(Humphrey & Milone-Nuzzo, 1991; Malloy & Hartshorn, 1989; Spradley,

1991; Stanhope & Knollmueller, 1992)

A. Exterior

barriers to delivery of equipment

driveway access to the home
condition and number of outside steps
presence of a wheelchair ramp and if so type of surface on ramp
presence of a porch
size of doorway
Are the thresholds high or uneven?
Is snow and ice removal adequate and efficient?
Are sidewalks, curbs and outside stairs maintained?
adequate outdoor lighting
B. Space

overall size of living quarters

number of occupants
number of rooms
arrangement of rooms
Is the home on one floor or several floors with stairs?
adequate privacy
noise level
sleeping arrangements
C. Heating, Ventilation and Air Conditioning

comfortable temperature
air quality and circulation
Are there any drafts present?
Are room heaters placed well away from curtains or drapes?
Are heating pads present and do they present a safety hazard?
Any exposed hot radiators or pipes?
Are furnace examinations/cleanings done on a regular basis by utility expert?
D. General Safety

1. Exits

Where are all exits located?

Are all exits easily accessible from all locations in the house?
2. Stairways

What is the condition of the stairways?

Are the steps of uniform height?
Are the steps covered with a non-skid surface?
Is there adequate lighting for the whole stairway?
handrails: present, easily grasped and secure
Are different colors used to mark changes in levels or are edges of each step painted
or taped?
If carpeting is present, is it low-pile and secured?
Are stairs free of clutter?
3. Elevators, if present
 easy to operate
adequate lighting
properly maintained
4. Flooring

What type of flooring is there?

Are there scatter rugs present?
Are scatter rugs secured by non-skid backing?
Does the flooring have even, non-skid surfaces?
Are the carpets low-pile?
If carpeting or large rugs are present, are they well anchored at the edges?
Does the client wear firm, supportive footwear with corrugated or crepe-soled shoes
to prevent falls on uncarpeted floors?
Are pathways cleared of toys, furniture, etc?
5. Furniture

Is the furniture sturdy, supportive and comfortable?

Is furniture designed to accommodate easy transfers on and off?
Are electrical cords, footstools and other low-lying objects kept out of walkways?
Are there clear passageways from one room to the next?
6. Smoke, fire and carbon monoxide detectors

Are they present outside each sleeping area and in every level of the home?
Are they functioning?
Are smoking materials disposed of safely?
Is smoking confined to one area of the home?
Are carbon monoxide detectors present and functioning?
7. Fireplace/Woodstove

Does the fireplace have a screen?

Is maintenance scheduled and completed on a regular basis?
Are curtains and flammable items kept away from the stove and other flame areas?
8. Electrical outlets

Does the home have electricity?

Are loose extension cords present?
Are electrical circuits overloaded?
Are electrical cords in good condition and free from fraying or cracking?
Are unused outlets covered?
Are appliances disconnected when not in use?
Are electric devices protected from and not exposed to moisture?
Do electric plugs fit snugly into their sockets?
Do electric cords run along the walls?
9. Locks

What are the type and condition of door and window locks?
10. Valuables

Are valuables secured properly?

11. Emergency plan

Is there a telephone present?

 Does the telephone have numbers that are easy to read?
Is there a list of emergency phone numbers near the phone (including the nearest
relative, neighbour, primary health care provider, police and fire department, and
ambulance)?
emergency system notification
Is the emergency number programmed into a quick-dial phone?
communication with the electric company in case of a power outage
distance from the nearest health facility and available transportation
fire evacuation plan safety/drill
E. Lighting

natural and artificial lighting available and adequate

presence of glare
Are curtains or blinds used to reduce glare?
Are nightlights used along routes/areas travelled after dark (such as the bed to the
bathroom)?
F. Personal Surroundings

flowers, pictures or photographs present

mementos of travel, accomplishments, children
evidence of hobbies or crafts
clocks, mirrors, calendars
books, magazines, newspapers
television, radio, computer, records, CDs, cassettes, DVDs
Is there a pet?
G. Cleanliness

Is trash taken out regularly?

degree of cleanliness
degree of sanitation
presence of insects, rodents
H. Plumbing and Bathroom Facilities

indoor plumbing
number of bathrooms
Where are bathrooms located and are they easily accessible?
Can the client have privacy?
Is bathroom accessible to client in wheelchair or with a walker?
Is there a seat in the tub/shower or by the sink, if necessary?
cleanliness of the bathrooms
Are tub, shower or toilet grab bars necessary and installed properly?
Are toilet seats high enough to get on and off without difficulty?
Is an elevated toilet seat necessary and available?
Is bathroom large enough to permit client in a wheelchair to transfer?
Do the tub, shower and floor have a non-slip surface?
Can water temperature be easily regulated?
If client suffers from impaired sensation, is water heater temperature lowered to
prevent accidental scalding?
Are sinks freely draining?
Are electrical cord, outlets and appliances a safe distance from the tub?
Are razor blades kept in a safe place?
 Is a first aid kit available?
I. Kitchen

1. Appliances

Is the cooking stove gas or electric?

Is there a microwave oven?
Are there easily readable dials present on the appliances with the "on" and "off"
position clearly marked?
Are refrigerators/freezers in good working order?
Is stove free of flammable objects and grease?
Are pot holders available for removing pots and pans from the stove?
2. Food storage

What food is available in cupboards and fridge?

Is food from all four food groups present?
Is food storage adequate?
Is spoiled food present?
Are there any unusual food odours?
3. General kitchen safety

Are sharp objects such as knives and scissors kept in special holders and out of reach
of children and confused clients?
Are cleaning fluids, polishes, bleaches, detergents and all poisons stored separately
and clearly marked?
Is baking soda/appropriate fire extinguisher available in case of fire?
Are the handles of pots and pans secured tightly?
Is a step stool available?
Are items used frequently arranged on lower shelves?
J. Bedroom

Is the bed positioned to enable bedridden client to observe who enters the room?
Is the room large enough to accommodate necessary equipment (O2, ventilator,
feeding apparatus, etc.)?
Is the room large enough to permit wheelchair transfers, if necessary?
Is the room pleasant?
Is there easy access to the bathroom?
Does the client have privacy?
K. Medications

What medications (prescription and over-the counter) are present?

Where are medications stored?
Are internal and external medications stored separately?
Do medication containers have childproof tops if children are present?
Are medications clearly labelled?
Have all outdated medications been discarded?
Do you identify any prescription or over-the-counter medications that could cause side
effects or drug-interactions?
L. Basements and Attics

Are they easy to get to?

 Are they well lit?
Are they well ventilated?