2. First Name*
3. Last Name*
5. Address*
   KFD can assist those that live within the City of Kennewick City Limits.
7. Primary Contact Phone*
8. Secondary Contact Phone
10. Email Address
12. The Current Issue with my Smoke Alarm Is:*

    1. Actively Beeping
    2. Battery Replacement Assistance
    3. Concerned about Recalled Alarms
    4. Request for Bed Shaker Installation for Deaf or Hard of Hearing
    5. Other - See Comments
14. Comments:

    If the above options do not match or, if you have additional information or questions, please provide them here to help us best assist you.

16. When one smoke alarm goes off, do they all go off? If yes, they are likely interconnected and will require assistance by a licensed electrician. *
    -- Select One --No, they are not interconnected.Yes, they are interconnected. I am unsure. I understand that if you determine my alarms are interconnected during your visit that KFD may not be able to assist and I may still need to reach out to a licensed electrician.
18. What is the age of your smoke alarms?*
    -- Select One --Less than 10 years old - Please have ten (10) year batteries or new ten (10) year smoke alarms for us to install.More than 10 years old - Please have new ten (10) year smoke alarms ready for us to install at our visit.I'm not sure and would like help checking the date. and I will have ten year batteries and/or ten year smoke alarms for installation at your visit.

    Smoke alarms have a ten (10) year lifespan, we recommend replacing all smoke alarms that are ten years or older.
20. How many smoke alarms do you have?*
    -- Select One --12345678910+
21. What is the highest ceiling height where smoke alarms are installed in your home?*
    -- Select One --9 feet or lower10 feet or higher
23. Red Cross Smoke Alarm Assistance Program Available
    http://www.redcross.org/nwhomefire

    If you need financial assistance with installing or replacing smoke alarms, the Red Cross and its partners will install a limited number of free smoke alarms for those who cannot afford to purchase smoke alarms or for those who are physically unable to install a smoke alarm. If you would prefer to reach out to them, please do not complete this form and simply follow the above link to their site instead and they will assist you from here.

25. The Kennewick Fire Department does not have smoke alarms or batteries available to provide to the public at this time.

    1. I agree

    By checking this box I am confirming that I will have ten year smoke alarms or ten year batteries for my existing smoke alarms that are less than ten years old available when the Fire Department arrives to assist me.
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field