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Do your children know their full home address including zip code?
 
Yes
 
No
 
 
 
Do your children know the full names of both their parents?
 
Yes
 
No
 
 
 
Do your children know how to call 911?
 
Yes
 
No
 
 
 
Do your children have a fire safety plan (example: evacuation route, location of fire extinguishers)?
 
Yes
 
No
 
 
 
Do your children know your phone number?
 
Yes
 
No
 
 
 
Do you have parental controls on your home computers?
 
Yes
 
No
 
 
 
Do you have established house rules for your children (example: no guests allowed, don't answer the door, don't tell anyone you are home alone)?
 
Yes
 
No
 
 
 
Are your medications and poisonous substances in a secure locked location?
 
Yes
 
No
 
 
 
Are your children familiar with appliance safety (example: how to use the oven or microwave)?
 
Yes
 
No
 
 
 
Are your children familiar with basic first aid?
 
Yes
 
No