HomeMy WebLinkAboutsafety first form 2025SAFETY FIRST!
Please complete this questionnaite and return it to Yarmouth Senior Services
Outreach.
DATE OF REQUEST:
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IF YOU ANSWERED NO TO ABOVE, IS YOUR HOUSE H ON YOUR MAILBOX OR NO
DO YOU NEED NEW HOUSE NUMBERS INSTALTED BY THE FIRE DEPT,? YES OR r-l t"1l'ii"t b"
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F,RE oEPr TocoMEAND.HANGE rHE BATTERTES '' "or@ro
DO YOU HAVE WORKIN RBON MONOXTDE (CO) ALARMS rN YOUR HOME?RNO
DO YOU KNOW IF YOUR SMOKE/CO ALARMS ARE MORE THAN TEN YEARS OLO?
IF YOU HAVE ANY OTHER QUESTIONS OR CONCERNS THAT YARMOUTH SENIOR
SERVICES AND/OR THE FIRE DEPT. CAN HELP YOU W|TH, PLEASE INCLUDE THEM
HERE:
NO
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WE WILL GALL YOU TO SCHEDULE AN APPOINTMENT
Fire Department Use Only
OATE COMPLETED
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NAME: /fuA R-c ;n RAMbAL-L^
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DEPARTMENT MEMBER NAME: