Safe & Well Request

WYFRS no longer accepts Safe and Well visit requests for threats of arson. Please report these to West Yorkshire Police via non-emergency phone 101.
West Yorkshire Police should follow their new internal process.

Who is this referral for?

Do you have the permission of the person you are referring to us?

We cannot accept a referral without permission from the person you are referring.

Do not submit this referral if the occupant has not yet been discharged from care/hospital or is not currently living at the property.

Who are you?

Which Partnership?

Your Contact Details

Your Name

Your Telephone Number

Your Email Address

Your Department

What are your contact details?

What are the contact details of the occupant?

Title

First Name

Last Name

Date of birth

Ethnic origin

Preferred Contact Method

Email Address

Phone Number

Other Number

Search for a Postcode

Address Line 1

Address Line 2

Town

Postcode

Property Ownership

Describe the other type of property ownership

This suggests another person is responsible for smoke detection in the property, so please provide their contact details

Risks Questions

Is there a working smoke detector on each level/floor of the property?

Is there only one adult (aged over 18) living in the property?

Is anybody in the household aged 75 or over?

Does anybody living in the property smoke?

Does anybody living in the property use a dynamic airflow mattress or cushion?

Is anybody living in the property deaf or hearing impaired?

Is this person ever left alone in the property?

If there was a fire, would anyone living at the property find it difficult to escape due to a disability or health condition?

Does anybody living in the property experience poor memory, confusion, lack of concentration, or falling asleep when they need to be awake?

Has anyone living at the property experienced 3 or more fire or smoke alarm incidents within the last 2 years?

Does anybody living at the property use home oxygen equipment?

Is there evidence of hoarding at the property?

Is there any evidence of issues with recreational drugs?

Is there any evidence of alcohol misuse?

Referral Comments

Are there any Health & Safety Risks?

Health & Safety Risks (Please consider lone-workers)

Important: Once you submit a Safe and Well visit request, and if it qualifies for a visit, it may take up to 28 days to complete. If you have an urgent visit request due to an imminent threat of arson, please do not submit this form. Instead, contact West Yorkshire Police directly to report the threat, as they have a separate process for handling urgent visit requests of this nature.