Centacare Home Safety Inspection

• Conducted on

  Date

• Document#

• Clients Name

• Clients Signature

  Sign

• Prepared by

• Officer Signature

  Sign
• Address
  Address

• Type of Property

  Select Acreage Rural Urban House Unit Independent living facility

  • Acreage
  • Rural
  • Urban
  • House
  • Unit
  • Independent living facility

General Condition and Working Conditions

• Pets on Premises ?

  Yes

  No

  N/A

• Description and access actions required

• Entry / Exits are free from debris?

  Yes

  No

  N/A

• Maintenance required to rectify

• Working areas (Kitchen, Bathroom, Bedroom, etc) are not extremely slippery?

  Yes

  No

  N/A

• Maintenance required to rectify

• Entry and potential work areas are free from clutter?

  Yes

  No

  N/A

• Maintenance required to rectify

• Sloping Driveways

  Yes

  No

  N/A

• Approx. Grade and Length

• Safe car park available in close proximity?

  Yes

  No

  N/A

• Approx. distance from main entrance

• Access is available and safe to clothes line?

  Yes

  No

  N/A

• Maintenance required to gain safe access

• Windows open and close properly?

  Yes

  No

  N/A

• Maintenance required to rectify

• Waste bins appear to be emptied regularly?

  Yes

  No

  N/A

• Issues and corrective actions discussed with client

Working area and equipment

• Stove type?

  Select Gas Electric

  • Gas
  • Electric

• Type of flooring?

  Select Carpet Tile Timber Linoleum

  • Carpet
  • Tile
  • Timber
  • Linoleum

• Domestic assistance equipment that is in good working order?

  Select Mop Brooms Vacuum Dusters Dustpan Cobweb brush

  • Mop
  • Brooms
  • Vacuum
  • Dusters
  • Dustpan
  • Cobweb brush

• Bed has height adjustment if required?

  Yes

  No

  N/A

• Is there sufficient space around the bed?

  Yes

  No

  N/A

• Are sharps used?

  Yes

  No

  N/A

• Are sharps disposal containers on site?

  Yes

  No

  N/A

• Are firearms located on the premises?

  Yes

  No

  N/A

• Are firearms locked away?

  Yes

  No

  N/A

• Does the client note any access issues during future or past natural events?

  Yes

  No

  N/A

• Details

Client Wellness

• Is there any evidence that the client may be at risk from sexual harassment?

  Yes

  No

  N/A

• Are there any risks apparent from co-tenants, neighbours or others?

  Yes

  No

  N/A

• Are there any evidence of challenging behaviours from co-tenants, neighbours, or others?

  Yes

  No

  N/A

• Is there evidence of hording behaviours?

  Yes

  No

  N/A

Facility controls

• RCD's are installed and tested?

  Yes

  No

  N/A

• Resolution required

• Emergency keys supplied?

  Yes

  No

  N/A

• Location

• Location of water shut off?

• Location of gas shut off?

• Location of solar main switch?

Falls Prevention

• Are there cords running across floors and doorways?

  Yes

  No

  N/A

• Corrective action taken?

• Mould on pathways?

  Yes

  No

  N/A

• Corrective action taken?

• Uneven or overgrown pathways?

  Yes

  No

  N/A

• Corrective action taken?

• Loose step treads?

  Yes

  No

  N/A

• Corrective action taken?

• Adequate and secure handrails?

  Yes

  No

  N/A

• Corrective action taken?

• Internal grab rails are secure and located in the correct areas?

  Yes

  No

  N/A

• Corrective action taken?

• Adequate lighting internal and external?

  Yes

  No

  N/A

• Corrective action taken?

• Would client benefit from Occupational Therapist assessment?

  Yes

  No

  N/A

• Any uneven or stepped floor levels that could represent difficulty?

  Yes

  No

  N/A

• Corrective action taken?

Fire Safety

• Adequate smoke alarms installed?

  Yes

  No

  N/A

• Corrective action taken?

• Smoke alarms are clean and serviceable?

  Yes

  No

  N/A

• Corrective action taken?

• Fire blankets are in place?

  Yes

  No

  N/A

• Corrective action taken?

• Fire extinguisher is installed?

  Yes

  No

  N/A

• Corrective action taken?

Electrical Safety

• Are power points overloaded?

  Yes

  No

  N/A

• Corrective action taken?

• Are power points and light switches in good working order?

  Yes

  No

  N/A

• Corrective action taken?

• Is a safety switch installed?

  Yes

  No

  N/A

• Corrective action taken?

Home Maintenance

• Taps leaking or hard to turn?

  Yes

  No

  N/A

• Corrective action taken?

• Light bulbs need replacing?

  Yes

  No

  N/A

• Corrective action taken?

• Rubbish removal required?

  Yes

  No

  N/A

• Corrective action taken?

• Shrubs need trimming / Yard maintenance?

  Yes

  No

  N/A

• Corrective action taken?

• Other suggested maintenance items?

  Yes

  No

  N/A

• Corrective action taken?

• Any urgent safety items that may pose risks to clients?

  Yes

  No

  N/A

• Action Required?

Timber Doors

• Front

  Select Entrance Set Deadlock Deadbolt Other

  • Entrance Set
  • Deadlock
  • Deadbolt
  • Other

• Back

  Entrance Set

  Deadlock

  Deadbolt

  Other

• Laundry

  Entrance Set

  Deadlock

  Deadbolt

  Other

• To Guarage

  Entrance Set

  Deadlock

  Deadbolt

  Other

Glass Doors

• Front

  Select Lock Patio Bolt

  • Lock
  • Patio Bolt

• Back

  Lock

  Patio Bolt

• Laundry

  Lock

  Patio Bolt

Security

• Front

  Select Single Lock Triple Lock Finger Guard

  • Single Lock
  • Triple Lock
  • Finger Guard

• Back

  Single Lock

  Triple Lock

  Finger Guard

• Laundry

  Single Lock

  Triple Lock

  Finger Guard

Windows

• Casement

  Select Lock Bars Grille

  • Lock
  • Bars
  • Grille

• Sliding

  Select Lock Bars Grille

  • Lock
  • Bars
  • Grille

• Hopper

  Select Lock Bars Grille

  • Lock
  • Bars
  • Grille

• Sash

  Select Lock Bars Grille

  • Lock
  • Bars
  • Grille

• Louvres

  Select Lock Bars Grille

  • Lock
  • Bars
  • Grille

Sensor Lights

• Front

  Yes

  No

  N/A

• Back

  Yes

  No

  N/A

• Left Side

  Yes

  No

  N/A

• Right Side

  Yes

  No

  N/A