Bedrooms & Bays

Room Designations/ Numbers

Windows

Window Frame
Window Handles
Window Hinges
Window Restrictors

Other Ligatures (specify)

Notes

Window Coverings

Curtains
Louvre Blinds
Venetian Blinds
Hanging Track

Other (specify)

Notes

Doors

Frame
Handle
Hinges
Closer
Lock

Other (specify)

Notes

Ceilings

Solid Plaster
False/ Suspended Ceiling & Tiles
Air Vents/ Diffusers
Light Fittings
Alarm Detector Heads
Hatches
Pull Switches

Other (specify)

Notes

Walls

Wall Lights
Pictures
Mirrors
Switches
Plug Sockets
Call Bells
Gas Supply Pipes
Radiators and Pipes
Vents/ Extractors
Alarm Housings
Grab Rails
TV Brackets
Bed Bumpers
Shelves
Cabinets
Hooks

Other (specify)

Notes

Sinks

Sink
Taps
Soap/ Cleaner Dispensers
Towel Holder
Plug
Pipework

Other (specify)

Notes

Bed

Make and Model

Can bed be upended?

Power Cables
Control Cables
Headboard
Footboard
Linen Tray
Bed rails
Bed Base
Drawers
Bed frame

Other (specify)

Notes

Wardrobes/ Cupboards/ Cabinets

Furniture types

Door
Handle
Hinge
Lock
Rail
Coat Hook
Shelves
Hangers

Other (specify)

Notes

Other Furniture

Chairs
Tables
Bean bags

Other (specify)

Notes

Electrical Equipment

Equipment Present

Cables

Other (specify)

Notes

Bathrooms, En-Suites, Shower Rooms & Toilets

Room Designations/ Numbers

Windows

Window Frame
Window Handles
Window Hinges
Window Restrictors

Other Ligatures (specify)

Notes

Window Coverings

Curtains
Louvre Blinds
Venetian Blinds
Hanging Track

Other (specify)

Notes

Doors

Frame
Handle
Hinges
Closer
Lock

Other (specify)

Notes

Ceilings

Solid Plaster
False/ Suspended Ceiling & Tiles
Air Vents/ Diffusers
Light Fittings
Alarm Detector Heads
Hatches
Pull Switches

Other (specify)

Notes

Walls

Wall Lights
Pictures
Mirrors
Switches
Plug Sockets
Call Bells
Gas Supply Pipes
Radiators and Pipes
Vents/ Extractors
Alarm Housings
Grab Rails
TV Brackets
Bed Bumpers
Shelves
Cabinets
Hooks

Other (specify)

Notes

Sinks

Sink
Taps
Soap/ Cleaner Dispensers
Towel Holder
Plug
Pipework

Other (specify)

Notes

Baths

Bath
Grab rails/ Handles
Taps
Soap/ Cleaner Dispensers
Towel Holder
Plug
Pipework

Other (specify)

Notes

Shower

Shower
Grab rails/ Handles
Shower controls
Shower Head
Shower Head Hose
Soap/ Cleaner Dispensers
Towel Holder
Pipework
Shower Chair/ Seat

Other (specify)

Notes

Shared Rooms [Lounges, therapy rooms, dining rooms, etc]

Room Designations/ Numbers

Windows

Window Frame
Window Handles
Window Hinges
Window Restrictors

Other Ligatures (specify)

Notes

Window Coverings

Curtains
Louvre Blinds
Venetian Blinds
Hanging Track

Other (specify)

Notes

Doors

Frame
Handle
Hinges
Closer
Lock

Other (specify)

Notes

Ceilings

Solid Plaster
False/ Suspended Ceiling & Tiles
Air Vents/ Diffusers
Light Fittings
Alarm Detector Heads
Hatches
Pull Switches

Other (specify)

Notes

Walls

Wall Lights
Pictures
Mirrors
Switches
Plug Sockets
Call Bells
Gas Supply Pipes
Radiators and Pipes
Vents/ Extractors
Alarm Housings
Grab Rails
TV Brackets
Bed Bumpers
Shelves
Cabinets
Hooks

Other (specify)

Notes

Sinks

Sink
Taps
Soap/ Cleaner Dispensers
Towel Holder
Plug
Pipework

Other (specify)

Notes

Wardrobes/ Cupboards/ Cabinets

Furniture types

Door
Handle
Hinge
Lock
Rail
Coat Hook
Shelves
Hangers

Other (specify)

Notes

Other Furniture

Chairs
Tables
Bean bags

Other (specify)

Notes

Electrical Equipment

Equipment Present

Cables

Other (specify)

Notes

Corridors & Circulation Spaces

Room Designations/ Numbers

Windows

Window Frame
Window Handles
Window Hinges
Window Restrictors

Other Ligatures (specify)

Notes

Window Coverings

Curtains
Louvre Blinds
Venetian Blinds
Hanging Track

Other (specify)

Notes

Doors

Frame
Handle
Hinges
Closer
Lock

Other (specify)

Notes

Ceilings

Solid Plaster
False/ Suspended Ceiling & Tiles
Air Vents/ Diffusers
Light Fittings
Alarm Detector Heads
Hatches
Pull Switches

Other (specify)

Notes

Walls

Wall Lights
Pictures
Mirrors
Switches
Plug Sockets
Call Bells
Gas Supply Pipes
Radiators and Pipes
Vents/ Extractors
Alarm Housings
Grab Rails
TV Brackets
Bed Bumpers
Shelves
Cabinets
Hooks

Other (specify)

Notes

Wardrobes/ Cupboards/ Cabinets

Furniture types

Door
Handle
Hinge
Lock
Rail
Coat Hook
Shelves
Hangers

Other (specify)

Notes

Other Furniture

Chairs
Tables
Bean bags

Other (specify)

Notes

Electrical Equipment

Equipment Present

Cables

Other (specify)

Notes

Any other ligature issues

Other (specify)

Notes

The Following rooms were found to be unlocked & unsupervised during the visit

Room Designations/ Numbers

Windows

Window Frame
Window Handles
Window Hinges
Window Restrictors

Other Ligatures (specify)

Notes

Window Coverings

Curtains
Louvre Blinds
Venetian Blinds
Hanging Track

Other (specify)

Notes

Doors

Frame
Handle
Hinges
Closer
Lock

Other (specify)

Notes

Ceilings

Solid Plaster
False/ Suspended Ceiling & Tiles
Air Vents/ Diffusers
Light Fittings
Alarm Detector Heads
Hatches
Pull Switches

Other (specify)

Notes

Walls

Wall Lights
Pictures
Mirrors
Switches
Plug Sockets
Call Bells
Gas Supply Pipes
Radiators and Pipes
Vents/ Extractors
Alarm Housings
Grab Rails
TV Brackets
Bed Bumpers
Shelves
Cabinets
Hooks

Other (specify)

Notes

Sinks

Sink
Taps
Soap/ Cleaner Dispensers
Towel Holder
Plug
Pipework

Other (specify)

Notes

Baths

Bath
Grab rails/ Handles
Taps
Soap/ Cleaner Dispensers
Towel Holder
Plug
Pipework

Other (specify)

Notes

Showers

Shower
Grab rails/ Handles
Shower controls
Shower Head
Shower Head Hose
Soap/ Cleaner Dispensers
Towel Holder
Pipework
Shower Chair/ Seat

Other (specify)

Notes

Beds

Make and Model

Can bed be upended?

Power Cables
Control Cables
Headboard
Footboard
Linen Tray
Bed rails
Bed Base
Drawers
Bed frame

Other (specify)

Notes

Wardrobes/ Cupboards/ Cabinets

Furniture types

Door
Handle
Hinge
Lock
Rail
Coat Hook
Shelves
Hangers

Other (specify)

Notes

Other Furniture

Chairs
Tables
Bean bags

Other (specify)

Notes

Electrical Equipment

Equipment Present

Cables

Other (specify)

Notes

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.