Smoke Alarm Installation

Resident Information

Name:
Address:
City/State/ZIP:
Phone Number:
Email (optional):

Property Information

Property Type:	☐ Single-Family Home    ☐ Apartment/Condo    ☐ Mobile Home
Number of Floors:
Number of Bedrooms:
Existing Alarms Before Visit?
Working Alarms Present?

Installation Details

Room/Area	New Alarm Installed	Battery Checked	Alarm Tested	Notes

Number of Alarms Installed:

Resident Acknowledgement & Waiver

I acknowledge that the smoke alarms were installed or checked by representatives of the Springfield Township Fire Department. I understand it is my responsibility to test the alarms monthly and replace batteries as needed. The fire department is not responsible for the maintenance or future performance of these devices.

☐ I have received fire safety information.    ☐ I give permission for installation and testing of alarms.

Resident Signature:		Date:
Fire Dept. Installer Name:
Signature:		Date: