PRE VISIT RISK ASSESSMENT

• Document No.

• PRE VISIT RISK ASSESSMENTAudit Title

• Given Name and Surname of Client

• Address of Place to be Visited
  Address

• Assessment Conducted on

  Date

• Name of Person/s Who Prepared this ssessment

• Personnel who are going to Site

EMPLOYEE DETAILS

• Given Name and Surname

• Reason for Home Visit

STAFF COMMUNICATION

• Mobile Phone Number

• Date and Time of Visit

  Date

• Is there mobile phone coverage at the residence

  Yes

  No

  N/A

CLIENT DETAILS

• Given Name and Surname

• Address
  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

  Front

  Side

  Rear

• Is there available parking on the street

  Yes

  No

  N/A

• Is the street name and number clearly visible

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

• Is there a possible infection risk

  Yes

  No

  N/A

• Is anyone unwell at the moment

  Yes

  No

  N/A

• Are there any animals

  Yes

  No

  N/A

• Are they likely to bite / attack

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the residence in an isolated area

  Yes

  No

  N/A

GENERAL COMMENTS

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

• Signed by Person who Completed this Assessment

  Sign