Title Page

  • Client Name

  • Contact Number

  • Risk Assessment Completed on

  • Person completing Risk Assessment

  • Location

Pre-Visit / Hazard Checklist

Pre-Visit Case manager confirmation phone call:

  • Covid Checklist complete

  • Is the address easy to find?

  • Can the occupant respond to the front door if alone?

  • Is there a recent history of violent aggressive behaviour, history of domestic violence (verbal or physical) or substance abuse

  • Are there known mental health issues?

  • Any known issues with the neighbours or those residing at the property?

  • Presence of firearms? Is the firearm licenced

  • If yes client has agreed to lock firearms away prior to, during & until the staff have left the premises’

  • Does the client live alone?

  • Will others be home for the visit?

  • Do they pose any threat to staff?

  • Whom will be present?

  • Are there issues around Infectious diseases or cytotoxic drugs?

  • Are there any unrestrained or aggressive pets/animals on the premises? If so, will the client agree to restraining the animal prior to and during this and subsequent visits?

  • Is car parking available?

  • Is the Property address clearly numbered?

  • Is the house visible from the street with a clear safe path from vehicle to the entry?

  • Is the driveway/road two-wheel drive safe?

  • Is it close to dangerous physical elements e.g. main roads, steep slopes, rivers creeks?

  • In a remote or isolated area?

  • Is there mobile phone coverage?

  • Special entry requirements? (Security, locks, or intercoms)

  • Any Further details regarding access to premises?

  • Based on the above answers, should the home visit assessment proceed?

  • If you have concerns regarding home visiting this client, contact your Manager to discuss prior to attending premises.

Hazard Review

Roof Areas

  • Any visual guttering not securely attached or leaking onto paths

  • Is the residence single story or split level

  • Does the site have power connected?


  • Stable, adjustable, with suitable access

  • Wires secure and taut


  • Handrail provided when more than 600mm above ground

Garden/Yard area

  • Are access ways clear of branches or debris?

  • Are pathways slippery or have a moss or mildew covering?

  • Are lawns at a level for safe access?

  • Pool on site - is there are fence and lockable gate

  • How are the waste bins taken to the street kerb (will the client need assistance with this)


  • Are steps even, free from slips hazards, undamaged and are rails in place?

  • Are entry and exit ways obstructed or cluttered?

  • All floors free from slips, uneven surfaces, cracked or broken tiles?

  • Are there non-slip mats in place for slippery areas?


  • Are floor surfaces free from water and grease?

  • Do kitchen appliances appear to be in safe working order?

  • Is Gas cooking in use?

  • Are chairs and tables in good working order and stable

  • Is this area free from infestation of rodents or insects


  • Washing machine/dryer securely fixed in position in a safe working condition?

  • Detergents appropriate for task & stored securely


  • Is there sufficient space for storage & movement?

  • Is the bed height suitable and adjustable if personal care or nursing is required?


  • Enough space for HSW to provide personal care?

  • Is the floor surface slippery?

  • Does the floor have non-slip mats?

  • Shower/toilets not leaking to the floor

  • Is there a handheld shower?

  • Are there grab rails in the shower & toilet? (take photos if permitted)

  • Is there adequate ventilation?

  • Is the bath or shower appropriate for the client’s mobility?

  • Is the water temperature easily adjusted?

  • Is there access to liquid soap, running water & paper towel for staff?


  • Wide enough for wheelchair & hoists if applicable?

  • Is a hoist in use. Is it in good condition, free of defects?

  • Has any lifting equipment been serviced in the last 12 months?

Electrical Risks (Ask Client to confirm)

  • Are electrical leads free from kinks, frays, loose or exposed wires?

  • Are plugs, sockets, and switches in safe condition, away from water, and free from obvious defects (loose, broken, overheating)?

  • Any known concerns with lighting i.e. sufficient or free of faults?

  • Are computer and other electrical leads and cables away from aisles and walkways?

Heating and cooling systems

  • Any portable heaters in use? If so, are flammable items more than a meter away?

  • Adequate clearance for ceiling fans?


  • Are vacuums suitable for housekeeping - light enough to move (most modern vacuums are between 6-8kg) with an adjustable handle? - free from cord defects?

  • Are mops suitable, functioning and wring out? (if not encourage purchase of spin mop)

  • Is equipment in good working order? Consider -

  • 4WW's

  • wheelchairs

  • walking frames

  • commodes

  • shower chairs

  • Is there an emergency kit (list of emergency Phone numbers, food, water, torch, radio-battery operated)? Where is it located?

  • Brooms in working order with appropriate handle length?

  • Iron and ironing board in good order and safe?

  • Are smoke detectors alarms in working order?

  • Check that the light on the cover flashes. It should flash at least once every 60 seconds

  • Are there fire blankets or fire extinguishers onsite?

  • If yes, please note their location: Add this information to Sandwai for the HSW

  • Encourage clients to store these items away from ignition sources such as stoves that may prevent their access

Chemical/Hazardous substances

  • Cleaning chemicals any noticeable risks?

  • Garden chemicals any noticeable risks?

  • Does client choose to use own chemicals for cleaning? if so, record chemical detail, source SDS (Safety data Sheet) upon return forward SDS document to WHS advisor for approval

  • Presence of smokers during visit?

  • Client or other household persons agreed to refrain from smoking during staff visits?

  • Is there excessive mould present on walls, & furnishings

  • If the property address is incorrect in Google maps, please update in the Priority note to alert those visiting

MSS Home Visiting Risk Assessment Form

  • If answers to the questions above have prompted concern regarding ongoing home visiting this client, contact your Manager to discuss

  • Based on the above answers and the Risk level colour, should home visits proceed?

  • Enter an alert in Priority notes in the client’s record if risks or concerns have been identified and control measures are in place to minimise the risk. This alert will be seen on all job cards and to alert HSW to identified risks

Completed & Approved Form

  • Form completed by

  • Manager Approving form

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.