Prehospital Home Safety Checklist

This survey is provided as an educational service and is not intended to be exhaustive or certify a residence as safe or unsafe. We advise occupants to seek additional information if questions arise.

	OK	Needs Improvement
Bathroom
Non-skid mats or decals in tub	☐	☐
Stairs (inside and outdoors)
Well-lit	☐	☐
Sturdy handrail along length of stairs	☐	☐
Bedroom
Phone next to bed (may be by report)	☐	☐
General
Secure carpeting on floors and staircases	☐	☐
Fire Safety
Smoke detector functional	☐	☐
Fire extinguisher (in kitchen or nearby)	☐	☐
Child Safety (if applicable)
Plastic plugs in unused electrical outlets	☐	☐
Cleaners out of reach or in locked cabinets	☐	☐
Medicines out of reach or in locked cabinets	☐	☐
Child safety gates installed around hazards	☐	☐