WCG-Environment of Care Safety Risk Assessment

• Site Name

• Conducted on

  Date

• Prepared by

• Inspected by

• Location
  Address

Entry

• Entry doors are locked and in working condition?

  Yes

  No

  N/A

• Entry areas are free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Hallways leading to client areas are free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Any additional compliance, safety, security, or cleanliness concerns related to entry or lobby areas?

Common Areas- Client Care

• Furniture in client common areas are free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Common area is free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Any additional compliance, safety, security, or cleanliness concerns related to the common/group areas?

Bathroom

• Bathroom Location

• Client bathroom is free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Any additional compliance, safety, security, or cleanliness concerns related to the client bathroom?

Laundry

• The laundry area is free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Any additional compliance, safety, security, or cleanliness concerns related to the laundry area?

Kitchen Areas

• Kitchen area is free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Any additional compliance, safety, security or cleanliness concerns related to the kitchen area?

Client Rooms

• Room identifier

• Overall the room is free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Any compliance, safety, security or cleanliness concerns related to client rooms?

Additional Questions, All Areas

• Any additional compliance, safety, security or cleanliness concerns related to the general site?

Exterior Spaces

• Exterior spaces are free from potential environmental hazards to individuals served?

  Yes

  No

  N/A

• Any additional compliance, safety, security or cleanliness concerns related to outdoor client spaces?