checklist - Modwell

Home Safety
Assessment
Checklist

Entry to the Home

Job Number

Is there adequate lighting in the following areas:

Driveway?

Yes No

Garage?

Yes No

Walkways?

Yes No

At all doors?

Yes No

Near the trash area?

Yes No

Any other areas of the yard that are used after dark?

Yes No

Comments

Driveway:

Is the driveway smooth and evenly paved?

Yes No

Is the transition between the driveway and surrounding surfaces (such as the yard), smooth and even, free of ruts and other things (rocks) that could cause tripping?

Yes No

Is the slope of the driveway low enough that it does not cause a problem?

Yes No

Comments

Walkways:

Are walkways smooth and level (no cracks, gaps, or other tripping hazards)?

Yes No

Are steps along walkways clearly visible?

Yes No

Do they have handrails?

Yes No

Are transitions between different surfaces (a patio and footpath, concrete and asphalt, walkway and grass, etc.) even and level?

Yes No

If there are steeply inclined walkways, do they have sturdy, easy to grasp, handrails?

Yes No

Are shrubs, bushes, and grass trimmed back or removed so that they do not infringe on or obstruct the walkway (potential tripping hazard)?

Yes No

Comments

Steps to the Doors:

Do all steps (even single steps) have sturdy, easy to grasp (cylindrical) rails on both sides?

Yes No

Are the risers on stairs and multiple steps of equal height?

Yes No

Are the stair treads sturdy, level, and in good condition?

Yes No

Have small single steps (that could cause tripping) been mini-ramped?

Yes No

Comments

Garage:

Are there adequate overhead lights in the garage?

Yes No

Is there a clear pathway to walk through?

Yes No

Do entry stairs or ramps to the house have railings?

Yes No

Comments

Ramps (If Applicable):

Are ramps rising at a minimum slope of 12:1 (12 metres of ramp length for every 1metre of height is standard. However, 14:1 is recommended.)

Yes No

Do ramps have sturdy rails on both sides?

Yes No

Are the rails cylindrical for easy grasping?

Yes No

Do ramps have smooth transitions from ramp surface to ground surface?

Yes No

Do ramps have non-skid surfaces or have non-skid strips been added?

Yes No

Do ramp railings extend beyond the ramp to help people transition off the ramp?

Yes No

Do ramps have sufficient width of at least 36” between handrails?

Yes No

Comments

Entry Landings - Front Rear

Have all potential tripping hazards been removed?

Yes No

Is the landing wide and deep enough to safely open the door?

Yes No

Is there a clearly visible, easily reachable doorbell?

Yes No

Do porches and decks have railings or barriers to prevent someone from stepping or falling off? (Are the railings secure?)

Yes No

Does the decking have secure, even floorboards with no protruding nails?

Yes No

Is there a non-skid surface on the porch/deck/landing?

Yes No

Do doormats have non-skid backing with no upturned corners?

Yes No

Comments

Exterior Doors - Front Rear

If necessary, are doorways wide enough to accommodate wheelchairs?

Yes No

Are locks in good working order and easy to use?

Yes No

Are latches and door handles in good condition and easy to use?

Yes No

If someone has trouble turning a doorknob, are there lever handles?

Yes No

Do the doors open and close easily without sticking?

Yes No

Do doors on springs close slowly enough (so they don’t close on someone going through the door)?

Yes No

Is the threshold at the door less than 25mm high?

Yes No

Do glass sliding doors have decals at eye level?

Yes No

Comments

Other Outdoor Area Concerns

If there is a patio or deck, is it level, smoothly surfaced and free of tripping hazards?

Yes No

Are walkways around the house, smooth and free of obstacles and overgrown shrubbery, grass, and weeds that could cause tripping?

Yes No

Are rubbish and recycling areas well lighted?

Yes No

Do these areas have safe, accessible stairs and railings?

Yes No

Comments

INSIDE THE HOME

Entry Ways and Vestibules - Front Rear

Have throw rugs (potential tripping hazards) been removed?

Yes No

Is there a clear pathway (devoid of clutter) through the entry hall?

Yes No

Are all cords and wires out of the pathway?

Yes No

Are thresholds low enough so someone does not trip over them?

Yes No

Is there adequate lighting?

Yes No

Is the light switch at the entrance to the room?

Yes No

If necessary, is the entryway wide enough for a wheelchair/walker?

Yes No

Comments

Hallways - #1 #2 #3

If people need support, are there handrails along the hall?

Yes No

Are halls free of clutter and other tripping obstacles?

Yes No

Are carpet runners tacked down or have anti-skid backing?

Yes No

Are thresholds less than one inch so they are not tripping hazards?

Yes No

If necessary, are halls wide enough for a wheelchair/walker?

Yes No

Is there adequate lighting?

Yes No

Is there a light switch at both ends of the hall?

Yes No

Comments

Doors/Doorways

Do all doors open easily?

Yes No

Are thresholds less than one inch?

Yes No

Comments

Interior Stairs - 2nd Fl. Base. Other

Do stairs have sturdy rails on both sides?

Yes No

Do rails continue onto the landings?

Yes No

Are the stair treads sturdy, not deteriorating or broken?

Yes No

Are edges of stair treads clearly visible (no dark, busy patterns)?

Yes No

Are stair pads in good repair (tacked down, in one piece)?

Yes No

(If bare wood) Are stair treads slip-resistant?

Yes No

(If carpeted) Is carpet securely attached, not worn/frayed?

Yes No

Are top and bottom steps highlighted?

Yes No

Are stairs free of clutter?

Yes No

If stairs have a low, overhanging beam that people could bump their heads on, has it been padded?

Yes No

Are stairs and landings well lit, with light switches at both top and bottom?

Yes No

Comments

Living/Dining/Family/Other Rooms - LR DR FR Other

Is the lighting adequate?

Yes No

Is there a light switch at the entrance to the room?

Yes No

Is there a clear, unobstructed path through the room (no clutter, cords, wires, baskets, and other things to trip over)?

Yes No

Are thresholds minimal and carpet binders tacked down?

Yes No

Are carpets in good condition (not frayed or turned up, torn, or with worn spots that someone could trip over)?

Yes No

Are plastic runners/carpet protectors tacked down (not folded or turned up at edges)?

Yes No

Do throw rugs have anti-skid backing and no upturned corners?

Yes No

Is tile/linoleum free of chips, tears, and not slippery?

Yes No

Are bare wood floors slip resistant?

Yes No

Is there at least one comfortable chair people can get in and out of safely and easily?

Yes No

Do tables have rounded edges that are clearly visible (no sharp edges or made of glass)?

Yes No

Do windows open easily?

Yes No

Are shades and blinds easy to open?

Yes No

Are they securely attached?

Yes No

Comments

Bathrooms - General Considerations - Bath 1 Bath 2

Is there a light switch at the entry?

Yes No

Is there adequate lighting overall?

Yes No

…..At the sink?

Yes No

…. Over the tub/shower?

Yes No

Is there a night light?

Yes No

Is the door threshold less than one inch?

Yes No

Is the room free of clutter and tripping hazards?

Yes No

Is the flooring non-slip/non-skid (including throw rugs)?

Yes No

Are there grab bars in other areas of the room as needed?

Yes No

Is the room kept warm during bathing (heat lamp, towel warmers, etc.)?

Yes No

Comments

Sinks - Bath 1 Bath 2

Are sink taps easy to reach and read?

Yes No

Is it easy to determine where the hot and cold areas of the taps are?

Yes No

Is it easy to mix the temperature?

Yes No

If necessary, have anti-scald devices been installed?

Yes No

Is the sink wheelchair accessible or can someone sit at the sink?

Yes No

Are mirrors at an appropriate height?

Yes No

Comments

Tub/Shower - Bath 1 Bath 2

Are there sturdy grab bars in the tub and/or shower, if needed?

Yes No

Is the shower curtain bottom out of the way so it is not a tripping hazard?

Yes No

Are toiletries in the tub easily reached from sitting and standing positions?

Yes No

Is there a non-skid bathmat in the bathtub?

Yes No

Is there a hand-held shower head?

Yes No

Are tub/shower taps/mixers easy to use and read (hot & cold clearly marked)?

Yes No

If needed, is there a tub or shower seat?

Yes No

Comments

Toilet - Bath 1 Bath 2

Are there sturdy grab bars at the toilet (or toilet arms and a raised seat)?

Yes No

Is toilet paper easily reachable from the toilet seat?

Yes No

Is the toilet seat in good condition and securely fastened?

Yes No

Comments

Kitchen

Are frequently used items visible and easily reached (front of pantry and refrigerator)?

Yes No

Are sink taps/mixers easy to reach and read?

Yes No

Is it easy to determine where the hot and cold areas of the taps are?

Yes No

Is it easy to mix the temperature?

Yes No

If necessary, have anti-scald devices been installed or the hot water temperature lowered?

Yes No

If necessary, have timers been installed on the oven and cook top?

Yes No

Are burners and control knobs clearly labeled and easy to use?

Yes No

Are the controls on the front of the stove, not the back?

Yes No

Is there a close resting place nearby for hot vessels coming out of the oven?

Yes No

Is glass cookware being used so person sees food is being cooked?

Yes No

Is the microwave easy to read, reach, and operate?

Yes No

Comments

Laundry Room

Is there a light switch at the entry?

Yes No

Is there sufficient lighting?

Yes No

Is the route to the laundry room (stairs) safe?

Yes No

Are the appliances at the right height so it easy to get clothes in/out of the washer and dryer?

Yes No

Are the control knobs easy to reach, read, and operate?

Yes No

Are laundry supplies easy and safe to reach?

Yes No

Is there a non-slip floor surface?

Yes No

Are tripping hazards off the floor (laundry basket or dirty clothes)?

Yes No

Comments

Bedrooms - BR1 BR2

Is there a light at the entrance to the room?

Yes No

Is a light reachable from the bed?

Yes No

Can bureau drawers be reached (height of the drawer) and opened easily?

Yes No

Is there a clear, unobstructed path through the room (clutter and furniture are out of the way)?

Yes No

Are cords and wires off the floor?

Yes No

Do throw and area rugs have non-slip backing and no upturned corners?

Yes No

Are wood and linoleum floors non-skid?

Yes No

Is carpet smooth (no folds or holes) and tacked down?

Yes No

Are curtains and bed coverings off the floor so they are not tripping hazards?

Yes No

Is there support for getting in and out of bed, if needed?

Yes No

Is there a place to sit and get dressed, if needed?

Yes No

Are windows easy to open and close?

Yes No

Are window blinds and shades working properly and easy to open?

Yes No

Are blinds and shades properly secured?

Yes No

Comments

Closets - Clo 1 Clo 2

Are shelves and clothes poles easy to reach?

Yes No

Have closet organizers been installed to maximize use of space?

Yes No

Are closets organized so clothes are easy to find?

Yes No

Are clutter and other tripping hazards off the floor?

Yes No

Do closets have lights that are easy to find and reach?

Yes No

Are closet door easy to open?

Yes No

If closet has sliding doors, do they stay on track?

Yes No

Comments

General Home Safety Concerns

Can an older person contact someone in an emergency (medi-alert, names and numbers by phone, picture telephone, etc.)?

Yes No

Are smoke detectors and carbon monoxide alarms installed and working?

Yes No

Is there a fire extinguisher in the house?

Yes No

Is there a safe place outside to hide a key to the house for emergency entry?

Yes No

Comments

Home Safety Assessment Checklist

Entry to the Home

Is there adequate lighting in the following areas:

Driveway:

Walkways:

Steps to the Doors:

Garage:

Ramps (If Applicable):

Entry Landings - Front Rear

Exterior Doors - Front Rear

Other Outdoor Area Concerns

INSIDE THE HOME

Entry Ways and Vestibules - Front Rear

Hallways - #1 #2 #3

Doors/Doorways

Interior Stairs - 2nd Fl. Base. Other

Living/Dining/Family/Other Rooms - LR DR FR Other

Bathrooms - General Considerations - Bath 1 Bath 2

Sinks - Bath 1 Bath 2

Tub/Shower - Bath 1 Bath 2

Toilet - Bath 1 Bath 2

Kitchen

Laundry Room

Bedrooms - BR1 BR2

Closets - Clo 1 Clo 2

General Home Safety Concerns

Home Safety
Assessment
Checklist