Residential Inspection Checklist (Internal)

• Conducted on

  Date

• Prepared by

• Location
  Address

• Sent to

Lift equipment assigned to location?

OFFICE

• Check R drive for SDS access (there should be a shortcut on the desktop)

  Yes

  No

  N/A

• Meds locked up and secure?

  Yes

  No

  N/A

• Sharps container not accessible to Persons Served?

  Safe

  At Risk

  N/A

• Sharps container not over filled?

  Safe

  At Risk

  N/A

• Evacuation and Shelter in Place drills completed and documented?

  Yes

  No

  N/A

• Emergency Procedures (CL) posted?

  Yes

  No

  N/A

• COVID PPE (N95 masks, face shields & isolation gowns) readily accessible for after-hours cases?

  Yes

  No

  N/A

• Is the office ergonomically safe?

  Yes

  No

  N/A

STAFF

• Wearing appropriate clothing?

  Yes

  No

  N/A

• Wearing appropriate shoes?

  Yes

  No

  N/A

• Name of staff present

LIFT EQUIPMENT

• Lift equipment is clean and operational?

  Yes

  No

  N/A

• Slings are safe for use?

  Safe

  At Risk

  N/A

• Does the house have a Camel? Is it charged?

  Yes

  No

  N/A

• HANDICARE LIFTS ONLY: Charge output (normal 27.6) Batteries holding charge?

  Pass

  Fail

  N/A

KITCHEN

• Clean and tidy, nothing on the counters that should be refrigerated?

  Yes

  No

  N/A

• Light fixtures in good condition?

  Yes

  No

  N/A

• Refrigerator clean and food covered or stored properly

  Yes

  No

  N/A

• Chemicals stored and labeled properly?

  Yes

  No

  N/A

• Using authorized supplies only?

  Yes

  No

  N/A

BATHROOMS

• Clean and tidy?

  Yes

  No

  N/A

• Shower chairs in good condition?

  Yes

  No

  N/A

LAUNDRY ROOM

• Clean and tidy?

  Yes

  No

  N/A

• Vents are clean, there is no buildup of dust on the outlet and plug, and dryer lint tray is clean?

  Safe

  At Risk

  N/A

• Chemicals stored and labeled properly?

  Yes

  No

  N/A

• Using authorized supplies only?

  Yes

  No

  N/A

• Reasonable amount of supplies on hand?

  Yes

  No

  N/A

COMMON AREAS

• Outlet plates in good condition?

  Yes

  No

  N/A

• Stairs are in good condition and well lit?

  Yes

  No

  N/A

• Emergency exit routes posted?

  Yes

  No

  N/A

• All legal exits marked if required (HUD)?

  Yes

  No

  N/A

• 911 stickers either on the phone or posted?

  Yes

  No

  N/A

• Fire extinguisher/blankets accessible?

  Yes

  No

  N/A

• Fire extinguishers signed off & fully charged?

  Yes

  No

  N/A

• Oxygen cylinders are stored in racks so they cannot fall over?

  Safe

  At Risk

  N/A

• Oxygen cylinders are stored in a location where nothing can fall on them?

  Safe

  At Risk

  N/A

• Locks are in working order – home safe and secure?

  Yes

  No

  N/A

• Windows are not blocked?

  Safe

  At Risk

  N/A

• Main routes of travel kept free of obstacles and stored materials?

  Yes

  No

  N/A

• Walkways, sidewalks, railings are in good condition?

  Yes

  No

  N/A

• Stairs are in good condition and well lit?

  Yes

  No

  N/A

• Propane tanks stored securely so they cannot fall over?

  Safe

  At Risk

  N/A

• Propane grills not stored in garage or on wood deck and not being used right next to the house?

  Safe

  At Risk

  N/A

ELECTRICAL

• Area is clear in front of breaker switch boxes?

  Yes

  No

  N/A

• Breaker switches identified?

  Yes

  No

  N/A

• Power strips are utilized when necessary?

  Compliant

  Non-Compliant

  N/A

• No extension cords in use (exception at Holidays on temporary basis)?

  Safe

  At Risk

  N/A

• Smoking receptacle present?

  Yes

  No

  N/A

• * Corrections due 30 days after receipt of inspection

  Sign

• **Please document corrections on this form and scan to Safety Coordinator, Asst. Dir. of CL and Director of CL

• Safety Inspection Checklist e-mailed to Community Living Supervisor, Asst. Director and Director of CL: