Carer Capacity Risk Assessment for Dependent Adults
Carer Information
Carer Name
Date
Relationship to Dependent Adult
Dependent Adult Information
Name
Age
Medical Conditions/Needs
Risk Assessment
Risk Factor
Risk Present (Yes/No)
Description/Details
Current Controls/Support
Level of Risk
Carer Health & Wellbeing
Yes
No
Low
Medium
High
Knowledge of Dependent's Needs
Yes
No
Low
Medium
High
Physical Environment/Suitability
Yes
No
Low
Medium
High
Social Support Network
Yes
No
Low
Medium
High
Carer Stress/Burnout
Yes
No
Low
Medium
High
Other (specify)
Yes
No
Low
Medium
High
Summary & Recommended Actions
Summary of Key Risks Identified
Recommended Actions/Interventions
Person(s) Responsible
Review Date
Assessor Name
Signature