Edit Form - Drag N' Drop FormBuilder

Basic Tools

Heading
Text Box
Text Area
Drop Down
Radio Button
Check Box

Advanced Tools

Full Name
Email
Address
Phone
Date Picker

Home
Save
Preview
Unpublish
LightDark

Burglary

This registration form has been published and is now live

Doors, Locks, and Windows
Type of doors? *
- wood
- metal
- wood and metal
- wood and glass
- metal and glass
- a varied mix of wood
- metal
- and glass
- a non-standard material
If a non-standard material, please describe. *
Type of locks? *
- double cylinder
- deadc bolt
- single cylinder
- spring lock
- pad lock
- cross bar
- a mix of different type
The windows are secured with: *
- window frames
- metal
- wood protection
- cam slide bolts
- bars
- wire mesh
- another type of protection
Other Window protection *
Sky Lights: *
- There are skylights
- There are NO skylights
Area Risk
The Crime Rate in this area is: *
- high
- moderate
- low
Known Burglaries in the area : *
- there have been burglaries
- there have NOT been any known burglaries
Alarms and Security
Is there a Burglar Alarm System *
- There is a burglar alarm system
- There is NO burglar alarm system
Provide the Name of the monitoring company if there is a Central Station Service *
The Central Station is: *
- UL certified
- NOT UL certified
Where is the signal transmitted *
The doors, windows, roof openings, and interior openings are *
- equipped with alarms
- NOT equipped with alarms
Is there Line Security *
- there is line security
- there is NO line security
What is the extent of the Installation *
Is there a button alarm *
- there is a button alarm
- there is NO button alarm
Grade the installation according the following: *
- response time of 15 min. or less
- response time of 15 min. or less with line security
- response time of 20 min. or less
- response time of 20 min. or less with line security
- response time of 30 min. or less
- response time of 30 min. or less with line security
Is there a Watchman Service *
- there is a watchman service
- there is NO watchman service
Does the watchman perform Hourly Rounds *
- the watchmen make hourly rounds
- the watchmen DO NOT make hourly rounds
Is there a Watchclock *
- A watchclock is used by the watchmen
- A watchclock IS NOT used by the watchmen
Are there video cameras in use for security *
- there are video security cameras
- there are NO video security cameras
General
The Person Interviewed *
The Interview Date *
- Month
- Day
- Year
General Comments *

Active fields on your form can be edited in the box below.

Form Properties

Title
Theme
Notification Email
Confirmation Msg	Thank you for filling this form

Field Properties -

Text
Label
Max Characters
Required
Hide Control
Control Action
Options
Selected Option
Hint
Property Lens
Valid Extensions
Max. File size (kb)
Min. File size (kb)
Help Text
Recommendations

Advance Setting

Auto-saving

Copy Embed Script

(or press ESC or click the overlay)

×