Assessment of Personal Safety at Home

Date:_______________________

YesNo Is There a Safety Risk?

Are medications properly labeled and stored in a safe environment?

Is the security of throw rugs, area rugs, and flooring materials guaranteed?

If so, does each room have sufficient lighting?

Telephone or electrical cables can be found in the paths between buildings.

Do the entrance doors have deadbolts that lock?

Are combustible materials, such as newspapers, kept on hand?
If so, is there enough room around the space heaters?

Are there any heating pipes that are exposed?

Is the room/house sufficiently heated and cooled in a safe manner?

Is the water heater set at 120 degrees Fahrenheit or lower?
Is there a portable fire extinguisher in the kitchen if a fire breaks out?

Is it possible for occupants who smoke to demonstrate safe handling?
Is the gas supply to the stove, furnace, and space heater working correctly?

Clear, sturdy, and wide enough walkways (with or without assistive devices) to allow for safe walking?
Will burglar bars on doors and/or windows bend if a person tries to force their way in?
Is there a phone that is easily accessible?
Does the kitchen have a working smoke detector, as well as smoke detectors near each sleeping area?

Is the bathtub equipped with a non-slip surface?
If oxygen is being used during the day, are all of the occupants aware of the importance of oxygen and cord safety?

Is it possible for all occupants to safely leave the house in five minutes or less?

Are firearms and other weapons kept in a secure location?

Is there a secure handrail on the stairwell?

A ramp may be required; is one present and in a safe state of construction?
Do you have a stove, fireplace, or heater that is at least three feet away?

what is the price of cigarettes, lighters, and matches?

if this becomes necessary)?

Is there an emergency exit or is the key nearby?

Health Risks Associated with Sanitation

Is there running water in the house?

Is the food being stored correctly?

Is there a toilet facility that is accessible from the inside?

Is the stove and/or microwave up and running correctly?

Is trash picked up on a regular basis and on a set schedule?

The water in your kitchen, bathroom, and utility is operating correctly.
Does your home or business show signs of a rodent or pest infestation?

Is there enough cold storage space for everyone?
Suggestions: each individual room?

Following your evaluation, modifications are recommended.

What surprised you the most when you were conducting your home security assessment?

Why is it important for a public health nurse to be familiar with and perform home safety assessments?

After conducting a home safety assessment, what kind of teaching/topics do you think it would be important for a public health nurse to cover would you agree?