| Does the patient smoke? | | | |
| Does anyone in patient’s household smoke? | | | |
| Is there an indication of smoking materials?? (i.e. cigarettes,
lighter, matchbox, etc.) | | | |
| Is there a presence of any cooktops or heaters with gas? | | | |
| Is there any presence of open flames? (i.e. fireplace, wood
burning stove, candles, etc.) | | | |
| Is there a presence of any flammable substances within 5 ft. of oxygen tanks? | | | |
| Are there any overloaded outlets without surge protection? | | | |
| Is there a presence of functioning smoke detectors? | | | |
| Are there any oxygen cylinders either in a stand or lying flat and
not stored in a confined space (small closet) or next to heat
source? | | | |
| Is there a “No Smoking” sign posted on front exterior door? | | | |
| Any there any fire risks for neighboring residencies and buildings? | | | |