⁠Service Environment / Home Safety Inspection Checklist

Please enable JavaScript in your browser to complete this form.

- Step 1 of 5

Service Environment / Home Safety Checklist

This form is intended to assess the safety of the service environment. Using this form, we will be able to evaluate the service environment in terms of its overall safety for participants and workers providing support services.

Completion Guidelines

In the event of an Emergency/Urgent/Imminent Danger that may cause death and/or a serious injury, halt this inspection and deal with the emergency as appropriate and necessary, the situation must be guarded and rectified immediately.

Report the issue to the responsible Manager, and document it in this form after the hazard has been adequately handled.

Review the previous home safety checklist to identify any outstanding actions.
If the situation meets the requirements, indicate it in the 'Yes' column. If it does not meet the requirements, mark it in the "No" column and describe why it did not meet the requirements in the comment/action section.
In the comments/actions section, also indicate what action is necessary to address the issue.
Sign off on the Checklist to retain a copy of the document in the client's file. (The Supervisor may provide additional comments in the Notes/Additional Issues section, if necessary.)
You may identify major outcomes from this assessment at the client team meeting.

Participant's Name *

Date of Inspection *

Inspection Frequency *

Select frequency from dropdown

Checklist Completed by *

Address of Participant *

Address Line 1

City

State / Province / Region

Country

A. General Cleanliness

Layout

Appropriate bins are available at suitable points for general waste, paper, sharps, etc.

Comments/Required Actions

Layout (copy)

General and hazardous wastes are emptied and/or removed.

Comments/Required Actions

Layout (copy) (copy)

Cleaning agents and other chemicals are used and stored safely.

Comments/Required Actions

Layout (copy) (copy) (copy)

Safety Data Sheet (SDS) is available for the chemicals.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy)

Toilet and Washrooms are clean and disinfected.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy)

Tiles and mirrors are clean.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy)

Toilet/s are well stocked with toilet/hand paper.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Taps are drip-free when turned off.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The service environment is hygienic, clean and tidy.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The noise level is appropriate for the participant.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The surfaces are dust-free.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The service environment is vacuumed.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Bed sheets are clean and changed regularly.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The equipment, devices, appliances, furniture and fittings that are used by multiple participants are cleaned and disinfected between each use.

Comments/Required Actions

B. Indoor

Layout

Light fittings are clean and in good condition.

Comments/Required Actions

Layout (copy)

There is no direct or reflected glare.

Comments/Required Actions

Layout (copy) (copy)

There are no single fluorescent tubes.

Comments/Required Actions

Layout (copy) (copy) (copy)

There is adequate good natural light.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy)

There is adequate ventilation and extraction.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy)

Indoor furniture, fittings and equipment are safe, clean, well maintained and suitable for use for the participant and staff.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy)

The beds are in good condition.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Beds are height-adjustable, fitted with brakes, cotsides fitted and accommodated with lifting.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Appropriate slings are available and in good condition, fitted and accommodated with lifting.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Other pieces of equipment such as oxygen cylinders, suction machines, etc. are available and serviceable (if applicable).

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The participant being able to move freely indoors.

Comments/Required Actions

C. Outdoor

Layout

Adequate personal protective clothing and equipment available.

Comments/Required Actions

Layout (copy)

Adequate protection from live animals.

Comments/Required Actions

Layout (copy) (copy)

There is adequate shade, rest and water.

Comments/Required Actions

Layout (copy) (copy) (copy)

Sunscreens with adequate SPF is available and used.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy)

Outdoor furniture, fittings and equipment are safe, clean, well maintained and suitable for use by the participant and staff.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy)

The heating or cooling equipment maintained regularly.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy)

All exits clear.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The access/egress paths/floors/walkways are clear and unobstructed.

Comments/Required Actions

D. Safety

Layout

The light switches, plugs, sockets and power points are safe and in good condition.

Comments/Required Actions

Layout (copy)

There are no frayed or damaged leads.

Comments/Required Actions

Layout (copy) (copy)

Electrical heating or cooling equipment are tested and tagged.

Comments/Required Actions

Layout (copy) (copy) (copy)

Portable power tools are in good condition and stored appropriately and safely.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy)

There are temporary leads on the floor (trip hazard).

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy)

The warning signs are available and visible.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy)

There are clear, non-slip floors.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The first aid kit is clearly labelled and easily accessible.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy)

First aid kit and its contents are appropriate to use for the first aid assessment and provision.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Emergency evacuation procedure is available and easily visible.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The fire extinguisher is available, clearly marked and accessible.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The fire extinguisher is regularly inspected and serviced.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Fire and Smoke Alarms are installed properly.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Fire alarm with flashing light or vibrating component available for hearing impaired people.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Fire and smoke detectors are working.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Adequate pointers to fire exits are marked and available.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Exit signs are adequately laminated and illuminated.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Aisle and floors are free of obstruction and trip hazards.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Hand sanitiser and masks are available and used to protect the participants and workforce from Epidemics and pandemics such as flu & COVID-19.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Appropriate handrails are available on the stairs (if applicable).

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Trained inducted workers and staff are available.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Relevant Policy and Procedures are available.

Comments/Required Actions

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

The available worker and staff is trained on Providing First Aid.

Comments/Required Actions

Any additional information (if applicable)

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Acknowledgement

I have completed the report to the best of my knowledge and ability.
I have informed the participant for the purpose of this report.
The participant actively participated in the preparation of this report.

Signature *

Report Completion Date

Service Environment / Home Safety Checklist

Completion Guidelines

A. General Cleanliness

B. Indoor

C. Outdoor

D. Safety

USEFUL LINKS