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2. Foster Home Fire Inspection Request
4. You will be contacted to confirm the inspection once approved.

   This is a request for a foster home fire inspection in accordance with North Carolina Department of Health and Human Services protocols. The fire inspection form utilized for the inspection can be viewed here:  https://policies.ncdhhs.gov/divisional/social-services/forms/dss-1515-foster-home-fire-inspection-safety-report/@@display-file/form_file/dss-1515-ia.pdf .

   Please review all requirements before requesting an inspection.

6. First Name*
7. Last Name*
9. Address of Foster Home*
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Date of Request
    Date of Request

    Date of Request
18. E-Mail Address
19. Preferred Method of Contact
    -- Select One --PhoneE-Mail
23. Requested Date and Time for Inspection*
    Requested Date and Time for Inspection

    Requested Date and Time for Inspection
24. Alternate Date and Time for Inspection*
    Alternate Date and Time for Inspection

    Alternate Date and Time for Inspection
26. Additional Comments/Information
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field