Sensible Care

Home Risk/Safety Assessment

Date of Assessment:

Name of Person Completing Assessment:

Email of assessor:

Client Information

Client Name:

DOB:

Other:

Street address

Suburb

State

Postcode

Location & Property Access

Is the home/number visible from the street?

YesNoOther

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Parking Access

FrontBackSideSpecial Access Instructions

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Are there any tripping hazards leading up to the house?

YesNoOther

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How is the phone reception at the property?

BadAverageGood

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Are there any gates or locks leading up to the house/property that we need to be aware of?

YesNoOther

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Pets

Are there any pets and/or animals at the house/property?

YesNo

What types of animals/pets are they?

How many animals/pets are there?

Are they indoor or outdoor animals/pets?

IndoorOutdoorBoth

Are the animals/pets friendly?

YesNoOther

Can the animals/pets be restrained/isolated during home visits?

YesNo

Why not?

Occupants

Who do you normally live with?

Condition of Home/Hazards

Is the home clutter free?

YesNoOther

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Are the walkways free?

YesNoOther

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Are there any issues with the lighting?

YesNoOther

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Are there any issues with accessing emergency exits or are there emergency exits?

FrontBackBoth

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Are you happy to keep the doors unlocked during the home visit?

YesNoOther

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Are there any steps or uneven surfaces?

YesNoOther

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Are there any pests within the property?

YesNo

What types of pests?

Hazards

Are there any behaviours of concern we need to be aware of (e.g., confusion, history of violence or aggression, deafness, vision impairment, etc.)?

YesNo

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Is the property located in a remote area?

YesNo

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Is the property located in a bushfire prone zone?

YesNo

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Are there any weapons (e.g., guns, hunting knives, etc) on the property?

YesNo

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Does client have or require a sharps container?

YesNoOther

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House Security

Is there a keylock?

YesNo

Provide code

Do you have security cameras?

YesNo

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Do you have working smoke alarms?

YesNo

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Service Delivery

Services that might be delivered

Domestic AssistanceShoppingPersonal Care

Domestic Assistance

Is the bed accessible and at an appropriate height?

YesNo Adjustable BedOther

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Is the access to the washing line clear? Is the washing line at an appropriate height?

YesNoOther

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Shopping

Please Specify

Please explain why

Do they have a disability parking permit?

YesNo

Personal Care

Do you have any manual handling aids for personal care?

YesNo

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What type of shower head do you have?

Handheld showerOverhead showerBothOther

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Suitability of the bathroom

Save and Complete Later