SAFE & HEALTHY LIVING SURVEY

This Safe & Healthy Living Survey is taken from a home safety survey that is provided to the community at no charge by the Federal Way Fire Department and St. Francis Hospital.  The survey on this page is not nearly as comprehensive as the actual home survey, but it is designed to help you find and eliminate common injury and fire causes found in the home.  Please take a few minutes to help make your home Safe & Healthy – your families will thank you.  If you would like to request a comprehensive home safety survey at your home, contact us here at the Federal Way Fire Department.
Please print out this form and use it to conduct the Safe & Healthy Living Survey.  For any "no" answers you may list, please take the appropriate steps to correct them.   If you have any questions, please feel free to contact us!
		GENERAL CONDITIONS
YES o	NO o	Are your address numbers clearly visible from the street? In the event of an emergency, clearly posted addresses will enable the local emergency service provider a quicker access to your home.
YES o	NO o	Do you throw old medications away by flushing them down the toilet?  It is important that old medicines be disposed of to reduce the possibility of accidentally taking the wrong or out-of-date medicines. Flush them down the toilet to prevent the possibility of old medicines being taken by inappropriate persons.
YES o	NO o	Are medications properly stored?  It is best to keep medications in a cool, dry location. For this reason, bathrooms and kitchens are often not good locations. Keep the containers closed. It is also important to keep medications out of the reach of children who may be visiting you.   Children can be extremely curious and amazingly fast at getting into medication bottles. They can also be very sensitive to medications. We recommend that you keep medications up out of the reach of any children.
YES o	NO o	Is transportation readily available to you?  Transportation is available through a variety of sources, including: Metro ACCESS program (door-to-door) based on age, income, disability qualifiers @ 1-800-201-8888. Senior Services of Seattle-King County @ 448-3110 or  TDD 448-5025.     DART Transit @ 838-2333 for Federal Way, Kent, Auburn areas.
YES o	NO o	Is the driveway adequate to accommodate emergency vehicles? Long, narrow, dirt driveways may hinder emergency vehicles approaching your home.
YES o	NO o	Does your family have and practice an escape plan? You and your family should practice exit drills in the home (EDITH).  Take a look at our Safety Tips for a sample plan.
YES o	NO o	Does your home have at least one working smoke detector?  A smoke detector is your first warning that you have a fire in the house. This is particularly important at night while you are asleep.  It will sound, giving you time to escape quickly and safely.   At the very least, you should have smoke detectors located in all sleeping areas, and on each separate floor of the home.
YES o	NO o	Do stairs/ramps have sturdy handrails? (inside and outside) Falls on stairs can be very serious, and handrails are needed that can support your weight if you should slip or lose your balance.   If handrails are inadequate to prevent a fall, we recommend that you have your stairs/ramps evaluated for proper handrails and have them installed.
YES o	NO o	Are pet food dishes on an absorbent surface to prevent falls?  Liquids on floors are a major source of falls in the home. One of the prime sources of this problem is from pet dishes. We recommend that pet dishes be placed on an absorbent surface such as a small towel that is easily cleaned. This will keep water from spreading across the floor and will ease in keeping the area around the pet dish clean. A washable non-skid rug is even better, since it will be less likely to move around when walked on.
YES o	NO o	Are electrical outlets or extension cords properly loaded? Extension cords are a signifcant source of fires. The general rule for extension cords is: one plug per outlet. An extension cord will often have two or three outlets on it. This is so you can choose the best angle for the plugged-in item, not to plug in three separate items. Multiple items can overload the capacity of the extension cord, causing a build up of heat which can start a fire. An extension cord should never be used as permanent wiring.
YES o	NO o	Do all doors and windows have locks and latches? A closed and locked door or window is one of the simplest deterrents to burglary or other unlawful entry into your home. Missing door locks or window latches should be replaced.
YES o	NO o	Are cleaning agents, pesticides, or other toxic materials stored in original containers?  If cleaning agents, pesticides, or other toxic materials are stored in something other than their original containers, it can lead to accidental poisoning and confusion as to exactly what might be in various containers. We would recommend that all materials of this nature be kept in their original containers.
		KITCHEN
YES o	NO o	Are combustibles removed from the cooking areas? Napkin holders, dishtowels, and other items that can burn that are left too close to burners and cooking appliances is a dangerous habit.
YES o	NO o	Are small appliances unplugged when not in use? Older or poorly manufactured appliances may cause electrical fires. Also, many a toaster has started a fire with a toy or other item placed in it by a child.
YES o	NO o	Is the range-hood ventilation kept cleaned? Maintain your hood and filters free from greases that can spread a fire.
YES o	NO o	Is the hot water set at or below 130 degrees Fahrenheit? Scalding water causes many burn injuries each year, especially to unsuspecting children.  Have your hot water tank temperature set by a qualified professional to 130 degrees or less.
YES o	NO o	Are 9-1-1 stickers (or other emergency numbers) visibly posted on or near the telephone? Just because you may know the numbers, guests may be unfamiliar or panic in an emergency.
YES o	NO o	Is an appropriate step stool available?  Kitchen falls can cause serious harm.  A sturdy step stool will reduce the possibility of falls and injuries and will make it easier to reach higher cupboards. Step stools are sold in many home and hardware stores.
YES o	NO o	Do you use a timer when you leave food cooking on the stove? Unattended cooking is the leading cause of house fires. If you have food on the stove, stay near the kitchen. If you must leave, turn the burners off and make sure pot handles are turned in, particularly if children are likely to be present. This will reduce the potential for them to reach up to a pot handle and pull it over on themselves.
YES o	NO o	Do you know how to deal with a fire in a pan or on the stove? Pan fires on the kitchen stove have been the most common source of fires in Federal Way. It is important that you know what to do if a pan catches fire, and what NOT to do.  Do NOT try to move the pan, and do NOT throw water on it.  If the fire is only inside the pan, put a lid on the pan and then turn the burner off.  If no lid is available to cover the pan, lay something flat on it (like a breadboard or cookie sheet). The fire will go out because oxygen cannot get to it.  Wait for the pan to cool down before taking the lid off.  If the fire has already spread outside the pan before you discover it, get out of the house and call 9-1-1.
YES o	NO o	Is a fire extinguisher installed where it is most likely to be used? Kitchen fires are frequent occurrences in homes throughout the United States.  A fire extinguisher should be installed close by.  Make sure you check yours to make sure it will operate properly if needed.
YES o	NO o	Do you know how to use your extinguisher in an emergency? We can help you if you want to learn more about your fire extinguisher.  Contact us at the Federal Way Fire Department.
		LIVING & FAMILY ROOMS
YES o	NO o	Does the fireplace have the proper screen or doors? This is also an area to keep combustibles off the hearth and away from the fire.
YES o	NO o	Is your chimney cleaned regularly? Chimney fires can extend into attics and cause major fires. Look under "Chimney Sweeps" in the phone directory for assistance.
YES o	NO o	Are combustibles kept safely away from heating appliances? Too many fires are caused by furniture and other combustibles pushed up against heating devices. Keep a safe distance away.
YES o	NO o	Are matches and lighters kept out of the reach of children? Children do not always understand the danger matches and lighters present. Keep them where small hands cannot play with them.
YES o	NO o	Are proper ashtrays provided for smokers? Ashtrays are designed to contain the ashes and dissipate the heat – cans, cups and other makeshift items may prove unsafe as ashtrays.
YES o	NO o	Are electrical cords of the correct size and in good condition? The extension cord you use should be at least the same gauge (size) or larger than the cord plugged into it.
YES o	NO o	Are electrical cords out of high traffic areas? You do not want anyone tripping on a cord. Also, traffic over a cord can ruin the insulation and help create a fire hazard.
YES o	NO o	Are outlets used properly? Avoid overloading your circuits. Overloaded wires are a sure cause of many fires in homes.
YES o	NO o	Are candles or other open flames used properly? Candles are safest with a mantle that surrounds and protects the flame. Never leave an open flame unattended – especially if you have pets or small children in the home.
		BEDROOMS
YES o	NO o	Do you leave a light on at night or use a night-light?  Falls are one of the most common injuries in the home, and can result in serious and long-term disabilities. A night light can be helpful in preventing falls due to limited vision at night. Night lights are available at most local hardware stores.  We also recommend keeping a flashlight within reach of your bed.
YES o	NO o	Is there a telephone in the bedroom?  Many emergencies occur while people are sleeping, such as sudden illness, fire, crime, etc. Quick access to a telephone can be crucial. We recommend a telephone be installed within reach of your bed. There are many suppliers of telephones locally. Installation should be performed by a qualified technician.
YES o	NO o	Are escape windows easily opened and accessible? A fire in the hallway right outside of your bedroom eliminates one of your escape paths. Be prepared to use a window in an emergency.
YES o	NO o	Is an escape ladder available for rooms on the second or third story? An escape ladder can be purchased at most hardware stores. Call your local fire department if you need additional information.
YES o	NO o	Are combustibles or other furnishings kept clear of heating devices? Clothes, beds, and chairs too close to a heating device are fires waiting to happen. Maintain a safe distance.
		BATHROOMS/LAUNDRY ROOMS/HALLWAYS/CLOSETS
YES o	NO o	Are medications, poisons, chemicals and cleaning supplies stored correctly? Common products in the wrong hands or used incorrectly can be very toxic. Call your local Poison Control Center for additional information. Childproof safety latches on cabinets that contain medications or chemicals are a good idea.
YES o	NO o	Does the tub or shower have a mat or nonskid surface?  A nonskid mat or adhesives applied to the tub or shower floor will help prevent falls or slips. Tub mats are available at most hardware stores.
YES o	NO o	Are there grab bars in the shower/tub and near the toilet?  Grab bars can assist with raising or lowering yourself and maintaining your balance. It is important that you do NOT use towel racks or toilet paper holders for support, as they may break away from the wall causing a potentially serious fall or injury.
YES o	NO o	Is the clothes dryer lint-collector and the area around the dryer free of lint and other combustible items? An accumulation of lint can cause a fire.
		FURNACE ROOM/GARAGE
YES o	NO o	Is the main electrical panel accessible and properly installed? Access and use of the electrical panel during an electrical emergency is critical to the fire department – it is also a safe habit for the homeowner to establish.
YES o	NO o	Is the heating system cleaned and serviced regularly? A poorly maintained system can be dangerous. Clogged furnace filters can cause the motor to overheat and start a fire. Filters should be checked and replaced or cleaned on a regular schedule according to manufacturers instructions.
YES o	NO o	If natural gas is used in your home, does everyone know what the product smells like in case of a leak? Carbon monoxide detectors are recommended in furnace areas to help detect improperly operating gas appliances.
YES o	NO o	Is there at least a safe 18-inch clearance around pilot lights? Items too close to a continuous open-flame can lose moisture and heat up to the point of ignition.
YES o	NO o	Is there proper storage provided for gasoline and other flammable and combustible liquids? These type of liquids give off vapors that can cause a fire it they find an ignition source. Always store flammable and combustible liquids away from the common living areas.
YES o	NO o	Do you have a disaster preparedness kit?  A disaster preparedness kit can be vital in case of emergency situations such as wind storms, extended power outages, etc. These kits contain basic supplies to help you get through the first few days of an emergency.  If you need some assistance, contact us here at the Federal Way Fire Department.
How did you do? Make it a point to maintain your home in a safe manner. Fire and/or injury can strike at any time and leave behind a devastating aftermath. Do your part to protect yourself and your family.