FIRST VISIT - Home Safety Checklist

Made to Help: Home Safety Risk Assessment Form
Purpose

When work is conducted in a home, the home becomes a workplace. It is essential for both the person receiving services and the workers to consult and take reasonably practicable steps to ensure a safe environment. This risk assessment helps identify and control common health and safety risks in the home environment.

A risk assessment is required:

- Before the first service starts

- When service provisions or the home environment change

- Annually
Document control

Version	Effective date	Approved by	review due	Comment
1.0	14/5/2026	Lesley-Anne Adamson
1.1	30/5/2026	Milan Pintar	30/5/2027	Added Lithium battery risk quesiton
1.2	1/6/2026	Milan Pintar	30/5/2027	Removed fields in section 1 that do not make sense. HOME ENVIROMENT CHECKLIST split the questions
1.3	4/6/2026	Milan Pintar	30/5/2027	Assessment scope and consent change from check box to dropdown and allow multiple choice
Review trigger	New participant / material change / incident / complaint / annually

Section One - To be completed prior to the first home visit.

Home visit risk assessment introductory statement

(Can be read out over the phone to explain why we need to do the risk assessment)

MADE TO HELP has a duty of care to make sure that all staff are safe at work – so it is routine for us to ask some questions before we visit you at home. I need to ask you about pets, firearms, smoking, infectious diseases – we ask these questions of all clients.
Client Full Name:   First Name   Last Name       DOB:   Date
Client NDIS #:   NDIS Number
Client Address:   Street Address   Address Line 2   City   State   Zip
Contact person (if not the client):   First Name Contact    Last Name Contact
Mobile:         Phone Number Participant

Rows	Answer
Participant name
Assessment date
Type of dwelling
Home address
Assessor name / role
Primary supports delivered in home
Landlord / housing provider contact if relevant
Religious or cultural needs staff need to be sensitive to? (e.g. clothing, food)
Nominated authorised representative, Community Treatment Order or similar?
Is anyone living at the premises known to be potentially aggressive or violent?
Are there others who live at your premises? Provide details.
Review due

Explain the purpose of the assessment to the participant and/or representative. Only assess areas relevant to safe delivery of agreed supports, worker safety and emergency response. Respect privacy and seek consent before inspecting private areas, taking photos or discussing household risks.

Rows	YES
Participant consent obtained
Representative/nominee consent obtained where applicable
Photos taken only with consent and stored securely
Participant preferences and privacy considerations recorded
Household members/pets considered
Urgent hazards discussed with participant/representative
High/Extreme risks escalated
Maintenance/referral actions agreed

Rate each risk before and after controls. Use professional judgement and participant context; escalate any High or Extreme residual risk to the nominated manager and relevant practitioner where required.

Likelihood	Score	Consequence	Score	Risk level guide
Rare	1	Insignificant	1	1-4 Low: manage with routine controls
Unlikely	2	Minor	2	5-9 Medium: controls/action owner required
Possible	3	Moderate	3	10-16 High: manager review and documented action plan
Likely	4	Major	4	17-25 Extreme: immediate escalation; consider suspending/altering supports until safe
Almost certain	5	Severe/catastrophic	5	Risk score = likelihood x consequence

Please list any devices with lithium-ion batteries from non reputable suppliers
Entry, exits and access Safe access path
Stairs/ramps/rails, door width
Keys/lockbox emergency access
Clutter-free exits
Easy to open door/gate
Adequate parking
Two safe exit points from the building and property in an emergency
Trip hazards
Adequate lighting
Mobility aid and needed clearances for the aids in question
Bathroom and toilet Grabrails in place
Hot water is this a scald risk
Privacy for personal care tasks
Bedroom and personal care area Bed height
Transfer space is adequate
Call bell and Phone access at the house
Storage of consumables
Any Sharp items needing to be disposed of
Electrical, oxygen and medical equipment Tagged/undamaged leads
Backup power eg; generators in place
Emergency Instructions available to you
Fire safety and evacuation Smoke alarms, exits, evacuation risk
Do you have any Cold and Hot weather risks
Infection prevention and waste Hand hygiene, PPE on site
Pets, pests and animals onsite and what are you Pet controls during visits
Chemicals, smoking, alcohol or other substances including cleaning products, poisons, substance-related safety risks affecting supports
Are weapons secured appropriately
Danger from smoke, including a person smoking?
Basic amenities like access to running water, working toilets and rubbish disposal
Biological hazards Body fluids, dressings needing to be disposed of?
Immediate Risk - Is their evidence of immediate danger to the anyone (please contact 000 and MTH)

HOME ENVIROMENT CHECKLIST (Rating Scale 1 (Low) - 25 (Extreme Risk)

Rows	N/A	Deemed Safe	Any issues	Rating	controls/action required	Owner / due date
Entry, exits and access Safe access path, stairs/ramps/rails, door width, lighting, keys/lockbox, emergency access, clutter-free exits. Easy to open door/gate; adequate parking; two safe exit points from the building and property in an emergency.
Floors, trip hazards and lighting Loose rugs, cords, uneven floors, wet areas, adequate lighting, mobility aid clearances.
Bathroom and toilet Grabrails, non-slip surfaces, shower chair/commode, hot water scald risk, privacy, transfer space.
Bedroom and personal care area Bed height, transfer space, pressure care equipment, privacy, call bell/phone access, storage of consumables.
Kitchen and food safety Food storage, appliances, sharp items, cooking supervision, infection control, participant access risks.
Medication storage and administration area Secure storage, temperature requirements, charts, disposal, sharps, privacy during administration.
Mealtime support area Seating/posture, choking response equipment/procedure, texture/fluid instructions accessible, distractions
Hoists and assistive technology Equipment condition, service dates, charging, sling compatibility, safe operating space, worker competency.
Electrical, oxygen and medical equipment Tagged/undamaged leads, overloads, backup power, oxygen/fire separation, emergency instructions.
Fire safety and evacuation Smoke alarms, exits, evacuation plan, extinguishers/blanket if required, participant ability to evacuate, meeting point.
Heating, cooling and hot weather Safe heaters, cooling, hydration, heat plan, burns risk, weather extremes.
Infection prevention and waste Hand hygiene, PPE, cleaning, laundry, clinical/incontinence waste, sharps disposal.
Pets, pests and animals Pet control during visits, allergies, bites/scratches, hygiene, assistance animal needs
Chemicals, smoking, alcohol or other substances Cleaning products, poisons, smoking/fire risk, substance-related safety risks affecting supports.
Weapons, aggression or unsafe visitors Known unsafe persons, weapons, duress plan, worker check-in, escalation protocols. Are weapons secured appropriately?
Privacy and confidential information Privateconversations, records storage, device use, consent for shared information.
Neighbourhood and community access Parking, public transport, lighting, safety at night, emergency services access.
Emergency and disaster readiness Emergency contacts visible, evacuation bag, medication/equipment backup, flood/fire/storm/power outage plan
Worker welfare and manual tasks Safework space, chair/bench height, lifting/reaching, lone work, fatigue, amenities.
Shared accommodation considerations Roles/responsibilities, shared hazards, participant compatibility, visitors, tenancy maintenance escalation.
Worker Welfare Are the clients or others living at the premises smokers? Explain the policy.
Infectious Diseases Does any occupant have or has any occupant recently been exposed to an infectious disease?
Communication Is there any difficulty with mobile phone coverage and/or working landline?
Basic amenities Access to running water, working toilets and rubbish disposal.
Biological hazards Body fluids, dressings.
Immediate Risk Assessment Is their evidence of immediate danger to the client or staff?

All staff must verify label integrity and safety before use. When in doubt, complete a Hazardous Chemical Register as per Made to Help policy.
Client must provide Safety Data Sheets for all hazardous chemicals, not including cleaning products that are consumer grade. An example of a hazardous chemical includes an oxygen cylinder.

Rows	Chemical Name	Label Present	SDS Available	PPE Required	Training Required	Notes
1
2
3
4
5
6

Link: Hazardous Chemical Register

Immediate safety decision If an imminent risk to the participant, worker or another person is present, do not commence or continue the affected support until safe interim controls area agreed and approved. Follow emergency, incident, OHS and escalation procedures.

Rows	Hazard	Interim control	Can support proceed?	Manager approval	Review date
1
2
3
4
5
6

Risk controls and action register

Rows	Risk / hazard	Existing controls	Initial rating	Additional action required	Owner	Due date	Residual rating	Closed / review notes
1
2
3
4
5
6
7
8
9

Maintenance, referrals and supporting evidence

Rows	Attached or requested?	Responsible person	Due date	Notes
Photos of hazard with consent
OT / allied health assessment
Equipment service record
Fire/evacuation plan
Medication/mealtime plan displayed or accessible to workers
Landlord/housing maintenance request
Participant emergency plan
Worker check-in/lone work plan

Participant / representative consultation and sign-off - Confirm the participant was consulted in a waythey can understand and that their preferences, dignity of risk, privacy, anddecision-making supports were considered

Rows	Name / role	Signature	Date	Comments / adjustments requested
1
2
3
4
5

Should be Empty:

Made to Help: Home Safety Risk Assessment Form

Purpose

A risk assessment is required:

Document control

Section One - To be completed prior to the first home visit.

Link: Hazardous Chemical Register

Occupants