community health nursing 3

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Home Safety Assessment

Student: ____________________
Date:_______________________

Assigned Agency:______________

Safety HazardYesNo

  • 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?

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