Are there any problems accessing the house ? eg. Steep driveway, stairs, gates, isolation of house

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Do you have mobile phone reception at your house ?

Is there suitable parking or on the street?


Will there be anyone else present during our visit ? If so who ?

Do you have a dog or other pets?

Can you ensure they are restrained whilst we visit ?

Do you or anyone in the house smoke ? (Advise of no smoking policy)

Are you aware of any behaviors of concern which may arise during our visit ?
Such as any violence within the home, Inappropriate or antisocial behavior towards others
If so what are the behavioural triggers eg gender, age,

In relation to your medical history are there any biological hazards which need to be considered?
Such as Flu or any other contagious illness?

Are there hazardous substances or chemicals which need to be considered?
Such as cleaning chemicals or Cytotoxics?

Is a second person required ?

Visit to proceed ?

Identified requirements and interventions

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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.