SAFEHOME Questionnaire if children under 5 live in the house or visit regularly.

1. Why are you completing this form? (Please tick all that apply)

To make my home safer
To gather information for discussing home safety with my landlord
For a school project
For a research project *
For local authority use
Care and Repair use
Other

What is care and repair? Care and Repair agencies work to help older and disabled owners or occupiers to remain in their own home by advising, suggesting or providing repairs, improvement or adaptations

*If you are completing this form as part of a research project and have a unique project code, please enter this in the box. This will enable us to provide additional project information.

Project code number:

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