Home Fire Safety Visit Request

For agency use only

To refer your client for a free Home Fire Safety Visit please complete this form in full.

Consent

It is necessary that your client gives you consent to pass their details to Avon Fire & Rescue Service to allow us to contact them to book and carry out a home visit. Please tick the box below to confirm the required consent has been given.

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Referring agency

If your agency is not included on this drop down list please contact the Partnerships Agency Referral Advocate on 0117 9262061 ext. 8260.

Person being referred

This referral

To enable us to prioritise this referral and tailor our visit to your client’s needs, please indicate below any concerns you have regarding their potential risk from fire in the home. Please select any of those that apply, and provide additional information in the box below.

Thank you

Please check the information you have provided before clicking on submit

Data Protection/GDPR: Your client’s privacy is important to us and the information you provide on this form will be stored in accordance with current data protection legislation and only used for the purpose of arranging and carrying out a home fire safety visit. If you require further information about how we use and store data please contact us on 0117 9262061 or see our Privacy Notice.

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Other ways to request a free Home Fire Safety Visit

Telephone - 0117 926 2061 Text - 'visit' to 07507 319 694