Support Coordinator

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*

Location of entrance door

Other

Type of dwelling

Write the name of the housing provider, if you live in social housing?

Occupants

Do you have religious or cultural needs our staff should be sensitive to?

If you have cultural needs, please list them here.

Are there others who live at your premises? Please list on client file:

Details of others living at premises

Do you currently have a nominated authorised representative, Community Treatment order or similar?

Is anyone living at the premises known to be potentially aggressive or violent?

Are there any firearms at the property?

If yes, are they appropriately secured?

Are there any access problems, eg; clear pathway, easy to open door/gate?

Is parking adequate on the street?

Assessment/Scope 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	Inspection Prompts	Safe	Issue	Rating	Action Required
Heating, cooling and hot weather Safeheaters, cooling, hydration, heat plan, burns risk, weather extremes.
Infection prevention and waste Handhygiene, PPE, cleaning, laundry, clinical/incontinence waste, sharps disposal.
Pets, pests and animals Petcontrol during visits, allergies, bites/scratches, hygiene, assistance animal needs.
Chemicals, smoking, alcohol or other substancesCleaningproducts, poisons, smoking/fire risk, substance-related safety risks affecting supports
Weapons, aggression or unsafe visitorsKnownunsafe persons, weapons, duress plan, worker check-in, escalation protocols. Are weapons secured appropriately?
Privacy and confidential informationPrivateconversations, records storage, device use, consent for shared information.
Neighborhood and community accessParking,public transport, lighting, safety at night, emergency services access.
Emergency and disaster readinessEmergencycontacts visible, evacuation bag, medication/equipment backup, flood/fire/storm/power outage plan
Worker welfare and manual tasksSafework space, chair/bench height, lifting/reaching, lone work, fatigue, amenities.
Shared accommodation considerationsRoles/responsibilities,shared hazards, participant compatibility, visitors, tenancy maintenance escalation.
Worker Welfare Are the clients or others living at the premises smokers? Explain the policy.
Communication Isthere any difficulty with mobile phone coverage and/or working landline?
BasicAmenitiesAccessto running water and rubbish disposal.
Biological hazards Body fluids, dressings.
Immediate Risk Assessment Is their evidence of immediate danger to the client or staff?
Infectious Diseases Does any occupant have or has any occupant recently been exposed to an infectious disease?

Hazards

Hazardous chemical checklist

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.

RATING GUIDE

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.

1 Low and manage with routine controls

2 Minor/unlikely Risk

3 - 4 Moderate Risk

5-9 Medium controls

10-16 High and needs Management Review and documented action plan rated 10 and over.

17-25 Extreme needs immediate escalation consider suspending/altering supports until situation is safe

Rows	Rating	Rating	Rating	Rating
Chemical Name
Label Present
PPE equipment required
Training Required
Additional Notes

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

Rows	N/A	Deemed Safe	Any issues	controls/action required	Rating
Entry, exits and access Safeaccess 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 substancesCleaningproducts, poisons, smoking/fire risk, substance-related safety risks affecting supports.
Weapons, aggression or unsafe visitorsKnownunsafe persons, weapons, duress plan, worker check-in, escalation protocols. Are weapons secured appropriately?
Privacy and confidential informationPrivateconversations, records storage, device use, consent for shared information.
Neighbourhood and community accessParking,public transport, lighting, safety at night, emergency services access.
Emergency and disaster readinessEmergencycontacts visible, evacuation bag, medication/equipment backup, flood/fire/storm/power outage plan
Worker welfare and manual tasksSafework space, chair/bench height, lifting/reaching, lone work, fatigue, amenities.
Shared accommodation considerationsRoles/responsibilities,shared hazards, participant compatibility, visitors, tenancy maintenance escalation.
Worker WelfareArethe 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 Isthere any difficulty with mobile phone coverage and/or working landline?
Basic amenities Access to running water, working toilets and rubbish disposal.
Biological hazards Bodyfluids, dressings.
Immediate Risk Assessment Is their evidence of immediate danger to the client or staff?

Required immediate controls before support proceeds
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 are agreed and approved. Follow emergency, incident, WHS and escalation procedures.

Type a question

Rows	Hazard	Interim Control	Can support Proceed?	Manager approved needed	Review Date
Hazard
Cleanliness
Responsiveness
Friendliness

If you wish to take photos of any issues at the property

Has the Support Coordinator reported these issues to mangement?

Completed By

First NameLast Name

Completed By

Completed by Date

Date

Home Safety Checklist

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

Occupants

Hazards