S.A.F.E. Family Installation Form

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Fire departments will install smoke alarms in hallways outside of bedrooms (with a maximum of two smoke alarms per home).

Fire Department Information

Fire Department

Date of Installation

Homeowners Name

Address of Installation

City/Town

Postal Code

Smoke alarm check/installation conducted by

Older Adults Home with young children New Manitobans People with disabilities Low-income family Other

Enter the other demographic(s)

How many working smoke alarms were previously installed in the home?

How many smoke alarms didn't work?

Why were they not working?

Basement First Floor Second Floor Other

Enter the other location(s)

Total Number of Alarms Installed

What fire safety information did you leave with the occupant?

What safety plans did you discuss/review?

If more than one installation completed, click the ADD button and continue with each additional installation. You can add up to 10 installations per day.
Click Submit once done.

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