Nursing Home Safety Checklist

• Nursing Home

• Address
  Address

• Safety Inspector

• Conducted on

  Date

Environmental Safety

• Are spills cleaned up immediately?

  Yes

  No

  N/A

• Are floors clutter/obstacle-free (with attention to the path between bed and bathroom)?

  Yes

  No

  N/A

• Are floors level (no step up or down into shower/bathroom)?

  Yes

  No

  N/A

• Are floors even-colored?

  Yes

  No

  N/A

• Are handrails distinctly different color from walls?

  Yes

  No

  N/A

• Are handrails and transfer poles clear for use?

  Yes

  No

  N/A

• Are locks on beds, stretchers, and wheelchairs secured?

  Yes

  No

  N/A

• Are furniture secured to the floor so there is a clear path around it?

  Yes

  No

  N/A

• Are chairs/benches placed strategically in hallways to provide a rest area for the elderly?

  Yes

  No

  N/A

• Are excess equipment/supplies/furniture removed from the rooms?

  Yes

  No

  N/A

• Are excess electrical and telephone wires secured?

  Yes

  No

  N/A

• Is safety around the bed environment (use of transfer poles/transfer assist rails) secured?

  Yes

  No

  N/A

• Is the call light placed and frequently used objects within the older adult's reach?

  Yes

  No

  N/A

• Is there adequate lighting, especially at night?

  Yes

  No

  N/A

• Are bathrooms large enough to bring in wheelchairs and walking aids?

  Yes

  No

  N/A

• Is there adaptive equipment in bathrooms (vertical, horizontal, diagonal grab bars near toilet and shower; raised toilet seat or commode; rubber-backed bath mat; shower seat; hand-held showerhead)?

  Yes

  No

  N/A

• Is the sink, toilet, soap and paper towel holder at low enough level to reach from wheelchair or standing?

  Yes

  No

  N/A

Elderly Safety

• Is the elderly oriented about surroundings, including bathroom, use of the bed, and location of call light?

  Yes

  No

  N/A

• Are older adults/families encourage to call for assistance when needed

  Yes

  No

  N/A

• Is properly fining nonskid footwear used?

  Yes

  No

  N/A

• Is ambulation assured as ordered?

  Yes

  No

  N/A

• Has the elderly's ability to interpret information been evaluated?

  Yes

  No

  N/A

• Have the potential medication side effects been evaluated?

  Yes

  No

  N/A

• Are assistive devices kept at the bedside and within reach?

  Yes

  No

  N/A

Sign Off

• Additional Observations

• Nursing Home Safety Inspector Name & Signature

  Sign