Use this form to tell us if you or someone in your home needs help to evacuate your home in the event of a fire or other emergency. For example, this may be because a person has difficulties with their mobility, a long-term illness, experiences hearing loss or sight loss.
Before you start
Complete this form if you, or the person you are representing, is a secure council tenant of Ealing Council.
Do not complete this form if you:
- you or your household would not have any problems self-evacuating
- you are the tenant of another landlord
- you are currently living in a council sheltered housing property
- you are living in temporary accommodation.
You will need
To include the reason why you or the person in your household cannot self-evacuate.
What happens next
Your details will be passed to your local housing hub, who will contact you within 5 days to talk about your form. They may ask for other information, to work out what kind of help you need. We may arrange to visit you at home to complete a person-centred fire risk assessment (PCFRA).
Sometimes we may suggest you have a visit from the London Fire Brigade. This visit would give advice on reducing risk factors and identify safety measures that may be available to you.
This form should take about 5 minutes to complete.
Each form page will time out after 20 minutes and cannot be saved.