• Assessment No:

  • Customers Name

  • Assessment Conducted On:

  • Assessment Prepared By:

  • Location

Kitchen Area:

  • Are all electrical cords and power points out of reach from children ?

  • Recommendations,

  • Are electrical equipment or power points visually damaged ?

  • Recommendations,

  • Are ovens ( including microwave ) out of reach ?

  • Recommendations,

  • Are oven hood filters clean from oil / grease build up ?

  • Recommendations,

  • Are large items at height secure and prevented from falling ?

  • Recommendations,

  • During cooking, are back rings used before front rings ?

  • Recommendations,

  • Are sharp objects (.i.e. Knives) and plastic bags ( knotted ) stored in save locations ?

  • Recommendations,

  • Are cleaning products and other chemicals / poisons accessible to children ?

  • Recommendations,

  • Is there a fire extinguisher / fire blanket available and easily located ?

  • Recommendations,

  • Are flammable items stored away from cooking area ?

  • Recommendations,

  • Is the dishwasher or rubbish bin accessible to children ?

  • Recommendations,

  • Has a table got sharp corners / edges or is table cloths (runners) used ?

  • Recommendations,

  • Is a high chair used and fitted with a harness ?

  • Recommendations,

  • Home Safety Plan - Recommendations,

Bathroom / Toilets / Laundry Areas

  • Detail number of areas assessed

  • Select from range

  • Temperature of hot water not above 50*C?

  • Are bath and sink plugs kept within reach of child?

  • medications and cleaning products accessible?

  • Electrical appliances and sockets accessible to children ?

  • Baths fitted with non-slip surface?

  • Taps fitted over bath?

  • Laundry dryer lint cleaned regularly?

  • Toilet seat lid securable?

  • Glass tempered or fitted with shatter resistant film?

Living Areas - including Access Ways & Stairways

  • Has furniture ( Glass Tables ) got sharp corners or edges?

  • Are blinds and curtain cords (or other) out of reach?

  • Can large heavy items fall over ( pulled over ) from heights?

  • Are draws / press doors accessible to be used to climb?

  • Is glass fitted in windows / doors / furniture safety glass or shatter proof film?

Bedrooms / Rumpus Rooms

Balconies / Verandas

Outdoor Areas - Gardens, Play Areas & Driveways

Garage / Sheds


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.