• Living Alone Participant Risk Assessment

  • Participant Details

  • Date of Birth
     - -
  •  -

  • Participant Requirements / Preferences

  • Known Medical Conditions or Allergies

  • Emergency Contacts

  •  -

  • Support Worker Details

  •  -

  • RISK ASSESSMENT DETAILS

    Persons Involved in Risk Assessment
  • Was the participant involved in the assessment?
  • Please Select

  • Daily Personal Activities – for participants living alone

  • Sole Support Worker

  • Information Sharing and Privacy

  • Privacy Policy Explained

  • STEP 1. IDENTIFY RISKS

  • Tick all applicable risk - Risk factors

    Daily Personal Activities Support – for participants living alone

  • Personal contact - Risk category
  • Physical - Risk category
  • Communication - Risk category

  • Note: If supports will be delivered by the sole support worker, and any of the above risks apply, a Monitoring and Supervision Plan must be created.

  • Medical conditions and interventions
  • Personal care
  • Eating and drinking
  • Accidental movement
  • Manual handling
  • Environmental risks
  • Mental health and wellbeing
  • Financial risks
  • Social risks
  • Substance use

  • STEP 2. ADDRESS RISKS IDENTIFIED IN STEP 1

    RISK MANAGEMENT PLAN (See APPENDIX for Consequence Rating Table and Example Risk Management Plan)

  • Likely Effect Level

  • Review Date
     - -

  • Likely Effect Level

  • Review Date
     - -

  • Likely Effect Level

  • Review Date
     - -

  • Likely Effect Level

  • Review Date
     - -

  • Likely Effect Level

  • Review Date
     - -

  • MONITORING AND SUPERVISION PLAN

    Risk Monitoring and Supervision – Participants Living Alone – Sole Support Worker

  • Participant Risk*

  • Monitoring Types and Frequencies

  • Communication with participant*

  • Do you want to add more Risk Monitoring and Supervision

  • Communication with participant*

  • Do you want to add more Risk Monitoring and Supervision

  • Communication with participant*

  • Do you want to add more Risk Monitoring and Supervision

  • Communication with participant*

  • Date
     - -
  •  
  • Should be Empty: