Smoke Alarm Program (Residential)

Platoon*

Officer's Name*

Vehicle ID*

Municipal Address*

Unit No.

Only if applicable

Visit Number*

Is the resident home?*

Was entry made?*

Alarms Located on Each Level

Notes:

a) A level includes a basement

b) It is the law for all Ontario homes to have a working smoke alarm on every level and outside all sleeping areas (including basement)

c) If there is more than one alarm, select "1" (e.g, if there are 3 smoke alarms on a level - select 1)

No. of Levels*

1st Level*

2nd Level

3rd Level

4th Level

Based on Info Entered: No. of Smoke Alarms Short by Level

Sleeping Areas

No. of Sleeping Areas*

No. of Smoke Alarms Outside each Sleeping Area*

Based on Info Entered: No. of smoke alarms short by sleeping area

Smoke Alarm Status Summary

Smoke Alarm Type*

Based on Info Entered: Total No. of smoke alarms required

Total No. of battery smoke alarms provided by LFD*

Alarm Deficiency - Should be "0"

If Alarms are "interconnected" or "hardwired", did you advise resident to purchase new "interconnected" or "hardwired" Alarms to replace the battery units provided by the LFD?*

YesNo

What are the estimated age of the alarms?*

Battery Operated Smoke Alarms

No. of Alarms without batteries or with dead batteries?*

No of Batteries provided by LFD?*

Battery Deficency - Should be "0"

Information

"From Our Family to Yours" booklet provided?*

YesNo

"Open Burn" pamphlet provided?*

YesNo

If No, please explain.

Does the home have a CO Alarm outside all sleeping areas? (Note: If the house contains a fuel burning appliance, fireplace or an attached garage, a CO alarm is required to be installed adjacent to each sleeping area in the house)*

YesNoNot Required

Did you advise the resident of the legal requirement for working Carbon Monoxide Alarms?*

YesNoNot Required

Resident refused to install CO or smoke alarm (Note: any other concerns outside the scope of the Smoke Alarm Program should be submitted via the Complaint Process)

Notify FPO that resident refused to install Co or Smoke Alarm

London Fire Department