Fire Safety Notice Report

• Village conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Distribution list

• Annual distribution

  Yes

  No

  N/A

• Name of Block/House

• Were Fire Safety Notices issued to all premises?

  Yes

  No

  N/A

• Which properties did not receive a Fire Safety Notice

• Why did the property not receive a Fire Safety Notice

• New resident to the village

  Yes

  No

  N/A

• Name and address of resident

Sign off

• Name of person who distributed notices

• Date

  Date