the assessment tool provided will be on

Safety Hazard Yes No

The safety tool has to be answered on the paper either yes or No

• Are medications safely stored and adequately labeled?______
• Are throw rugs, area rugs, and flooring materials secured?______
• Is there adequate lighting in each room?______
• Are there telephone cords or electrical cords in walkways?______
• Do the entry doors locks with deadbolts?______
• Are combustibles, such as newspapers, stored ______
• Is there adequate space around space heaters?______
• Are there exposed heating pipes?______
• Is the room/house heated cooled adequately and safely?______
• Is water heater set at 120F or lower?
• Is there a portable fire extinguisher available in the kitchen?______
• Do occupants who are smokers demonstrate safe handling
• Does the gas at the stove, furnace , and space heater work properly?______
• Are walkways clear, sturdy and wide enough to walk safely (using assistive devices
• If burglar bars are present on doors and/or windows, will they bend for
• Is there a phone within easy reach?______
• Is there a working smoke detector near the kitchen and near each sleeping area?______
• Dos the bathtub have a non-skid surface?______
• If oxygen is in use in the hours, are all occupants aware of oxygen and cord safety?______
• Are all occupants able to safely exit the home in five minutes or less?______
• Are guns or weapons safely stored?______
• Are there secure handrails on stairs?______
• If a ramp is needed, is one present and safely constructed?______

at least three feet from stove, fireplace or heater?

of cigarettes, lighters and matches?______

if necessary)?______

Emergency exit or is the key close by?______

Sanitation Hazards

• Is there indoor running water?______
• Is food stored properly?______
• Are there indoor toilet facilities?______
• Do the stove and/or microwave operate properly?______
• Is trash picked up on a regular scheduled basis?______
• Is the water in the kitchen, bathroom and utility are working properly
• Are there signs of rodent or pest infestation?______
• Is there adequate refrigeration?______
• Comments:

each room?______

Modifications recommended after your assessment_____________________________________________________________

What surprised you when doing your home safety assessment?

Why are home safety assessments important for a public health nurse to know and do?

What kind of teaching/topics can you see would be important for a public health nurse to do as a result of a home safety assessment?