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Fire Risk Assessment


Family name*
Address*


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County*
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Telephone*
Best time to contact you*
Do you have a smoke alarm in your home?
Are there smokers in the home?
How many children in the home?
Would you require instruction in a language other than English?
If so what language?
Do you require a hearing impaired smoke alarm system?
Can you easily leave your home without needing assistance?
Is there anybody over the age of 65 living in the house?
Are there more than 3 children under the age of 10 living in your home?
Do you have working smoke alarms fitted at the moment?
Is there anybody with a hearing or visual impairment living in your home?

If you require a free home fire risk assessment and 10 year smoke alarms, please fill in the information on the left or freephone 0800 9178137. Please tick any checkboxes that apply to you.

Data Protection Notice
Any personal data that you supply will be treated in accordance with the Data Protection Act 1998 and will be used only for the purpose for which it is given.

It will not be disclosed to anyone outside of Norfolk County Council or its agents without your prior approval. If you wish to view, update or rectify data you have voluntarily given the Norfolk Fire and Rescue Service, please contact us.

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