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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: |