Residential Alarm Safety Inspection Tenant Verification Form

Tenant 1

First NameLast Name

Tenant 2

First NameLast Name

Address

Street Address Line 2

City

Postal Code

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Smoke Alarms - there should be a working smoke alarm on every floor of the property. Please confirm you have tested each alarm and it is in working order

Smoke Alarm Ground Floor - please state loaction:

Smoke Alarm Ground Floor- please press the test button and record your findings below:

Other

Smoke Alarm First Floor - please state loaction:

Smoke Alarm First Floor- please press the test button and record your findings below:

Other

Smoke Alarm Second Floor - please state loaction:

Smoke Alarm Second Floor- please press the test button and record your findings below:

Other

Carbon Monoxide Alarms - where there is a carbon monoxide alarm it should be tested to confirm it is working

Carbon Monoxide Alarm 1 - please state loaction:

Carbon Monoxide Alarm 1- please press the test button and record your findings below:

Carbon Monoxide Alarm 2 - please state loaction:

Carbon Monoxide Alarm 2 - please press the test button and record your findings below:

Other comments or feedback provided by the tenant

Signature

Smoke & CO Alarm