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A Home Fire Risk Check is free and available to residents of Norfolk, following an assessment of need, to help you prevent a fire in your home by reducing the risks of having a fire and how to stay safe if one occurs. The visit covers useful safety guidance, the importance of fitting working smoke detectors on each floor of your home and advice to support you making an escape plan.

We prioritise those people whom we consider to be most at risk and you can help us do this by completing as fully as possible the questions below.

Home Fire Risk Check Form

Please fill in all sections to allow us to assess your needs.

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* Required information.

Section One

 

Address of property where HFRC is required:
Postcode *

About you:

Are you?
The occupier
A friend or relative of the occupier
Referring on behalf of an agency
If you are referring on behalf of an Agency, please state which one:

Section Two

Please answer the questions below to enable us to assess whether we are able to offer you a Home Fire Risk Assessment.

Is anyone in the home over 60? *
Does the person live alone? *
Does anyone in the home have mobility issues (or had two or more falls in the last 12 months)? *
Is the person a single parent (with children under the age of 5 who stay in the home)? *
Is the home rented? *
Is anyone in the home profoundly deaf or use British Sign Language? *
Does anyone in the home use oxygen for medical reasons? *
Does anyone in the home smoke? *
Has anyone in the home been involved in a fire in the last three years? *
Is there anything that would affect anyone’s ability to identify or react appropriately to a fire/smoke alarm/other home emergency? Please give as much detail as possible.
Is there any other relevant information you would like to let us know about? Please give as much detail as possible.

Section Three

Contact Details:

Your Name: *
Is the HFRC required for yourself or someone else?
You
Other Person
Their Name:
Who would you like us to make contact with?
You
Other Person
Contact telephone number
E-mail address * (This will be used to confirm whether or not we are able to offer you a Home Fire Risk Check)

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