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Multi Agency Referral

It is our intention to work with other agencies to identify target areas within Hampshire. These agencies will be able to refer 'at risk' individuals for a home visit by a representative from the Fire Service. Their home will be assessed for fire risk, with a view to fitting free smoke detector alarms if required. We will also discuss the formation of a home escape plan and provide education advice to lower fire risk.

Not sure who to refer?

View our tips on who should be referred for a Home Fire Safety Visit...

I should like to make a referral:

(*) indicates a required field.

Referrers details...

Name:(*)

Organisation:(*)

Telephone:(*)

E-mail:(*)

Referral code:(*)

Householders details...

Name:(*)

Address:(*)

Postcode:(*)

Age:

Telephone:(*)

Is there anyone in the home...

Please tick all that apply:

who is over 60 years of age who is under 5 years old who is hearing impaired who is sight impaired who has mobility difficulties who is affected by a disability who is a smoker who is receiving benefits who does not speak English as their first language

If someone in the home has a disability, please specify:

About the property...

Please tick all that apply as this information will allow us to properly prepare for any visit:

smoke alarms are not installed the occupier lives alone the property is rented the property is a bedsit

This form will deliver to Community Fire Safety

Hampshire Fire and Rescue Service will only use the information submitted for the purposes of undertaking Home Fire Safety Visits and providing safety education. It will only be disclosed to other parties to assist in this purpose. All data will be processed in accordance with the Data Protection Act 1998.

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