Safe Work Checklist - CHSP
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 Level surface, clear/uncluttered path to/from entry
2 Is there well-lit parking available for staff on site or street?
3 Access to home – clear, easy access to entry point
4 Entry point noted – side entrance, back door, through garage etc
5 Steps/stairs – level surface, uncluttered, non-slip, appropriate height and width
6 Handrails – secured, undamaged
7 Doors – easily opened, unobstructed, more than one exit
8 Adequate Lighting – well lit, dark spots
9 Are power switches and plugs in good condition?
10 Are all electrical cords in good condition? Electrical cords present no risk of trips
11 Signs of Mould
If yes, describe severity (colour) and location
12 Condition of floors, walls and ceiling
13 Cleaning Equipment used appears safe and undamaged – including washing machine, vacuum etc
14 Cleaning products are in easy to reach location
15 Sufficient space for storage and safe movement throughout home
16 Are there any weapons on the property. If yes, are they kept in a secure location
17 Does the participant or other residents smoke?
Is there a designated outside area this occurs
18 Is there any designated Fire Equipment in the property?
If yes, where is it located?
19 Is there a First Aid Kit located at the property?
20 Any pets - Type (cat, dog etc.) How many pets?
21 Are they adequately restrained - how/why?
22 Pets are not aggressive and present no risk of harm to workers.
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