Home Health Care Home Safety Assessment

Client Name

Home Address

Assessment Date

Entry & Access Walkways clear and non-slip Adequate entry lighting Steps/stairs have handrails Locks easy to operate

Living Areas Clutter free pathways Loose rugs secured Electrical cords secured Sufficient lighting

Bathroom Safety Grab bars installed Non-slip mats in tub/shower Toilet seat height appropriate Easy access to bathroom supplies

Bedroom Safety Easy access to bed Bedside lighting available Floor clear around bed Call/alarm system available

Kitchen Safety Frequently used items accessible Appliances functioning properly Fire extinguisher available Electrical cords and outlets safe

Notes / Other Safety Concerns

Assessor Name

Signature