(Download link is below the form)




Dear                                                       ,

We would like to take a few minutes of your time to double-check the condition and safe operation of the smoke detectors in your home.  According to our records, smoke detectors should be located at all of the locations shown below.  Please take a minute, now while you think about it, to complete this survey.  Please sign and return to us.  We will return to you a copy for your own information. Here are some facts you should know:

1 . The battery (or batteries) in each of your smoke detectors should be replaced at least once a year. If they are older than that (or if you are unsure), they MUST be replaced. It's important that you replace them with batteries of the same type. (Let us know if you are unsure of the type.)

 2. The smoke detectors should be tested by pushing the test button now and then again once each month.

 3. If smoking is permitted in your rental agreement, an additional smoke detector should be installed in their bedroom - even if no one smokes in bed. This is extremely important and we will be happy to install one without charge.

 4. If you are having trouble with smoke detectors going off from kitchen odors or from someone smoking, let us know. Do not remove the batteries. A detector with a "silencer" can be installed.

Smoke Detector #1    


Date Battery Changed                                                                  

Smoke Detector Tested                 OK                                 Didn't operate

Smoke Detector #2   


Date Battery Changed                                                                    

Smoke Detector Tested                 OK                                 Didn't operate

Tests performed by                                                  Date                

Does anyone in the household smoke?               Yes             No

REMINDER, IN CASE OF FIRE, your personal belongings and furniture are not covered under the company's fire insurance.  Be sure and have renter's insurance.

Do you presently have renter's insurance?                  Yes                 No

Would you like us to send you an application?              Yes                      No

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