Safe At Home Checklist printable pdf download

Rebuilding Together

Safe

1899 L Street NW, Suite 1000

AT HOME

Washington, DC 20036

Checklist

800-473-4229

www.

Created in partnership with the Administration on Aging and the

American Occupational Therapy Association

Rebuilding Together has long recognized that greater attention must be given our elderly

population, so they may age-in-place and safely in their homes. We have also built lasting

national partnerships with Area Agencies on Aging, AARP, American Occupational Therapy

Association, National Association of Home Builders, National Council on Aging, and others.

Use this list to identify home safety, fall hazards and accessibility issues for the homeowner and

family members. Home safety, fall prevention and accessibility modification interventions on the

reverse side of this page can help prioritize your work. Underline or use a highlighter to note.

problems and add comments.

EXTERIOR ENTRANCES AND EXITS

TELEPHONE AND DOOR

Note condition of walk and drive surface; existence of curb cuts

Phone jack location near bed, sofa, chair?



Note handrail condition, right and left sides

Able to get phone, dial, hear caller?



Note light level for driveway, walk, porch

Able to identify visitors, hear doorbell?



Check door threshold height

Able to reach and empty mailbox?



Note ability to use knob, lock, key, mailbox, peephole, and

Wears neck/wrist device to obtain emergency help?



package shelf

Is there an answering machine?



Is there a wireless phone system?

Do door and window locks work easily?



Are the house numbers visible from the street?



STORAGE SPACE

Are bushes and shrubs trimmed to allow safe access?



Able to reach closet rods and hooks, open bureau drawers?



Is there a working door bell?



Is there a light inside the closet?



INTERIOR DOORS, STAIRS, HALLS

10. WINDOWS

Note height of door threshold, knob and hinge types; clear width



Opening mechanism at 42 inches from floor?



door opening; determine direction that door swings

Lock accessible, easy to operate?



Note presence of floor level changes



Sill height above floor level?



Note hall width, adequate for walker/wheelchair



Are storm windows functional?



Determine stair flight run: straight or curved



Note stair rails: condition, right and left side



11. ELECTRIC OUTLETS AND CONTROLS

Examine stairway light level



Sufficient outlets?



Note floor surface texture and contrast



Are there ground fault outlets in kitchen and bathroom?



Note if clutter on stairway



Light switch at the entrance to each room



Outlet height, wall locations



BATHROOM

Low vision/sound warnings available?



Are sink basin and tub faucets, shower control and drain plugs



Extension cord hazard?



manageable?

Are there any uncovered outlets or switches?



Are hot water pipes covered?



Is mirror height appropriate, sit and stand?



12. HEAT, LIGHT, VENTILATION, SMOKE, CARBON

Note ability reach shelf above, below sink basin



MONOXIDE, WATER TEMP CONTROL

Note ability to step in and out of the bath and shower



Are there smoke/CO alarms and a fire extinguisher?



Can resident use bath bench in tub or shower?



Are Thermostat displays easily accessible and readable?



Note toilet height; ability to reach paper; flush; come from sit to



Note rooms where poor light level exists



stand posture

Able to open windows; slide patio doors?



Is space available for caregiver to assist?



Able to open drapes or curtains?



Note last service date for heating/cooling system



KITCHEN

Observe temperature setting of the water heater



Note overall light level, task lighting



Note sink and counter heights



Note wall and floor storage shelf heights



Are under sink hot water pipes covered?



Is there under counter knee space?



Is there a nearby surface to rest hot foods on when removed



from oven?

COMMENTS:

Note stove condition and control location (rear or front)



Is there adequate counter space to safely prepare meals?



LIVING, DINING, BEDROOM

Chair, sofa, bed heights allow sitting or standing?



Do rugs have non-slip pad or rug tape?



Chair available with arm rests?



Able to turn on light, radio, TV, place a phone call from bed, chair,



and sofa?

LAUNDRY

Able to hand-wash and hang clothes to dry?



Able to safely access washer/dryer?



BASEMENT

Are the basement stairs stable and well lit?



Is there any storage of combustible materials?



Safe At Home Checklist

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