CHSP - Allied Health Home Safety Checklist
Tips for Workers:
This form is to be completed at your first shift within a Participants home.
Please ensure you answer ALL questions and comments as required.
Ensure you are checking all areas of the home and take pictures to upload to Flowlogic if required.
Add N/A to any areas that are not applicable to the Participants home.
Add any addition risks/ hazards in the text box at the end of the document.
Support Worker's Name
Participant's Name
1. Is there safe parking available for staff on the street?
2. Access to home- clear, easy access to entry point.
3. Other available exits identified
4. Is the residence clearly numbered/identifiable?
1. Is there a clear pathway within the house?
2. Is there adequate ventilation?
3. Is there adequate lighting
4. Does the participant or others in the house smoke? If yes- is there a designated outside area for smoking?
5. Is there an appropriate area for client interview to take place?
6. Are there any weapons in the home? If yes, are they kept in a secure location?
7. Is it possible to leave the home quickly in the event of an emergency?
8. Is there any fire safety equipment in the property? Where located?
9. Is there a first aid kit in the property? Where located?
1. Any pets in the home
2. Are they adequately restrained- how/why?
3. Pets are not aggressive and present no risk of harm to staff
1. Is there any history or evidence of aggression, violence from the participant or anyone else who is present during visits?
2. Are there other people likely to be home during vsits? If so who + relationship to person
3. Are there any other hazards/issues that may impact staff safety, e.g. drug or alcohol abuse
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