p.m.)

Weekday evening (between 5:00 p.m. and 8:00 p.m.)

Weekend morning (between 9:00 a.m. and 12:00 p.m.)

Weekend afternoon (between 1:00 p.m. and 4:00 p.m.)

Weekend evening (between 5:00 p.m. and 8:00 p.m.)

Any time and any day

Preferred contact method to arrange appointment?

Are any accommodations needed during the appointment (medical communication device, language interpretation, etc.)?

Details About the Household

(This information will enable us to personalize the call to help make YOUR home safer)

How many people live in your household?

How many youth ages 17 and under?

How many adults ages 65 and older?

How many individuals with a disability, access, or functional need?

How many veterans, military members, or military family members?

How many pre-existing smoke alarms does the household already have?

Anything else you would like us to know?

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