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Survey/Form Review

Home Safe Program

Online Home Safety Check Registration

Use this form to submit your request directly to Port Moody Fire Rescue. Once we have processed your request, you will be contacted to arrange a visit by fire service personnel. If you have any difficulty with the form, please call 604.469.7795.

About you:

Name:
Street Address:
Email:
Phone:
Best time to schedule an inspection:

About the residents:

How many people live in the home?
How many residents are seniors?
How many residents are children?
Are any residents disabled?
If yes, please provide details:

About the home:

Type of Home:
Year Home Built (Estimate okay)

Do you have a working smoke alarm?
Do you have any safety concerns right now?
If yes, please provide details:

Required Waiver

All households will be required to sign a waiver prior to the inspection. Before submitting please review this information and this waiver form.
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