Client details (The occupant)
Referring Agency/Service Details
Eligibility Questions

Please tick all relevant boxes.

Is this a rental property?
Has your client had a Project WakeUp (PWU) visit in the past?
Is this a call back to installed faulty or expired PWU smoke alarm/s?
Is there working smoke alarm/s in the client's home?
If yes, are these smoke alarms hard wired (wired in to electricity) ?
Is your client receiving home support by a HACC, CHSP, NDIS or HCP funded service?
If yes, then please indicate which one:
Funded level
Does your client have any means to have a smoke alarm installed by a relative, friend, home maintenance service and/or fire safety business?

Your client is not eligible for this program.

Will the agency/service assist the client with regular maintenance of installed smoke alarms by testing monthly and cleaning every six months?

Consider finding a local community service, support agency, and/or fire safety business that can help with regular maintenance, hazards and safety issues.

Will the agency/service assist the client with identified fire hazards and safety concerns reported in the home fire safety check?

Consider finding a local community service, support agency, and/or fire safety business that can help with regular maintenance, hazards and safety issues.

Does your client agree to being contacted directly to arrange a home fire safety check?
Does your client require an Auslan interpreter?