Community Care Tasmania

Home Safety Checklist

Client's Name: *

Address: * 🛈

Date * +

Support Worker Name: *

This form is to be completed at first visit and annually to ensure the safety of the work environment for staff and to promote safety for clients.

Do you feel in anyway unsafe? How do you feel?

Is there something about the property that makes you feel on edge/cautious?

SHOULD YOU FEEL UNSAFE Do not enter the property. Please Call Casemanager 03 6334 0990

Do you feel UNSAFE on this property * 🛈

YES I feel UNSAFE and I will ring the office immediately on 6334 0990

NO I feel quite safe & I will proceed with Home Safety Checklist

If YES Please describe Why\How you Feel unsafe.

Access

Is the house number clearly visible? 🛈

Yes

No

N/A

Comments - Visibility of House Number 🛈

Is there a safe place to park? 🛈

Yes

No

N/A

Corrective Action Required - Comments 🛈

Is there adequate outdoor lighting? *

Yes

No

Corrective Action Required - Comments

Is access to the front and back door clear of obstacles? *

Yes

No

N/A

If Access obstacles to front door please describe

Access to Front & Back Door Issues 🛈

Is there a clear exit available in the event of a fire? *

Yes

No

Is there MORE than ONE Fire exit available? * 🛈

Yes

No

Please describe Issues regarding Fire Exit

Are the steps Safe? *

Yes

No

N/A

Are the surface of steps safe? (Not rough) *

Yes

No

N/A

Issues regarding Steps

Is there a handrail? *

Yes

No

N/A

Is the handrail secure to the wall *

Yes

No

N/A

Does the client have pets? * 🛈

Yes

No

What type of pets are in the household *

Is the Pet secured away from support worker? * 🛈

Yes

No

N/A

Actions required to secure pet 🛈

Is the yard overgrown?
Report to CM so they can arrange HGM service. *

Yes

No

N/A

Corrective Action Required - Comments

Are there bushes growing across pathways?
Potential scratch or eye injury. *

Yes

No

N/A

Corrective Action Required - Comments

Residence - Internal

Is there clutter inside house that makes movement difficult? *

Yes Clutter

No Clutter

Limited Clutter

Is it safe & clear to walk through house *

Yes.. Safe & Clear

Not.. Safe & Clear

Restricted clearways

Is it safe & clear to vacuum throughout house? *

Yes.. Can get vacuum through easily

No .. Unsafe to get vacuum through

Restricted - Need to move items to vacuum

Can the client take a walking aid through house clearly *

Yes - Plenty of room for walking aid

No - Restricted access for walking aid

Room for walking aid in limited areas

Are Doorways clear of obstacles *

Yes - Clear doorways

No - Restricted access to doorways

If doorways have deadlocks Is easy exit available such as Keys are in locks *

Yes - Deadlocks present, Easy Exit is available

No - Difficult to Exit Due to deadlocks

N/A No Deadlocks present

Are there any tripping or slipping hazards?
(include mats) e.g Do mats sit flat/have a non-slip backing *

Yes	No
N/A

Corrective Action Required - Comments

Are there any indoor steps present? *

Yes

No

Corrective Action Required - Comments

Are the inside steps safe? (consider height of steps, secure, handrail present, lighting) *

Yes

No No

Is there evidence of pest infestation? *

Corrective Action Required - Comments

Is the lighting adequate Around the House? *

Yes	No
N/A

Corrective Action Required - Comments

Electrical

Are power points easily accessible? *

Yes	No
N\A

Corrective Action Required - Comments

Do you have to get behind furniture, bend, reach high? *

Yes	No
N/A

Corrective Action Required - Comments

Are power points or power boards overloaded? *

Yes	No
N/A

Corrective Action Required - Comments

Are the light switches in good working order? *

Yes	No
N/A

Corrective Action Required - Comments

Are extension cords or cords to electrical equipment causing a hazard?
(example frayed cords, exposed wiring, washing machine, iron, vacuum, hair dryer etc)
If using and extension cord, place your RCD into the power point then plug the cord into this. *

Yes	No
N/A

Corrective Action Required - Comments

Domestic Assistance Tasks

Is there an appropriate vacuum cleaner available and
in working order?
(height adjustable, not too heavy, good suction) *

Yes	No
N/A

Corrective Action Required - Comments

Is there sufficient access to power points to do the vacuuming? *

Yes	No
N/A

Corrective Action Required - Comments

When cleaning, If dusting is done above shoulder height
is there a suitable duster?
(long handle) *

Yes	No
N/A

Corrective Action Required - Comments

Is the broom, mop and bucket appropriate for the job? *

Yes	No
N/A

Corrective Action Required - Comments

Does the client have appropriate cleaning products available
and in original containers?
Labels are clear Advise of approved chemicals
(No Bleach or corrosives) *

Yes	No
N/A

Corrective Action Required - Comments

Bathroom

Is the shower hand held? *

Yes	No
N/A

Corrective Action Required - Comments

Is there a separate shower? *

Yes	No
N/A

Corrective Action Required - Comments

Is the Shower Easily Accessible? *

Yes	No
N/A

Corrective Action Required - Comments

Is there a shower stool or bath board (for a bath) available? *

Yes	No
N/A

Corrective Action Required - Comments

Are there handrails? *

Yes	No
N/A

Corrective Action Required - Comments

Are These handrails easy to reach by client? *

Yes	No
N/A

Corrective Actions Required - Comments

If there is a heater but not fixed to the wall,
can it be removed prior to wash/shower?
Trip hazard, burns risk, fire risk if clothing/towels fall on it *

Yes	No
N/A

Corrective Action Required - Comments

Cooking

Can you observe any obvious issues with kitchen appliances?
(including oven, microwave, toaster)
(If it is a gas oven, Is it easy to light,
Does the microwave have clear instructions.) *

Yes	No
N/A

Corrective Action Required - Comments

Back Yard

Is the clothesline easy to reach and height adjustable?
(e.g Can you peg out the washing without reaching too high) *

Yes	No
N/A

Corrective Action Required - Comments

Is there a safe path? *

Yes	No
N/A

Corrective Action Required - Comments

Is there a suitable clothes basket and trolley?
(How far do you need to carry the load?
Take in multiple loads to reduce the weight.) *

Yes	No
N/A

Corrective Action Required - Comments

Client

Does the client have mobility limitations that require support
from the carer/support worker?
Refer to CM in case a review and / or mobility aid is required *

Yes	No
N/A

Corrective Action Required - Comments

Does the client use mobility aids? *

When was the Mobilty Aid last serviced? (brakes, wheels) *

N/A

When When

Corrective Action Required - Comments

Is the client /carer in the home a smoker?
Advise support workers cannot work whilst the
client/carer is smoking in the house. *

Yes	No
N/A

Corrective Action Required - Comments

Other HouseHold Equipment

Does the clothes dryer have a clean lint filter?
Clean before each use *

Yes	No
N/A

Corrective Action Required - Comments

Is the ironing board height adjustable?
(Ensure it is a comfortable height for you to be working) *

Yes	No
N/A

Corrective Action Required - Comments

Type of Heating in House? *

Are there any issues related to heating? (Include wood heater, heat pump, fan or radiant heaters) You may be required to bring wood in (if on support plan) – are there gloves available? *

Yes	No
N/A

Are heaters fixed so that they will not tip over?
Does the client sit too close?
Report to CM *

Yes	No
N/A

Corrective Action Required - Comments

Is there a working smoke alarm?
If a client has no other way of getting assistance, they may
be eligible for assistance from Project Wake UP (Tas Fire Service).
CM to refer *

Yes	No
N/A

Corrective Action Required - Comments

Does the client have anyone who will assist them to change the batteries every 6 months? *

Yes	No
N/A

Corrective Actions Required - Comments

If a large home, are there multiple smoke alarms? *

Yes	No
Small home

Corrective Actions Required - Comments

Other Environmental Factors

Are there others in the home? *

Yes	No
N/A

Corrective Action Required - Comments

Is there anyone else in the home that poses a potential
risk to staff or others ? *

Yes	No
N/A

Corrective Action Required - Comments

Do they live outside an urban area? Surrounded by bush *

Urban Area	Surrounded by Bush
Other, please Describe Other, please Describe

Corrective Action Required - Comments

Does the client live in a high risk bushfire area? *

Yes

No

Corrective Action Required - Comments

Is there someone who can support in case
of emergency of any kind? *

Yes	No
N/A

Corrective Action Required - Comments

Do you have a bush-fire plan in place? *

Yes

No

Corrective Action Required - Comments

Would mobility hinder client from
escaping home in an emergency? *

Yes	No
N/A

Corrective Action Required - Comments

Are there firearms in the home? *

Yes	No
N/A

Corrective Action Required - Comments

Are they in a locked storage area? *

Yes

No

Corrective Action Required - Comments

Additional Comments / Observations with this Home Visit Check

Name: *

Date * +

Siganature *

clear

Support workers are reminded of the following:

While at work a worker must

take reasonable care for your own health and safety (this includes following the instructions on the support plan, using your RCD for hand-held electrical devices, identifying and reporting hazards)
take reasonable care that your acts or omissions do not adversely affect the health and safety of other persons
comply, so far as the worker is reasonably able, with any reasonable instruction that is given by the person conducting the business or undertaking to allow the persons to comply with the Work Health and Safety Act 2011
Cooperate with any reasonable policy or procedure of CCT relating to health or safety in the workplace that has been notified to workers.

Poor pathway	No Pathway
Steep Driveway	Sloping Yard
Gates easy to Unlock	Bushes
Pets - Loose	Rubbish
Path uneven	Path Slippery
Shade over pathway	Ice in Winter
Other Other

No	Rats
Cockroach	Wasp
Other Other

Walking Stick	Rollator
Scooter	Wheel Chair
Other Other

Heat Pump	Wood
Gas	Radiant Heating - wall Mounted
Electric Heating	Other Other