Life Safety Survey Form
Complete this life safety survey to share general safety conditions, emergency readiness, and any notes about the space. The form title must remain exactly "Life Safety Survey Form" everywhere it appears.
Respondent Information
Respondent Name
*
First Name
Last Name
Contact Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Property and Environment
Property Type
Please Select
Home
Apartment
Office
Retail
Warehouse
Other
Number of Occupants Regularly Present
*
Primary Area Covered by This Survey
*
Life Safety Survey
Overall safety rating
*
1
2
3
4
5
Emergency exit accessibility
*
Clear
Partly blocked
Blocked
Not sure
Smoke alarm status
*
All working
Some working
None working
Not sure
Fire extinguisher availability
*
Available and accessible
Available but hard to reach
Not available
Not sure
Emergency lighting condition
*
Good
Needs attention
Not present
Not sure
Notes / comments
Submit
Should be Empty: