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Exhibit B I <br /> Fire Safe Families - Washington State <br /> Monthly Report <br /> Community: <br /> Month of Activity: <br /> Completed by: <br /> Please attach application forms to the completed installation form and submit with this report. <br /> Jan Feb March April May June July Final <br /> # of Households <br /> canvassed <br /> # of Households <br /> enrolled <br /> # of smoke alarms <br /> installed <br /> # of fire incidents in <br /> program homes <br /> # of fatalities <br /> /injuries in program <br /> homes <br /> Potential lives saved <br /> Public Awareness activities and other activities: Media Coverage (interviews, articles, <br /> flyers, etc.) <br /> What did you do this month? How did you conduct the installations and <br /> education portions of the project? What materials did you use? Examples might <br /> include: Meetings conducted regarding this project; new partners in coalitions/communities; Contributions <br /> by others (funds, donations, alarms, in-kind services, volunteers etc.); Smoke Alarm legislative changes: <br /> (a law passed, change in scope of law, etc.); Enforcement activities: (Special activities, fines, citations, <br /> training for police, etc.);Anecdotes (success stories, lives saved/injury prevented by the program) <br /> Additional Comments: <br /> Send hard copy and an electronic copy to Katharine.Fitzgerald(a�seattlechildrens.orq <br /> Katharine Fitzgerald, Children's Hospital&Regional Medical Center <br /> PO Box 50020-S217, Seattle, WA (8145-5020 <br /> Phone 206-987-5245 Fax 206-987-5705 <br /> Due the 15th of each month ' ' s <br />