Safe and well form

Safe and well visits are only available for private properties in the West Midlands areas. For safety checks outside of our area, please contact your local fire service. To submit your details to us, just complete the form below and a member of our team will be in touch!

Is the safe and well visit for you or someone else?
for mefor someone else





Is the property owned or rented?



Should we contact you to get more information and book the appointment, or speak to the occupier?



It's important the occupier has given you permission to share their personal details with us, though we understand sometimes due to safety risks or medical impairments this isn't always possible. Please indicate below if you have the occupiers permission to share their details with us.


Are you a partner or stakeholder of West Midlands Fire Service?






Do you own or rent your property?





The following information helps us to prioritise those who need a visit most, please answer all questions as honestly as you can


Are there currently working smoke alarms in the property?

Are you or anyone who lives in the property:

Deaf or very hard of hearing?

Living alone?

A single parent with children under 18?

Of working age but unemployed for more than 1 year?

A smoker?

Anyone with mobility issues that would prevent or slow escape if there was an emergency?

A regular user of alcohol or other substances?

A user of medical oxygen?

At West Midlands Fire Service we take privacy seriously never share your personal data unless you agree or we are legally required to do so. For further information about how we use information collected for a safe and well visit and how we maintain the security of information, including your rights to access information, please see our privacy policy.

If you have any difficulties with our compliments form, or you want to speak to someone about it, please call our general contact number 0800 389 5525 during office hours.