Support at Home โ€” Home Safety & Risk Assessment

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Consumer Detail

How to use: For each checklist item, select Yes, No, or N/A. Optionally add comments and set Likelihood (L) and Consequence (C) ratings (1โ€“5) to calculate the risk level. Click Generate Excel to download, or PDF Preview to print. Login to save records and access them from any device.
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Part A: WHS Screening

To be completed before Home Visit

7/7
Checklist ItemResponseComments & Risk Management

Does the participant has a history of aggressive behaviour or mental health issues

Is there Pets at the premises of visiting

Does the participant or other member of the premises have Weapons or potential weapons

Is there known infectious illnesses recorded for people who living in the property

Is there known family conflict of the participant

Does the participant has known communication barriers

Is there a safety risk for parking

๐Ÿก

Outside the Home

Part B: Home Visit

7/7
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

House number and street name are clearly visible

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The gate is easy to open

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Steps, access ramps, footpaths and public areas in good repair (e.g. surface is level)

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Steps, access ramps, footpaths and entrances are free from clutter and obstruction

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Garage and garden shed are free from clutter and securely locked

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Garden tools (e.g. hose, rake, broom) are in good repair, easy to access and kept tidy

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Clothes line is in good repair, easy to access and within comfortable reach

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Entrance and Hallways

Part B: Home Visit

3/3
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Doorbell or door knocker is in good repair

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Passageways are cleared from clutter and obstruction

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Exits are free from clutter and obstruction

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Stairs and Steps

If applicable

4/4
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Stairs and steps are in good repair and well lit

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Stairways are cleared from clutter and obstruction

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Hand rails are in good repair and within comfortable reach to navigate stairs and/or steps

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Light switch at the top and bottom of stairways

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Bathroom

Part B: Home Visit

6/6
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Adequate lighting for safe access and navigation

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Shower recess is easy to access (e.g. no access over bath, raised edge or hob)

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Grab rails are in good repair and within comfortable reach to assist with getting in and out of the shower and/or on and off the toilet

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Flexible handheld shower hose is in good repair and accessible

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Soap and shampoo are within easy reach

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Other safety equipment are in good repair, (Shower chair, anti slipper mat, etc.)

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Kitchen

Part B: Home Visit

6/6
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Adequate lighting for safe access and navigation

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Area is well ventilated

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Stovetop and oven are in good repair and kept clear of any clutter or flammable materials

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Electrical appliances and electrical cords are in good repair.

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Regularly used items are within comfortable reach without climbing or bending

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At least one smoke detector is installed on each level of the home and is functional

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๐Ÿ’Š

Medication

Part B: Home Visit

1/1
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Medication are labelled and stored appropriately

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๐Ÿงบ

Laundry

Part B: Home Visit

3/3
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Adequate lighting for safe access and navigation

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Area is well ventilated

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Chemical products are labelled and stored appropriately

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๐Ÿงน

Housekeeping & Cleaning

Part B: Home Visit

2/2
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Vacuum cleaner is in good repair and easy and practical to use

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Broom, mop and bucket are in good repair and easy and practical to use

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Bedroom

Part B: Home Visit

2/2
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Bedroom is well lit or light can be easily switched on when in bed

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Carpets and mats lie flat without wrinkles, curled or frayed edges. Flooring is even without trip hazards.

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Living and Dining Room

Part B: Home Visit

3/3
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Carpets and mats lie flat without wrinkles, curled or frayed edges. Flooring is even without trip hazards.

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Furniture are arranged so that it is easy to walk around

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Chairs and lounge are easy to get in and out of

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๐Ÿš—

Transport

Part B: Home Visit

4/4
Checklist ItemResponseComments & Risk ManagementLikelihoodConsequenceRisk

Walking aids or wheelchairs are used as recommended by health professionals

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Walking aids or wheelchairs are in good repair.

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Difficulties or issues of consumer while in travelling in vehicles are documented in care plan with appropriate strategies.

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There is no manual handling or equipment usage risk to support workers.

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Note: If Home safety risk is identified, a formal OT home safety assessment is strongly recommended and to implement intervention strategies to minimize the risks.

Signatures & Dates

Consumer / Authorised Representative

Signature area (print)

Assessor

Signature area (print)