| Area/Room | Potential Risk | Risk Present? | Notes / Actions Needed |
|---|---|---|---|
| Living Room | Uncovered electrical outlets, unsecured furniture | ||
| Kitchen | Sharp objects accessible, cleaning supplies accessible, stove knobs within reach | ||
| Bathroom | No slip mats, medication accessible, cleaning supplies accessible | ||
| Bedrooms | Loose cords, small objects, window safety | ||
| Outdoors/Yard | Open gates, pools or water features, hazardous plants | ||
| Stairs | No safety gate, loose carpet | ||
| Other |