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  • This form can be used by any agency to refer a person(s) to Kent Fire & Rescue Service where a risk of fire in the home has been identified. KFRS will attempt to undertake a visit for all cases referred

Personal details of client being referred

  • Name

  • Address
  • Date of Birth

  • NHS number (if known)

  • Telephone number

  • SWIFT / ID number

  • Has the person(s) consented to the referral including the sharing of information via this form?

  • Reason for referral

  • Is the referral urgent

  • State reason

  • Are there any known risks to a lone KFRS worker?

  • Provide details

Contact details for referring agency

  • Name of agency

  • Address
  • Email

  • Responsible person / case worker

  • Telephone

  • Date of referral

  • Is feedback required

  • Return this form to: Kent Fire & Rescue Service, The Godlands, Straw Mill Hill, Tovil, Maidstone, Kent ME15 6XB

    Telephone: 01622 692121
    Email: home@kent.fire-uk.org

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