Request a home safety visit

Use our online form to request a home safety visit.

Please note: We can only visit properties with the usual occupants present and cannot accept referrals before hospital discharge or when the occupant is not going to be home for the visit.

If the referral you are making is a genuine risk, or potential risk, to life or property do not use this form.

If there's an immediate emergency or risk to life, dial 999 and report it to us.
If there is no immediate risk, but a visit is urgently needed, call 0800 05 02 999. Please note, the phone line and email are monitored Monday to Friday, 10am to 4pm.
If your carbon monoxide alarm is sounding, call the Gas Emergency Helpline on 0800 111 999.

I would like to express an interest in a home safety visit for:

Someone else - I am from a partner agency and I have a reference code

Myself

Someone else - I am a friend, family member or other third party

Partner agency reference code

Please enter your 3-digit reference code or agency name and choose from the displayed options.

Your contact details

Please provide your contact details. You will receive an email confirmation.

First name

Last name

Phone number

Your relationship to the person

Please let us know the relationship to the person you are referring.

Relationship to the person being referred

Relative

Friend

Member of the community

Member of the fire and rescue service

Other

The occupier's details

Please provide the main contact details for a person (at the household) that you are referring for a home safety visit.

Title

First name

Last name

Phone number

Email address

Who can we contact to arrange the visit?

The occupier (at the household)

Other - please add more details about that person and their relationship to the occupier

Title

First

Last

Contact phone

Contact email

Relationship to the occupier

About the household

Postcode

Please enter the full postcode and select your address from the dropdown list.

Address

The address is not in this list?

Address

City or Town

Postcode

Is there a working smoke alarm in the property?

Yes

Don't know

General notes

Please state any known risks or concerns about the property and occupants. Include any known risks to the safety of our staff when visiting the property.

Additional support

We can provide translation and interpretation for home safety visits. To request this, please select the boxes below:

Translation requirements

British Sign Language (BSL)

Other language

Not required

Please state the languages you would like us to use. We may not be able to provide interpretation for all languages but, we will try to accommodate requests as best as we can.

Languages

Please tell us which station/area

Important information

This form has been designed for collecting data for the purpose of delivering Home Safety Visits. The data is normally kept for six years, however, where we have identified a high safety risk for an individual, we will retain the relevant information for as long as it remains current. The lawful basis for processing the information is necessary to perform a task in the public interest.

By completing this form, I agree for Devon and Somerset Fire and Rescue Service to make contact for the purposes of booking a home safety visit for myself or someone else.

For further information on why we collect and use your personal data and your statutory rights relating to personal data, visit the Privacy Notices (https://www.dsfire.gov.uk/about-us/data-protection/privacy-notices) page.

	Please tick all that apply
Someone in the property is over 85 years old	Someone in the property is over 85 years old
Someone in the property is over 65 years old	Someone in the property is over 65 years old
Someone in the property is under 18 years old	Someone in the property is under 18 years old
Someone in the property is under 12 years old	Someone in the property is under 12 years old
The resident lives alone	The resident lives alone
The property has a thatched roof	The property has a thatched roof
Someone in the property has a disability	Someone in the property has a disability
Someone in the property has mobility issues that would prevent or slow escape in an emergency	Someone in the property has mobility issues that would prevent or slow escape in an emergency
Someone in the property has sensory needs (partially sighted, hearing impairment)	Someone in the property has sensory needs (partially sighted, hearing impairment)
There is evidence of hoarding or poor housekeeping	There is evidence of hoarding or poor housekeeping
There are concerns about a resident's mental health	There are concerns about a resident's mental health
Someone in the property is a smoker	Someone in the property is a smoker
There are concerns about a resident misusing alcohol	There are concerns about a resident misusing alcohol
There are concerns about a resident using drugs	There are concerns about a resident using drugs
Occupant has previously had a fire or a near miss incident	Occupant has previously had a fire or a near miss incident
None of the above	None of the above