Distance from Worksite (required):
Smoke Detectors in All Bedrooms (required):
Heat, Electricity, Clean Water (required):
Carbon Monoxide Detector (1 Central) (required):
First Aid Kit (required):
Fire Extinguisher (required):
Telephone (required):
Dishes, Glasses, Cooking Utensils (required):
Kitchen Table & Chairs (required):
Vacuum Cleaner, Broom, Cleaning Tools (required):
Stove & Refrigerator (required):
Dressers, Beds w/Linens & Blankets, Bath Towels (required):
Living Room Couch or Chair (required):
High Speed Internet (required):