info@cosmosdivinecare.com.au
|
Make a Referral
|
Get In Touch
Home
Our Service
Pricing
Contact
Cosmos Documents
Hazard Identification Report Form
Service Environment / Home Safety Checklist
Participant Exit or Transition Form
Risk Indemnity Form
Complaints Management Form
Mealtime Management Form
Medication Management Form
Workplace Incident Report Form
Feedback Form
Call Us For Free
1800 953 997
Home
/
Service Environment / Home Safety Checklist
Service Environment / Home Safety Checklist
Step
1
of 5
Service Environment / Home Safety Checklist
Completion Guidelines
In the event of an Emergency/Urgent/Imminent Danger that may cause death and/or a serious injury, halt this inspection and deal with the emergency as appropriate and necessary, the situation must be guarded and rectified immediately.
Report the issue to the responsible Manager, and document it in this form after the hazard has been adequately handled.
Review the previous home safety checklist to identify any outstanding actions.
If the situation meets the requirements, indicate it in the
'Yes'
column. If it does not meet the requirements, mark it in the
"No"
column and describe why it did not meet the requirements in the comment/action section.
In the comments/actions section, also indicate what action is necessary to address the issue.
Sign off on the Checklist to retain a copy of the document in the client's file.
(The Supervisor may provide additional comments in the Notes/Additional Issues section, if necessary.)
You may identify major outcomes from this assessment at the client team meeting.
Participant's Name
Email
Checklist Completed by
Date of Inspection
Address
Previous
Next
A. General Cleanliness
Appropriate bins are available at suitable points for general waste, paper, sharps, etc.
YES
NO
NA
General and hazardous wastes are emptied and/or removed.
YES
NO
NA
Cleaning agents and other chemicals are used and stored safely.
YES
NO
NA
Safety Data Sheet (SDS) is available for the chemicals.
YES
NO
NA
Toilet and Washrooms are clean and disinfected.
YES
NO
NA
Tiles and mirrors are clean.
YES
NO
NA
Toilet/s are well stocked with toilet/hand paper.
YES
NO
NA
Taps are drip-free when turned off.
YES
NO
NA
The service environment is hygienic, clean and tidy.
YES
NO
NA
The noise level is appropriate for the participant.
YES
NO
NA
The surfaces are dust-free.
YES
NO
NA
The service environment is vacuumed.
YES
NO
NA
Bed sheets are clean and changed regularly.
YES
NO
NA
The equipment, devices, appliances, furniture and fittings that are used by multiple participants are cleaned and disinfected between each use.
YES
NO
NA
Previous
Next
B. Indoor
Light fittings are clean and in good condition.
YES
NO
NA
There is no direct or reflected glare.
YES
NO
NA
There are no single fluorescent tubes.
YES
NO
NA
There is adequate good natural light.
YES
NO
NA
There is adequate ventilation and extraction.
YES
NO
NA
Indoor furniture, fittings and equipment are safe, clean, well maintained and suitable for use for the participant and staff.
YES
NO
NA
The beds are in good condition.
YES
NO
NA
Beds are height-adjustable, fitted with brakes, cotsides fitted and accommodated with lifting.
YES
NO
NA
Appropriate slings are available and in good condition, fitted and accommodated with lifting.
YES
NO
NA
Other pieces of equipment such as oxygen cylinders, suction machines, etc. are available and serviceable (if applicable).
YES
NO
NA
The participant being able to move freely indoors.
YES
NO
NA
Previous
Next
C. Outdoor
Adequate personal protective clothing and equipment available.
YES
NO
NA
Adequate protection from live animals.
YES
NO
NA
There is adequate shade, rest and water.
YES
NO
NA
Sunscreens with adequate SPF is available and used.
YES
NO
NA
Outdoor furniture, fittings and equipment are safe, clean, well maintained and suitable for use by the participant and staff.
YES
NO
NA
The heating or cooling equipment maintained regularly.
YES
NO
NA
All exits clear.
YES
NO
NA
The access/egress paths/floors/walkways are clear and unobstructed.
YES
NO
NA
Previous
Next
D. Safety
The light switches, plugs, sockets and power points are safe and in good condition.
YES
NO
NA
There are no frayed or damaged leads.
YES
NO
NA
Electrical heating or cooling equipment are tested and tagged.
YES
NO
NA
Portable power tools are in good condition and stored appropriately and safely.
YES
NO
NA
There are temporary leads on the floor (trip hazard).
YES
NO
NA
The warning signs are available and visible.
YES
NO
NA
There are clear, non-slip floors.
YES
NO
NA
The first aid kit is clearly labelled and easily accessible.
YES
NO
NA
First aid kit and its contents are appropriate to use for the first aid assessment and provision.
YES
NO
NA
Emergency evacuation procedure is available and easily visible.
YES
NO
NA
The fire extinguisher is available, clearly marked and accessible.
YES
NO
NA
The fire extinguisher is regularly inspected and serviced.
YES
NO
NA
Fire and Smoke Alarms are installed properly.
YES
NO
NA
Fire alarm with flashing light or vibrating component available for hearing impaired people.
YES
NO
NA
Fire and smoke detectors are working.
YES
NO
NA
Adequate pointers to fire exits are marked and available.
YES
NO
NA
Exit signs are adequately laminated and illuminated.
YES
NO
NA
Aisle and floors are free of obstruction and trip hazards.
YES
NO
NA
Hand sanitiser and masks are available and used to protect the participants and workforce from Epidemics and pandemics such as flue & COVID-19.
YES
NO
NA
Appropriate handrails are available on the stairs (if applicable).
YES
NO
NA
Trained inducted workers and staff are available.
YES
NO
NA
Relevant Policy and Procedures are available.
YES
NO
NA
The available worker and staff is trained on Providing First Aid.
YES
NO
NA
Any additional information (if applicable)
Acknowledgement
I have completed the report to the best of my knowledge and ability.
I have informed the participant for the purpose of this report.
The participant actively participated in the preparation of this report.
I consent for an electronic signature for the purpose of this report.
Report Completion Date
Signature
*
Clear
Sign above using mouse or finger
Previous
Submit
