Fill in the form to the best of your ability, and submit your responses to recieve a detailed assessment of the safety, security, and preparedness of your home or office.   The main benefit of this report is to make you think of issues concerneing safety and preparedness which you may not have already thought of.  For many of the questions, there is no "right or "wrong" answer.  Feedback on any answer you choose will be provided.  Answer honestly for the best possible use of this tool.   Notes and suggestions made in the report are derived from information from FEMA, The Arlington Police Department, and  The Dallas Fire Department.  Following  or not following the suggestions is no guarantee of safety, as these are just guidelines.

Location Information
Location information is not mandatory.

Assessor name:
Promo Code:
Client First Name:
Client Last Name:
Client Street Address:
Client City:
Client State:
Client ZIP:
Client Primary Phone:
Client Secondary Phone:
Client E-Mail:
Assessed Address:
Building Type:

Section One - Safety and Security

Outside - General

Yes   No    N/A   Do you have exterior lighting?
Yes   No    N/A   Is exterior lighting properly aimed at the house, and not toward the street?
Yes   No   N/A   Are all doors and windows plainly visible from the street?
Yes   No    N/A   Is there a neighborhood watch with signs posted?
Yes   No    N/A   Is vegitation kept trimmed so as to not allow hiding places by doors or windows?
Yes   No   N/A   Do you have a home alarm system?
Yes   No   N/A   Is the alarm system remotely monitored?
Yes   No   N/A   Do you have signage about an alarm system, dogs, or surveillance?
Yes   No   N/A   Do you have dogs?
Yes   No   N/A   Does your yard have fencing?
privacychainrural      N/A   What  type of fencing do you have?
Yes   No    N/A   Are your fences kept locked?


Inside - General

steelwoodglass          N/A    What is your front door made of?
deadboltchain    N/A   What type of lock do you use on your front door?
Yes   No    N/A   Do you have any additional door securing method?  
latchbolt           N/A   What type of locks are on your windows?
Yes   No    N/A   Do you have any additional type of window securing method?  
Yes   No     N/A   Are there any firearms present in the home?  
safetrigger         N/A   How are your firearms secured?
Yes   No    N/A   Do you have a surveillance system?  
Yes   No     N/A   Does your surveillance system have remote viewing?  
hollowcoresolidwood   N/A   How are interior doors constructed?
Yes   No    N/A   Does each room of your home have both a way to make an escape and a way to make a stand                                                      against intruders?
Yes   No    N/A   Do adults in the home have "code names" for each other to be used when under duress?
Yes   No    N/A   Have you established a "forbidden word" which is only to be used when under an imminent threat?
Yes   No    N/A   Do you and your significant other notify each other when you are leaving work to return home, and                                                notify them when you have arrived at your destination?
Yes   No    N/A   Are you in the habit of stopping newspaper and/or mail delivery when you will not be home for                                                        several days?
Yes   No    N/A   Do you have timers for your inside lights to turn them on and off at random times when you are not                                              home?
Yes   No    N/A   Are you in the habit of destroying  any boxes for big ticket items instead of leaving them in tact at the                                              curb for trash pick up?
Yes   No    N/A   Are you in the habit of leaving a television or radio on while you are not home during the day or gone                                            during evening hours? 


Inside - Fire Specific

Yes   No   N/A   Is there a working smoke detector on each level of the home and in each sleeping area?  
Yes   No   N/A   Are smoke detectors mounted high on walls or on ceilings?     
Yes   No   N/A   Do you replace smoke detector batteries at least twice a year?     
Yes   No    N/A   Do you test your smoke detectors monthly?:  
Yes   No    N/A   Have you pushed the "test" button with family present so everyone recognizes the sound?:  
Yes   No    N/A   If you are hearing and/or visually impaired, do you have smoke detectors with strobes                                                                      and/or vibration signals as well as an audible alarm?:  
Yes   No    N/A   Does everyone in the home know that they should first escape the house and THEN call the fire                                                  department from a safe location?  
Yes   No   N/A   Do you have an escape plan?:  
Yes   No    N/A   Does your escape plan include two ways out of every room?:  
Yes   No    N/A   Is everyone living in the home familiar with the escape plan?:  
Yes   No   N/A   Does your escape plan designate a specific meeting place outside the home?:  
Yes   No   N/A   Do you practice your escape plan regularly?:  
Yes   No   N/A   Have you practiced your escape plan while family members are sleeping?:  
Yes   No    N/A   Have you practiced your escape plan crawling on hands and knees as if there were heat and                                                         smoke?:  
Yes   No   N/A   Have you practiced your escape plan with an exit blocked to become familiar with alternate exits?  
Yes   No   N/A   Is there a working flashlight within reach of each person's bed?  
Yes   No   N/A   Is there a whistle within reach of each person's bed to alert others of a fire or to alert rescuers to that                                           location?:  
Yes   No   N/A   Are the house and car keys near the bedside of each adult so they are easily accessible?:  
Yes   No   N/A   Do doors and windows open easily from the inside?:  
Yes   No   N/A   Do you keep escape routes clear at all times (toys, furniture, storage, clutter)?:  
Yes   No    N/A   Have you provided escape ladders for upper floors?:  
Yes   No   N/A   Have you ensured that family with special needs have a "buddy" to help get them out to safety?:  
Yes   No    N/A   Are the address numbers on your home at least 3-5 inches high, contrasting to the color of the                                                     exterior of the home, and visible from the street?:  
Yes   No   N/A   Are space heaters at least three feet from anything that can burn (newspapers, furniture, clothes,                                                 curtains)?:  
Yes   No   N/A   Are electrical cords and plugs in good condition?:  
Yes   No    N/A   Are you careful not to overload any outlet, extension cord, or power strip?:  
Yes   No    N/A   Do you frequently check wires and cords to make sure they are not damaged?:  
Yes   No   N/A   Are bathroom and kitchen outlets protected by Ground Fault Circuit Interrupters?:  
Yes   No   N/A   Are you in the practice of fully extinguishing oil lamps and candles before residents leave the room                                               or go to sleep?:  
Yes   No   N/A   Do you use candles in sturdy non-tip and non-flammable candleholders?:  
Yes   No    N/A   Do you keep candles out of reach of children and pets, and is there a rule that children may not have                                           candles or incense in their rooms?:  
Yes   No    N/A   Do you keep matches and lighters out of reach and out of sight of children, preferably in a locked                                                 cabinet?:  
Yes   No    N/A   Is there an all purpose fire extinguisher within easy access to the cooking area? Do you know how to                                           use it?:  
Yes   No    N/A   Is the fire extinguisher charged and ready for use?:  
Yes   No    N/A   Do you always keep things that can burn at least three feet from the range top? (dish towels, paper,                                             plastic, curtains):  
Yes   No    N/A   Do you always remain in the room while cooking?:  
Yes   No    N/A   Do you avoid wearing loose clothing that could catch fire while cooking?:  
Yes   No    N/A   Do you have functional CO2 detectors?:  
Yes   No    N/A   Are fireplace ashes and coals placed in a metal container and away from the house?:  
Yes   No    N/A   Are appliances turned off an unplugged when not in use? Are curling irons and hot rollers                                                               unplugged immediately after use?:  
Yes   No    N/A   Are appliances and surrounding areas kept clean so that grease does not build up and catch fire?:  
Yes   No    N/A   Is every smoker committed to never smoking in bed?:  
Yes   No    N/A   Are cigarette and cigar butts doused with water before dumping them in the trash?:  
Yes   No    N/A   Is there a large, deep, non-tip ash tray for smokers to use?:  
Yes   No    N/A   Are any newspapers, empty boxes, rags, paints, and gasoline cans stored outside the house in                                                   proper containers?:  
Yes   No   N/A   Are chimneys, fireplaces, wood/coal stoves, central furnaces, and space heaters inspected by                                                       professionals once a year, and cleaned regularly?:  
Yes   No    N/A   Is firewood stacked at least 10 feet from the house?:  
Yes   No   N/A   If there is a wood or coal fueled stove, is it properly installed and maintained?:  
Yes   No   N/A   If there is a fireplace, is it fitted with an approved set of doors or a screen? Is everything that can burn                                           kept well away from the fireplace?:  

Section Two - General Preparedness

Yes   No    N/A   Do you have water stored or have the ability to produce 1 gallon of fresh water per person per day for                                            as long as a crisis may last?
Yes   No    N/A   Do you have enough food stored (either long term storage or short term storage) to allow for a 2000                                            calorie diet per person per day for as long as a crisis may last?
Yes   No    N/A   Have you made provision for communication needs should there be a power outage or cell tower                                                failure?
Yes   No    N/A   Have you established a meeting place, both local and remote, for family members to regroup                                                        should you all become separated during a crisis?
Yes   No    N/A   Does each adult and child of appropriate age have cell phone numbers and home phone and                                                      address memorized?
Yes   No    N/A   Have you stored some generic medical supplies for a crisis?
Yes   No    N/A   Have you stored some specific medications for specific medical conditions which may be difficult to                                            obtain during a crisis?
Yes   No    N/A   Does your home have the ability to filter water to make it drinkable?
Yes   No    N/A   Does your home have an ample number of rechargable flashlights that are easily found during an                                                unexpected power outage?
Yes   No    N/A   Have you made sure that the following are readily available should a crisis occur?  (plastic                                                            sheeting, small wastebaskets with liners, portable toilet with liners, duct tape, vitamins, bleach,                                                    soap, tissues, gloves, hand wipes, and feminine products)

Click on "Submit Query" when done.