FOSTER HOME FIRE INSPECTION SAFETY REPORT 

NORTH CAROLINA DIVISION OF SOCIAL SERVICES 

 

NAME OF FOSTER HOME_________________________________ PERSON IN CHARGE____________________ 

 

STREET ADDRESS_______________________________________ PHONE #______________________________ 

 

 

 

DOCUMENT THE APPROPRIATE ANSWERS AS TO THE 

CONDITIONS IN THE HOME RELATING TO THE INSPECTION 

 

 

YES

 

NO 

 

N/A

1 

Does the occupant utilize listed extension cords? These cords shall not be substituted for 
permanent wiring and must be used only for portable appliances. 

 

 

 

 

2 

Is a working, mounted fire extinguisher(s), rated 2-A: 10-B: C or larger readily available in the 

residence? 

 

 

 

3 

Does a fire evacuation plan remain posted continually in a prominent location, and is it 
visible to all residents and guests? 

 

 

 

4 

Does the home have a working telephone and are emergency numbers posted within 

sight of the telephone? 

 

 

 

5 

Are there working smoke alarms in the residence that comply with the appropriate rule? 

CHECK ONE OF THE FOLLOWING 

• Houses built prior to 1976: must have a battery or electric smoke alarm 
installed outside every sleeping area. 




 

 

• Houses built 1976 – June 30, 1999: electric smoke alarms shall be placed 
outside sleeping areas as required by the code in effect at construction time. 




 

 

• Houses built after June 30, 1999: must have smoke alarms in every sleeping 
room, outside bedrooms and other areas, interconnected as required in the 
N.C. Building code. 




 

 

6 

Are all hallways, doorways, entrances, ramps, steps, and corridors unobstructed, free of 
storage, and readily accessible? 

 

 

 

7 

Do doors and windows in rooms used for sleeping open properly with little effort? 

 

 

 

8 

Double key dead bolts are NOT installed on designated egress doors? 

 

 

 

9 

Designate Primary heat source: 

_____________________________________________________________________________ 

Designate Secondary heat source (if applicable): 

 

10 

List any substandard components or hazards found which are not addressed above or which 
require additional inspections. 

 _____________________________________________________________________________ 

 

 _____________________________________________________________________________ 

 

 



 

 


Approved:__________ 

This Fire Inspection is Valid Until (Date) :_________________ 

 

 

Not Approved__________ 



 

 

 INSPECTOR’S SIGNATURE / TITLE__________________________________ DATE OF INSPECTION__________________ 

 

PRINT NAME OF INSPECTOR_______________________________ INSPECTOR’S PHONE#__________________________ 

 

FOSTER PARENT’S SIGNATURE_________________________________________ DATE______________________________ 

Foster Parent’s signature on this form indicates that he/she understands any item marked NO on this form will result in non-approval of their home 
until the item(s) in question are brought into compliance with license regulations. This includes obtaining written reports of other inspectors if so 
indicated. 

 

 

DSS-1515 (Rev. 01-15-09) 

North Carolina Division of Social Services 

Child Welfare Services