Pre-Planning | yes | no |
| 1. Have you planned at least two ways out of every room in your home in case of fire? | | |
| 2. Has your family agreed on a meeting place, outside of your home, in case of fire? | | |
| 3. Do you keep potential escape routes in your home clear of clutter? | | |
| 4. Do you know your local emergency number for fire-police-ambulance, and do you have it posted near you phones? | | |
| 5. Do you have a functioning smoke detector on at least every floor in your home? | | |
| 6. Do you have a fire-extinguisher on every floor in your home? | | |
| 7. Do you keep flammable liquids in only approved containers, and out of your home in a separate outbuilding? | | |
Smoking | yes | no |
| 8. Is smoking in bed absolutely forbidden in your home? | | |
| 9. Are you sure all smoking materials are extinguished before bedtime? | | |
| 10. Are matches and lighters kept out of reach of small children? | | |
Heating and Cooking | yes | no |
| 11. Are furnaces, stoves, and flue pipes properly maintained and inspected? | | |
| 12. Are portable space heaters properly maintained and used only in compliance with the manufacturers recommendations? | | |
| 13. Is the central heating system in your home inspected annually by a qualified technician? | | |
| 14. Do you have a fire extinguisher in your kitchen and do you know how to properly extinguish a stove top fire? | | |
| 15. To prevent burns or scald injuries to children, do you ensure that pot and pan handles are turned inward when on the stove top? | | |
Electricity | yes | no |
| 16. Do you see that extension cords are never placed under rugs, or hooked over nails or other sharp objects? | | |
| 17. Do you see that only the right fuse is used in the right socket in the fuse box? | | |
| 18. Are all electrical appliances installed according to manufacturers recommendations, including ventilation and minimum space requirements? | | |
Baby-sitters | yes | no |
| 19. Do your baby-sitters know the first rule of fire safety in the home? Get everybody out of the home - don't go back in! | | |
| 20. Do you never leave small children unattended? | | |
