Living Alone Safety Checklist Form
Review your home safety and preparedness essentials as someone living alone.
Full Name
*
First Name
Last Name
Best Contact Email
*
example@example.com
Do you have at least one up-to-date emergency contact easily accessible?
*
Yes
No
Are there working smoke and carbon monoxide detectors in your home?
*
Yes, both
Only smoke detector
Only carbon monoxide detector
Neither
Do you have a stocked first aid kit in your home?
*
Yes
No
Is there an emergency plan (fire, medical, evacuation) you can follow?
*
Yes
No
Are all doors and windows equipped with secure locks?
*
Yes, all secure
Some secure
Not secure
Do you have a flashlight and extra batteries available in case of power outage?
*
Yes
No
Is there anything else about your living situation you want to note?
Submit Checklist
Should be Empty: