Forms Module

2. Smoke Alarm Request

   The members of the Charleston Fire Department would like to assist you in making your home as safe as possible. Free smoke alarms and alarm batteries are available for installation by CFD members in residential homes located in the City of Charleston. Members of our department will visit the home to install or test the alarms to help ensure they are functioning properly. If you need a smoke alarm for your home please complete the information listed below. If you are not sure if you are in the city use GIS Interactive Map to check your address and if you do not reside within the City of Charleston please contact your local fire department to inquire about their smoke alarm program.

4. Name of person making the request*
5. Relationship to property*
   -- Select One --Home ownerResidentFamily memberFriendCaregiverOther
7. Name of primary resident*
8. Phone Number*
10. Address*
11. Best time to visit?
    -- Select One --9:00am - 12:00pm2:00pm - 5:00pm6:00pm - 8:00pm
12. Email*
    Email that you can be reached at.
16. Own or rent?
    -- Select One --OwnRent
17. How many floors?
    -- Select One --123
18. How many bedrooms?
    -- Select One --12345+
20. Do you currently have working smoke alarms in the home?
    -- Select One --YesNoI'm not sure
21. Are any residents hearing or visually impaired?*
    -- Select One --YesNoI'm not sure
23. How many residents are hearing impaired?*
24. How many residents are visually impaired?*
28. Children
    How many children reside in the home in each age group?
29. Grades 0-5?
    -- Select One --012345+
30. Grades 6-8?
    -- Select One --012345+
31. Grades 9-12?
    -- Select One --012345+
33. Adults
    How many adults reside in the home in each age group?
34. Adults ages 18-65?
    -- Select One --012345+
35. Adults over 65?
    -- Select One --012345+
37. Please note
    Please note that if you are renting your home the landlord is required to provide you with a working smoke alarm(s) upon initial move-in and replace defective alarms. It is your responsibility to notify the landlord of missing or defective alarms. If you live outside of the City of Charleston, please contact your local fire department to request a smoke alarm or battery.
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field