Audit

EMPLOYEE DETAILS

Given Name and Surname

Reason for Home Visit

STAFF COMMUNICATION

Mobile Phone Number

Date and Time of Visit

Is there mobile phone coverage at the residence

CLIENT DETAILS

Given Name and Surname

Address

Phone Number

Mobile Phone Number

INFORMATION OBTAINED FROM REFERRING AGENCY / CLIENT

Which Best Describes the Residence

House

Flat / Unit

Single Storey

Multi Storey

Shanty

Which door is used for entry

Is there available parking on the street

Is the street name and number clearly visible

How Many People Live in the Residence

Who will be Present at the Visit (Excluding Bidgerdii Staff)

Do any occupants have a history of violence / aggressive behaviour

Is there a possible infection risk

Is anyone unwell at the moment

Are there any animals

Are they likely to bite / attack

If YES! are they happy to restrain the animal/s prior to, during and until after leaving

Is the residence in an isolated area

GENERAL COMMENTS

What Controls are being put in Place to Manage the Identified Risks?

Signed by Person who Completed this Assessment
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.