Home Fire Safety Check Central Lakes Area

• HFSC - Document No:

• Audit Title (surname)

• Conducted on

  Date

• Prepared by

Audit process instructions

• HFSC Process for Tablet Based use of iAuditor
  
  Please enter information into the audit in the following format.
  
  Information Section
  
  1. Audit Title: Surname of the Occupant
  
  Contact Information
  
  1. Name: Format: “ MR B. BLOGGS”
  2. Address: Use GPS to locate to the address, if the address is slightly different, select the closest one then amend manually. It is also possible to enter the address manually. (3G enabled tablet will locate for you, press the” locate me” button when at the desired address)
  3. Phone: Format includes area code please.
  
  Checklists
  
  Please note, the questions are all asked in a manner that has yes being a positive answer (No further action required) and no being a fault or something that is a negative. A No answer will require some comments and a comments field will appear if no is selected. Please enter some meaning descriptive comment for the home owner
  
  Demographic (optional)
  
  This section is a series of check boxes designed to help NZFS staff complete the associated SMS tasks (Home Safety Visit task)
  
  Additional Information (optional)
  
  This section is another data collection section that will allow the NZFS to analyse how we are delivering services to our communities.
  Sign Off Staff member completing the form to enter name
  Sign off with initials or signature (Touch the “Sign “Box)

Visit Information

• Visit Date:

  Date

• Station:

  Select Rotorua Taupo

  • Rotorua
  • Taupo

• Watch:

  Select GREEN BLUE RED BROWN

  • GREEN
  • BLUE
  • RED
  • BROWN

Contact Information

• Name: [Mr, Mrs, Miss, Ms], [Initial], [Surname]

• Address: (use GPS or enter manually)
  Address

• Telephone:

HALLWAY

• WORKING SMOKE ALARM FITTED ON CEILING - INSTALL LONG LIFE

  Yes

  No

  N/A

• ESCAPE ROUTE CLEAR

  Yes

  No

  N/A

• KEYS KEPT IN DEADLOCK AT NIGHT

  Yes

  No

  N/A

LIVING ROOM

• WORKING SMOKE ALARM(S) FITTED ON CEILING - RECOMMEND PHOTOELECTRIC

  Yes

  No

  N/A

• CANDLES KEPT AWAY FROM CURTIANS AND IN PROPER HOLDER.

  Yes

  No

  N/A

• ASHTRAYS EMPTIED CORRECTLY

  Yes

  No

  N/A

• MATCHES AND LIGHTERS KEPT AWAY FROM CHILDREN

  Yes

  No

  N/A

• SPARKGUARD AROUND OPEN FIRE

  Yes

  No

  N/A

• CHIMNEY SWEPT ANNUALLY

  Yes

  No

  N/A

• HOT ASHES REMOVED IN A METAL CONTAINER

  Yes

  No

  N/A

• CLOTHING, BEDDING AND FURNITURE KEPT A METRE FROM THE HEATER

  Yes

  No

  N/A

• APPLIANCES WITH REMOTES SHOULD BE SWITCHED OFF AT THE APPLIANCE BEFORE BED OR WORK.

  Yes

  No

  N/A

KITCHEN

• UNDERSTANDS LEAVING COOKING UNATTENDED IS DANGEROUS

  Yes

  No

  N/A

• KNOW WHAT TO DO IF A FRYPAN CATCHES FIRE

  Yes

  No

  N/A

• UNDERSTANDS THE DANGERS OF DRINKING AND FRYING

  Yes

  No

  N/A

• NON-ESSENTIAL ELECTRICAL APPLIANCES TURNED OFF BEFORE BED OR WORK

  Yes

  No

  N/A

• POWERBOARDS OR MULTIBOARDS NOT OVERLOADED

  Yes

  No

  N/A

• UNDERSTANDS THE BENEFITS OF EXTINGUISHERS AND FIRE BLANKETS

  Yes

  No

  N/A

• AWARE OF THE DANGERS OF CHILDREN BEING IN THE KITCHEN WHILE COOKING

  Yes

  No

  N/A

• SAUCEPAN HANDLES TURNED TOWARDS THE BACK OF THE STOVE

  Yes

  No

  N/A

• JUG CORDS KEPT AWAY FROM THE EDGE OF THE BENCH

  Yes

  No

  N/A

BEDROOM

• WORKING SMOKE ALARM(S) FITTED ON CEILING - RECOMMEND PHOTOELECTRIC

  Yes

  No

  N/A

• CANDLES KEPT AWAY FROM CURTIANS AND IN PROPER HOLDER.

  Yes

  No

  N/A

• UNDERSTANDS NEVER TO HAVE CANDLES IN A CHILDS BEDROOM

  Yes

  No

  N/A

• KNOWS ELECTRIC BLANKETS TO BE TURNED OFF BEFORE GOING TO BED

  Yes

  No

  N/A

• CLOTHING, BEDDING AND FURNITURE KEPT A METRE FROM THE HEATER

  Yes

  No

  N/A

FAMILY

• CARRY OUT NIGHT TIME SAFETY CHECK

  Yes

  No

  N/A

• CLOSE DOORS BEFORE GOING TO BED

  Yes

  No

  N/A

• REGULARLY TEST SMOKE ALARMS TO ENSURE THEY WORK

  Yes

  No

  N/A

• PRACTICE ESCAPE PLAN

  Yes

  No

  N/A

• KNOW WHERE THE SAFE MEETING PLACE IS

  Yes

  No

  N/A

• KNOW TO CALL 111 IN AN EMERGENCY

  Yes

  No

  N/A

ADDITIONAL INFORMATION (OPTIONAL)

• Does the home owner have an e-mail address?

  Yes

  No

  N/A

• Enter e-mail address

• Post form to street address.

• Have you lived at this address for more than 2 years?

  Yes

  No

  N/A

• Has the New Zealand Fire Service visted you at this address before?<br><br><br><br>

  Yes

  No

  N/A

• When did the Fire Service vist last?

  Date

SIGN OFF

• Officer completing check to sign

  Sign