Institutional Care Risk Assessment Form for Vulnerable Adults
Personal Information
Name:
Date of Birth:
Gender:
Male
Female
Other
Institution Name:
Assessment Date:
Vulnerability Details
Primary Vulnerability:
Other Relevant Medical or Psychological Conditions:
Risk Factors
History of Abuse or Neglect:
Yes
No
Self-Harm/Suicide Risk:
Low
Medium
High
Risk of Falls or Accidents:
Low
Medium
High
Other Risks Identified:
Support Needs
Supervision Level Required:
Independent
Intermittent
Continuous
Assistance with Activities of Daily Living:
Communication/Linguistic Needs:
Safeguarding Actions & Recommendations
Actions Taken:
Recommendations:
Assessment Completed By
Name:
Position:
Date: