1.    Our family buckles up on every car ride.

                            Yes                            No

2.    Our family wears bike helmets when bicycling.

                         Yes                            No

3.    Kids under 10 never cross streets alone.    

                          Yes                            No   

4.   Kids are always supervised in or near water.

                         Yes                            No

5.    Our home has working smoke detectors and we check the batteries monthly.

                         Yes                            No   

6.     Our water heaters are set no higher than 120 degrees F to prevent scald burns.

                         Yes                            No

7.    If guns are in our home, they are kept unloaded and locked away.

                         Yes                            No

8.    Kids are protected against falls from windows, stairs, furniture and playground.

                         Yes                            No   

9.    Household cleaners, medicine, and vitamins are stored out of young kids’ reach.

                         Yes                            No

1o.    Our home has emergency numbers near the telephone and first aid supplies.

                          Yes                            No