• Made to Help: Home Safety Risk Assessment Form

    version 15072026

  • 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
    • Home assessment details 

    • 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:             DOB:   Pick a Date   
      Client NDIS #:      
      Client Address:                  
      Contact person (if not the client):         
      Mobile:            

    • Date*
       - -
      2 digit day, 2 digit month, 4 digit year
    • *
      Rows
    • Assessment date*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Entry, exits and access Safe access path*
    • Stairs/ramps/rails, door width*
    • Keys onsite and if a lockbox emergency access exists *
    • Clutter-free exits*
    • Easy to open door/gate*
    • Adequate parking*
    • Two safe exit points from the building and property in an emergency*
    • Assessment scope and consent 
    • Trip hazards*
    • 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
    • Adequate lighting*
    • Risk rating guide 
    • Mobility aid and needed clearances for the aids in question *

    • 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

       

       

    • Home environment risk checklist 
    • 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 for hoists etc *
    • Call bell and Phone access at the house*
    • Storage of consumables*
    • Any Sharp items needing to be disposed of safely*
    • Electrical, oxygen and medical equipment Tagged/undamaged leads*
    • Backup power eg; generators in place*
    • Emergency Instructions available to you and you know where to find them*
    • 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 in place during visits*
    • Chemicals, smoking, alcohol or other substances including cleaning products, poisons, substance-related safety risks affecting supports to your home*
    • 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
    • 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.

    • Rows

    •  Link: Hazardous Chemical Register

    • 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 area agreed and approved. Follow emergency, incident, OHS and escalation procedures.*
      Rows
    • Risk controls and action register
      Rows
    • Maintenance, referrals and supporting evidence*
      Rows
    • 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
    • Assessor declaration 
    • Location of entrance door
    • Type of dwelling

    • Occupants

    • Do you have religious or cultural needs our staff should be sensitive to?
    • Are there others who live at your premises? Please list on client file:
    • 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?
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Completed by Date
       - -
      2 digit day, 2 digit month, 4 digit year
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