Write down visible concerns and unknowns, then route each question to the right instruction, local source or qualified person, with a follow-up date of your own choosing.
How to use this sheet
- Print the sheet or copy its headings onto paper. It is for your own notes; nothing is sent anywhere.
- Take one area at a time and look only. Record what you can see or read without touching, moving, opening, testing or taking apart anything.
- In the unknowns column, write what you cannot tell from looking. A blank or the word 'unknown' is a complete answer.
- In the source column, name the document or person who could answer: the maker's instructions, building management, your landlord, your local fire department, your local authority or a qualified professional. Write where you will find them, not what you assume they would say.
- Name who will follow up and choose your own review date. There is no recommended interval.
- Mark each row with one of three statuses: Observed, Question open or Follow-up recorded. None of them means 'fine' or 'not fine'.
Not for emergencies
If there is an active emergency, do not use this sheet. Contact your local emergency services immediately, using the number you already know for your country or region.
What this sheet is and is not
It records what you notice and where to take each question. It does not rate a home, find faults, certify anything or replace advice from a product maker, building management, a local authority or an inspector.
Rules differ by country, state or province, and building. Check yours separately. Health Canada's fire-safety guidance, for example, is Canadian guidance and should not be read as the law where you live.
Cleaning a surface does not repair a leak or deal with the cause of dampness, so moisture questions go in their own section and to the person responsible for investigating the source. For label-reading on cleaning products, see cleaning versus disinfecting.
Sheet details
Keep this general. Do not write an address, medical details or account numbers on a sheet you may share.
- Date I started this sheet
Write today's date.
- Part of the home covered
For example 'upstairs rooms' or 'kitchen and hallway'. No street address.
- Country or region whose rules I need to check
Write the country or region, so you look up local sources rather than guidance from elsewhere.
- Who is filling this in
A first name or a role such as 'tenant' or 'owner'.
- My overall review date
A date you choose for looking at the whole sheet again.
Status key
Use these three statuses only.
On a small screen, scroll the table horizontally. Use the PDF for handwritten notes.
| Status | What it means |
|---|---|
| Observed | I wrote down what I can see or read. I am not claiming anything beyond that. |
| Question open | There is something I cannot tell, and I have not yet asked the person or source who could. |
| Follow-up recorded | I have named the source and who is responsible. This does not mean the question is answered or resolved. |
A. Labels and written instructions
Product labels, care labels, rating plates and manuals. Choose products suited to the actual surface and follow that product's label. One product's directions do not authorise another use, and products should never be mixed. For washable soft items, follow the maker's instructions and dry completely.
On a small screen, scroll the table horizontally. Use the PDF for handwritten notes.
| Area | What I can see (no touching or dismantling) | Unknowns | Instruction or local source to consult | Responsible follow-up | Review date I choose | Status |
|---|---|---|---|---|---|---|
| (room or area) | Which labels are readable, and which are missing or worn | What the product is for; whether its label covers the use I have in mind | The product label or maker's instructions; the supplier if there is no label | (who) | (date) | ☐ Observed ☐ Question open ☐ Follow-up recorded |
| ☐ Observed ☐ Question open ☐ Follow-up recorded | ||||||
| ☐ Observed ☐ Question open ☐ Follow-up recorded |
B. Storage
What is kept where, as far as you can see. If a label gives storage directions, those are the directions to follow.
On a small screen, scroll the table horizontally. Use the PDF for handwritten notes.
| Area | What I can see (no touching or dismantling) | Unknowns | Instruction or local source to consult | Responsible follow-up | Review date I choose | Status |
|---|---|---|---|---|---|---|
| (cupboard, shelf, shed, garage) | What is stored there; whether containers still carry their original labels | Whether the storage matches what the label describes; what any unlabelled container holds | The label's storage directions; whoever filled an unlabelled container | (who) | (date) | ☐ Observed ☐ Question open ☐ Follow-up recorded |
| ☐ Observed ☐ Question open ☐ Follow-up recorded | ||||||
| ☐ Observed ☐ Question open ☐ Follow-up recorded |
C. Access and routes
Doors, halls, stairs and the ways people move through the home. Note anyone in the household who finds a route difficult, without giving medical details. Questions about fire safety can go to your local fire department.
On a small screen, scroll the table horizontally. Use the PDF for handwritten notes.
| Area | What I can see (no touching or dismantling) | Unknowns | Instruction or local source to consult | Responsible follow-up | Review date I choose | Status |
|---|---|---|---|---|---|---|
| (route, door or stairs) | What stands on or beside it; how it is used day to day | Whether anything about the route needs advice from someone who knows local rules | Local fire department; building management or landlord, if the route is shared | (who) | (date) | ☐ Observed ☐ Question open ☐ Follow-up recorded |
| ☐ Observed ☐ Question open ☐ Follow-up recorded | ||||||
| ☐ Observed ☐ Question open ☐ Follow-up recorded |
D. Moisture
Describe what you see, not what you think caused it. Do not try to work out the cause by taking anything apart. Cleaning or an air cleaner does not deal with the source of a moisture problem, so record who is responsible for finding the source (you, a landlord, a building owner or management) and whether they have been told.
On a small screen, scroll the table horizontally. Use the PDF for handwritten notes.
| Area | What I can see (no touching or dismantling) | Unknowns | Instruction or local source to consult | Responsible follow-up | Review date I choose | Status |
|---|---|---|---|---|---|---|
| (room or area) | Visible marks, staining or peeling; condensation on glass; a smell I notice | Cause; whether it is new or recurring; whether anyone has looked at it | Landlord, building owner or management; a qualified professional for an assessment | (who) | (date) | ☐ Observed ☐ Question open ☐ Follow-up recorded |
| ☐ Observed ☐ Question open ☐ Follow-up recorded | ||||||
| ☐ Observed ☐ Question open ☐ Follow-up recorded |
E. Alarms and equipment instructions
This section records where instructions are, not how to do the work. Follow the maker's instructions for household electrical products and for checking, testing and cleaning smoke alarms; this sheet does not give those steps. Do not open, remove or test anything to fill in a row. For a heating or ventilation system, whether a filter is compatible depends on the actual system and its instructions, and professional advice may be needed.
On a small screen, scroll the table horizontally. Use the PDF for handwritten notes.
| Item or area | What I can see (no touching or dismantling) | Unknowns | Instruction or local source to consult | Responsible follow-up | Review date I choose | Status |
|---|---|---|---|---|---|---|
| (alarm, appliance, heating or ventilation system) | Whether a model name or label is visible; whether the maker's instructions are on hand | Whether the instructions I have are for this exact model | The maker's instructions for this model; local fire department for fire-safety questions; a qualified professional for the system | (who) | (date) | ☐ Observed ☐ Question open ☐ Follow-up recorded |
| ☐ Observed ☐ Question open ☐ Follow-up recorded | ||||||
| ☐ Observed ☐ Question open ☐ Follow-up recorded |
Escape plan note (optional)
Health Canada recommends a personalised emergency escape plan and practising it. This sheet does not create a plan. Use these lines to note who will help you make one.
- Do I have a personalised escape plan written down?
Write yes, no or unsure.
- Who I will ask for help preparing it
For example, my local fire department. Write where I will find their contact details.
- When we will practise
A date or routine the household chooses.
Local sources I will look up
Write where you will find each contact, such as an official local website, a notice in the building or your tenancy paperwork. Do not write a number from memory.
- Local fire department (non-emergency questions)
Where I will find their contact details.
- Building management or landlord
Role and where their contact details are kept.
- Local authority office for rules in my area
Which office, and where I will look it up.
- Maker or supplier of a specific product
Product name as shown on its label, and where the instructions are kept.
- Qualified professional for a question outside my knowledge
The kind of professional needed. Leave the name blank until you have chosen one.
Hypothetical examples of completed rows
These rows are invented for illustration. They describe no real home and predict nothing about any real situation.
On a small screen, scroll the table horizontally. Use the PDF for handwritten notes.
| Area | What I can see (no touching or dismantling) | Unknowns | Instruction or local source to consult | Responsible follow-up | Review date I choose | Status |
|---|---|---|---|---|---|---|
| Hallway cupboard | An unlabelled spray bottle on a shelf | What it contains; who filled it | Ask household members who filled it. Do not use an unidentified product, and never mix cleaning products. If its contents remain unknown, look up the local authority's advice on unidentified products. | Me | A date I choose | Follow-up recorded |
| Bedroom corner | A pale patch on the ceiling paint | Cause; whether it is new or old | Landlord or building management; send a written message and keep a copy | Me, to send the message | A date I choose | Question open |
Before you put the sheet away
- Each entry describes something I saw or read, not a guess about its cause.
- Anything I could not tell is written as 'unknown'.
- Each open question has a named source or person.
- I used statuses as records only. None of them means safe or unsafe.
- I did not touch, open, move, test or repair anything to fill in the sheet.
- I left out my address, medical details and account numbers.
- If I plan to share the sheet with a landlord or manager, I re-read it first.
Questions about using this sheet
Does a completed sheet show that my home is safe?
No. The sheet records what you noticed and where you will take each question. It has no scoring and no pass mark, and it does not replace an inspection, advice from a product maker or a local authority's rules. A row marked Follow-up recorded means you have named a source and a person responsible. It does not mean the question has been answered.
Which rules apply to my home, and who should I ask?
That depends on your country or region, your building and your tenancy. Write the country or region at the top of the sheet and look up the local sources there. Product questions go to the maker's instructions. Fire-safety questions can go to your local fire department. Questions about a shared building, a leak or the flooring go to building management or the landlord. Guidance from another country, such as Health Canada's fire-safety page, is background only and not the law where you live.
Sources and scope
- Fire safety in your home
- When and How to Clean and Disinfect Your Home
- Guide to Air Cleaners in the Home
Personal paper worksheet only. It collects no data and has no scoring, certificate or pass mark.
Not a tool for an active emergency and not an inspection.
Gives no electrical, gas, alarm installation, fire-fighting, structural or remediation instructions.
Carries no legal compliance determination. Country and local rules must be checked separately.