Directions: Use this list to identify accessibility, safety and security issues and fall hazards.
| General Living Areas |
Yes |
No |
Action Taken |
| Is there adequate lighting throughout the house? |
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| Are there night lights where needed? |
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| Is home well ventilated? |
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| Are all doorways accessible and easy to operate? |
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| Are doors wide enough for a walker or wheelchair? |
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| Are locks sturdy and easy to operate? |
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| Is furniture arranged for good traffic flow? |
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| Is there an uncluttered walking pathway? |
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| If there are any changes in levels, are they obvious or marked in some way? |
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| Is it easy to get up and down safely from chairs, sofas, and other seats? |
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| Can the TV, radio, light or telephone be operated from the chair or sofa? |
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| Are windows easy to use? |
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| Is it necessary to walk over or around cords or wires (like cords from lamps, extension cords, or telephone cords)? |
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| Are there any frayed or cracked cords or exposed wiring? |
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| Are there any outlets or switches which are unusually warm or hot to touch? |
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| Do all outlets and switches have cover plates so that no wiring is exposed? |
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| Does any outlet have smudge marks indicating an electrical short has occurred around the socket where plugs are inserted? |
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| Are cords attached to the walls, baseboards, etc., with nails or staples? |
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| Are light bulbs the appropriate size and type for the lamp or fixture? |
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| Do extension cords carry more than their proper load, as indicated by the rating labeled on the cord and the appliance? |
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| Are there working smoke detectors on every floor? |
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| Are the smoke detectors checked every six months? |
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| Is there a carbon monoxide detector? |
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| Is there a fire extinguisher and does someone in the home know how to use it? |
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| Is the fire extinguisher inspected or checked on a regular basis? |
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| Are small stoves or heaters placed where they cannot be knocked over and away from furnishings and flammable materials, such as curtains and rugs? |
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| Is carpeting in good condition and not loose or torn? |
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| Are throw rugs and runners slip-resistant or tacked or taped down? |
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| Is the house free of pests? |
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| If using floor wax, is it the non-skid type? |
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| Are shelves well-secured to the wall and not overburdened with items that have the potential of falling? |
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| Does the fireplace have a spark screen? |
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| Has the chimney been cleaned in the last year? |
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| Are the plumbing and utilities working? |
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| Is the telephone readily available for emergencies? |
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| Can the telephone ring be heard in all areas of the home? |
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| Does the telephone have a volume control for increased hearing if necessary? |
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| Are emergency phone numbers posted near each telephone? |
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| Is there a first aid kit and manual handy? |
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| If smoking in the home, are deep, wide ashtrays with grooves used? |
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| If smoking in the home, are lit cigarettes never left unattended? |
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| If smoking in the home, are ashtrays and furniture always checked before leaving the house or going to bed? |
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| If smoking in the home, is it done safely by never doing so in bed or when drowsy? |
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| Stairways |
Yes |
No |
Action Taken |
| Are secure handrails present? |
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| Are there light switches at both the top and bottom of the stairs? |
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| Are the stair treads deep enough for your whole foot? |
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| Are the steps even and of the same size and height? |
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| Are any of the steps broken or uneven? |
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| Is there adequate lighting? |
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| Has the stairway light bulb burned out? |
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| Is the covering or carpet secure and in good condition? |
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| Are the steps free of clutter? |
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| Would a lift or ramp be feasible if it became necessary? |
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| Are throw rugs and runners kept away from stairs and landings? |
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| Kitchen |
Yes |
No |
Action Taken |
| Is the area over the stove, counters and sink well lit? |
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| Are the appliances in working order and unplugged when not in use? |
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| Are all extension and appliance cords located away from the sink or range areas? |
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| Are the sink faucets easy to use? |
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| Can the refrigerator and freezer be opened and closed easily? |
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| Can the high and low cabinets be opened and closed easily? |
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| Are cabinet doorknobs easy to use? |
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| Is adequate workspace available and at the right height? |
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| Is there seating available while working? |
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| Are the dishes, pots, silverware, and food supply easily reached without climbing or bending? |
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| Are cupboards and drawers kept closed to avoid bumping into them? |
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| Are the stove controls easily reached and clearly marked? |
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| Are ventilation systems or range exhausts functioning properly and are they in use while cooking? |
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| Is there a timer available as a reminder to turn off the burner? |
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| Are pot holders in easy reach but not hanging above the stove? |
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| Are clothes with loose flowing sleeves avoided when cooking? |
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| Are pot handles turned away from the edges of the stove and from other burners when cooking? |
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| Can the stove door be opened and closed easily? |
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| Are the outlets easily reached? |
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| Can food be safely transported to eating area? |
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| Are spills mopped up immediately? |
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| Are sharp objects stored safely in protective racks? |
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| Are flammables kept away from the stove area? |
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| Is there a stable, well-maintained step stool with handles? |
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| Are toxic products like cleaners, detergents, etc. stored separately from food? |
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| Are toxic products kept in their original containers with their original labels? |
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| Bathroom |
Yes |
No |
Action Taken |
| Can you safely transfer into the tub or shower? |
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| Is there a tub bench or tub chair to assist with transfer into the tub or shower? |
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| Are there grab bars where needed? |
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| Is the bath mat skid-resistant? |
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| Can you safely transfer to the toilet? |
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| Is there a safety frame, raised seat or grab bar available to assist with transfer to the toilet? |
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| Are the outlets within reach? |
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| Are the light switches easy to use? |
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| Are the sink and tub faucets, shower control and drain plugs easy to use? |
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| Are soap, shampoo and towels within easy reach? |
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| Are appliances such as hair dryers, shavers and radios kept away from water? |
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| Are appliances unplugged when not in use? |
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| Are hot water pipes covered? |
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| Is the hot water heater regulated to prevent scalding or burning? |
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| Is mirror height appropriate for both sitting and standing? |
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| Is the medicine cabinet cleaned out yearly? |
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| Is there a bottle of Ipecac on hand in case of poisoning? |
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| Bedroom |
Yes |
No |
Action Taken |
| Can you get up and down safely from the bed? |
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| Is the light switch accessible from the bed? |
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| Is the telephone in easy reach? |
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| Are clothes in the closet or dresser in easy reach? |
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| Is there a clear path to the bathroom? |
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| If a walking aid is used, is it next to the bed? |
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| Is there an exit route planned and practiced in case of fire? |
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| Is there a flashlight with fresh batteries within easy reach of the bed? |
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| Are electric blankets used safely by never tucking the coils under the mattress? |
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| Are electric blankets used safely by never keeping anything on top of them? |
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| Are electric blankets used safely by never folding the blanket when it is plugged in? |
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| Garage/Basement/Storage Areas |
Yes |
No |
Action Taken |
| Does the garage have an automatic opener? |
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| Are work areas, especially where power tools are used, well lit? |
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| Can lights be turned on without first having to walk through the dark area? |
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| Are the closets well lit? |
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| Can the closest rods and hooks in the closets be easily reached? |
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| If fuses are used, are they the correct size for the circuit? |
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| Are power tools equipped with a 3-prong plug or marked to show that they are double insulated? |
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| Are power tool guards in place? |
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| Are containers of volatile liquids tightly capped? |
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| Are gasoline, paints, solvents, or other products that give off vapors or fumes stored away from ignition sources? |
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| Outside |
Yes |
No |
Action Taken |
| Are all entrances well lit? |
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| Are the driveway, steps, footpath and porches well lit? |
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| Do steps and walk surfaces provide good traction (textured surfaces) and are in good condition, free of clutter, snow and leaves? |
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| Do steps have a sturdy, easy-to-grip handrail? |
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| Are steps edges clearly marked? |
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| Is a parking space always available? |
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| Is the parking space close to the home entrance? |
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| Is the door threshold too high or low to get in or out easily? |
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| Can visitors be viewed prior to entry? |
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| Can the doorbell be heard in every part of the house? |
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| Is the door lock sturdy and easy to operate? |
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| Can the mail be retrieved safely? |
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| Is the number of the house easily clearly visible from the street and well lit at night? |
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| Personal Safety |
Yes |
No |
Action Taken |
| Are street shoes worn instead of slippers around the home? |
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| Do shoes have low, flat heels? |
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| Do slippers have non-slip soles? |
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| Does clothing fit securely with no dangling cords or hems? |
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| Do you get up slowly from sitting or lying down to avoid becoming dizzy? |
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| Do you carry smaller loads, especially when using stairs, and make extra trips if necessary? |
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| Do you know how to reduce the impact of a fall by relaxing and letting your muscles go limp and rolling as you fall? |
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| Have you learned the stop, drop and roll technique if an article of clothing lights on fire? |
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