Firewise Home Assessment Request – Hidden Hills Firewise

Firewise Home Assessment Request Form

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Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address

Street Address Address Line 2 City State ZIP Code

Home Owner or Renter?(Required)

Home Owner

Renter

None of the above

Are you a Hidden Hills Resident?(Required)

Yes

Firewise Activity To Record(Required)

I have completed the following Firewise volunteer activities needed by my community to maintain Firewise status. (You may choose more than one). When you select an activity, a "Please enter ACTIVITY completed" section that will be added after your selection. Please use the dropdown or field of this activity section to record your activity. For the "Resident Structural Work,” “Resident Yard Work,” and "Common Area Work," please select volunteer hours completed, AND/OR if you paid a 3rd Party to do the work for you, please select the appropriate “Resident Structural 3rd Party Payments,” "Resident Yard Work 3rd Party Payments,” or “Common Area Work 3rd Party Payments" categories and enter the dollar amounts spent on materials or services to improve your residence, community, or defensible space. Each $33.49 spent is converted to one Volunteer Hour to help meet your Firewise Community goals.

Please enter RESIDENT STRUCTURAL HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter RESIDENT STRUCTURE MONEY PAID to 3rd parties(Required)

If you paid someone else to complete recommended RESIDENCE STRUCTURE work on your behalf to harden your residence against wildfire, please enter the amount paid.

Please enter a number from 1 to 50000.

Please enter HOME YARD WORK HOURS completed by you the RESIDENT(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter MONEY PAID to 3rd PARTY for HOME YARD WORK(Required)

If you paid someone else to complete recommended RESIDENCE YARD work on your behalf to harden your residence against wildfire, please enter the amount paid.

Please enter a number from 1 to 50000.

Did you the RESIDENT remove vegetation from your yard?(Required)

The amount of any vegetation removed is required for Firewise recognition.

Yes

Did a 3rd PARTY remove vegetation from your yard?(Required)

The amount of any vegetation removed is required for Firewise recognition.

Yes

Please select below one of the containers and amounts of containers used.

Type of RESIDENT Clearing Container Used

Please select from the five sizes of containers below, and use the dropdown to select the amount of containers used.

Lawn and Leaf Bag

Yard Waste Bin

Pickup Truck

Dump Truck

Roll Off Dumpster/Container

Type of 3rd PARTY Clearing Container Used

Please select from the five sizes of containers below, and use the dropdown to select the amount of containers used.

Lawn and Leaf Bag

Yard Waste Bin

Pickup Truck

Dump Truck

Roll Off Dumpster/Container

Lawn and Leaf Bags Removed by RESIDENT

Please use drop-down to select approximate amount of Lawn and Leaf Bags of vegetation removed by RESIDENT.

Lawn and Leaf Bags Removed by 3rd PARTY

Please use drop-down to select approximate amount of Lawn and Leaf Bags of vegetation removed by 3rd PARTY.

Yard Waste Bins Removed by RESIDENT

Please use drop-down to select approximate amount of Yard Waste Bins of vegetation removed by RESIDENT.

Yard Waste Bins Removed by 3rd PARTY

Please use drop down to select approximate amount of Yard Waste Bins of vegetation removed by 3rd PARTY.

Pickup Trucks Removed by RESIDENT

Please use drop-down to select approximate amount of Pickup Trucks of vegetation removed by RESIDENT.

Pickup Trucks Removed by 3rd PARTY

Please use drop-down to select approximate amount of Pickup Trucks of vegetation removed by 3rd PARTY.

Dump Trucks Removed by RESIDENT

Please use drop-down to select approximate amount of Dump Trucks of vegetation removed by RESIDENT.

Dump Trucks Removed by 3rd PARTY

Please use drop-down to select approximate amount of Dump Trucks of vegetation removed by 3rd PARTY.

Roll Off Dumpsters/Containers Removed by RESIDENT

Please use drop-down to select approximate amount of Roll Off Dumpsters/Containers of vegetation removed by RESIDENT.

Roll Off Dumpsters/Containers Removed by 3rd PARTY

Please use drop-down to select approximate amount of Roll Off Dumpsters/Containers of vegetation removed by 3rd PARTY.

Please enter HOME ASSESSMENT HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter COMMUNITY TEAM LEADER HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter COMMUNITY EVENTS HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter COMMUNICATIONS HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter FUNDRAISING HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter IT / ADMIN HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter BOARD MEMBER HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter COMMON AREA WORK HOURS completed(Required)

Please use drop-down to enter hours completed. If hours completed are more than the allotted hours, please resubmit another form.

Please enter COMMON AREA WORK MONEY PAID to 3rd parties(Required)

If you paid someone else to complete recommended COMMON AREA work on your behalf to harden your community against wildfire, please enter the amount paid.

Please enter a number from 1 to 250000.

Did a 3rd PARTY remove vegetation from a COMMON AREA?(Required)

The amount of any vegetation removed from COMMON AREAS is required for Firewise recognition.

Yes

Type of 3rd PARTY COMMON AREA Clearing Container Used

Please select from the five sizes of containers below, and use the dropdown to select the amount of containers used.

Lawn and Leaf Bag

Yard Waste Bin

Pickup Truck

Dump Truck

Roll Off Dumpster/Container

Lawn and Leaf Bags Removed by 3rd PARTY from COMMON AREA

Please use drop-down to select approximate amount of Lawn and Leaf Bags of vegetation removed by 3rd PARTY.

Yard Waste Bins Removed by 3rd PARTY from COMMON AREA

Please use drop down to select approximate amount of Yard Waste Bins of vegetation removed by 3rd PARTY.

Pickup Trucks Removed by 3rd PARTY from COMMON AREA

Please use drop-down to select approximate amount of Pickup Trucks of vegetation removed by 3rd PARTY.

Dump Trucks Removed by 3rd PARTY from COMMON AREA

Please use drop-down to select approximate amount of Dump Trucks of vegetation removed by 3rd PARTY.

Roll Off Dumpsters/Containers Removed by 3rd PARTY from COMMON AREA

Please use drop-down to select approximate amount of Roll Off Dumpsters/Containers of vegetation removed by 3rd PARTY.

Please enter WATCH VIDEO HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter READ DOCUMENTS HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Please enter OTHER HOURS completed(Required)

Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.

Would you like to receive our newsletter?

We email out an informative monthly newsletter of important information about keeping your property safe from wildfires.

Yes

Notes

Please add any details about your recorded Firewise Activities.

Please note it can take up to 15 seconds to submit your information.

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Combined Cubic Yards Gravity

Name

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