Client Support Plan – Flair & Fine Care

Home Safety Checklist
Details
Client's Name*

First NameLast Name
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date

DayMonthYear
Checklist completed by:
Completion Instructions

Step 1 - Check the previous home safety checklist undertaken to identify any outstanding actions.

Step 2 - If the situation fulfils the requirements indicate it in the ‘Yes’ column. If it does not meet the requirements, indicate it in the ‘No’ column and make notes in the comments/actions section of this checklist as to why it failed.

If there is an Urgent / Imminent Danger likely to cause death / serious injury - cease the inspection, guard the situation (e.g. physical barriers) and correct immediately. Report the issue to the responsible Manager (document on this form after the hazard is adequately controlled).

Step 3 - Within the comments/actions section also indicate the action that is required to address the issue.

Step 4- Sign off the Checklist and file an original copy of this inspection checklist with the Supervisor and client file. If the Supervisor wants to provide additional comment this should be indicated in the Notes/Additional Issues section.

Step 5 - Discuss major outcomes from the assessment (positive & unresolved corrective actions) at any client review or team meeting as appropriate.