Introduction
Bedfordshire Fire and Rescue Service's Home Fire Safety visits help protect communities by providing safety advice to those most at risk. Each visit includes fire safety advice and additional guidance on health, wellbeing and crime prevention. If hazards or risks are identified during the Home Fire Safety visit, the Service can make a referral to appropriate partner agencies for further help and support. If you would like to refer yourself or someone else for a Home Fire Safety visit please complete the below referral form by clicking next page. If you are making this referral on behalf of someone else please ensure that you have their consent to do so.
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Referrer Information
Are you making this referral for yourself or someone else?
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Personal Consent
By making this referral, you acknowledge that the details you are providing us are your own and are not of another individual.
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Gather Consent
If you are making this referral on behalf of someone else it is important that you tell them you are doing so. If you do not have their consent, we will be unable to process this application. Please obtain their consent before continuing.
The person I am referring for a Home Fire Safety visit has given me their consent to do so
If you do not have their consent but you are concerned for their safety, please call us on 01234 845000 so that we can provide advice.
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Referrer Information
Are you making a personal referral or a referral on behalf of a professional agency?
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Professional referral
Please select the name of your organisation. If your organisation is not listed, please select "Other Agency or Professional".
If Other, please enter the name of the Agency or Professional
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Contact Information
Occupier Name
Please enter the occupier name
House Name/Number
Please enter an answer for this question
Street Name
Please enter a street name
Telephone
Please enter a telephone number
Would you prefer the Home Fire Safety visit is arranged with someone other than the occupier?
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Arrange the visit with another person
The Home Fire Safety visit is to be arranged with someone other than the occupier please enter their details here. Please notify them that they will be contacted by personnel from Bedfordshire Fire and Rescue Service and the reason why.
Contact name
Please enter the contact name
Contact number
Please enter the contact number
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Household Risks
Are candles/tea lights or other naked flames used?
Does anyone in the household smoke?
Does anyone regularly use emollient creams such as E45?
Does anyone use an air pressure mattress?
Does anyone in the property use oxygen therapy/ cylinders?
Is there any evidence of hoarding or excessive clutter?
Are portable heaters used?
Has there been previous fire or near miss? (e.g. Scorch marks visible)
Is there a history or risk of fire setting? (e.g. child fire setting or arson attack)
Are there concerns about cooking practices? (e.g. deep fat frying, cooking left unattended)
Are there any electrical safety concerns? (e.g. overloaded extension leads, damaged wiring, electric blankets etc.)
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Reduced ability to react to an alarm or escape in case of fire
Does anyone have a reduced ability to react to an alarm or escape in case of fire?
Does the householder live alone?
Are they aged 65 or older?
Does anyone have restricted mobility, frailty, history or risk of falls?
Does anyone have blindness, deafness or impaired hearing/ vision?
Is anyone bed, chair or housebound?
During an emergency would anyone be unable to unlock front door to escape?
Does anyone have a mental impairment? (e.g. memory, dementia, depression etc.)
Are internal doors missing or left open at night?
Does anyone use alcohol regularly that may impair alertness?
Does anyone use medication or substances that may impair alertness?
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Smoke Alarms
Does the household have no working smoke/heat alarms?
Are the concerns that there are too few working smoke/heat alarms? (e.g. alarm may not operate or be heard in all areas)
Are there solid fuel/gas appliances with no Carbon Monoxide alarm? (e.g. wood burners, boiler, gas fire)
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Additional Information
If you have any further information please add it below
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Complete Survey
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