Mental Health Home Visit Risk Assessment
Client Information
Date
Assessor Name
Client Name
Client Address
Visit Details
Scheduled Visit Date
Purpose of Visit
Time of Visit
Known Risks
History of Violence
Yes
No
Unknown
History of Substance Misuse
Yes
No
Unknown
Other Risks
Details
Environmental Risks
Location Safety Concerns
Yes
No
Unknown
Animals/Pets Present
Yes
No
Unknown
Other Environmental Hazards
Details
Communication & Lone Working
Mobile Phone Signal at Location
Adequate
Poor
Unknown
Lone Working Necessary
Yes
No
Additional Comments
Risk Management Plan
Actions to Mitigate Risks
Advice Given to Staff
Next Review Date