• Individual Support Home Visit Risk Assessment Checklist

    Individual Support Home Visit Risk Assessment Checklist
  • Date of Assessment*
     / /
  • Review Date*
     / /

  • Section 1: Information from the referral

  • Review BEFORE making the initial phone call, to book in an appointment with the Participant/ NOK, to visit the premises in which supports will be conducted by GOCare staff.

  • Did the referral highlight any concerns?*
  • Any current family orders?*
  • Does the participant have a history of mental illness, excessive drug or alcohol use, aggression or infection disease?*
  • Does the referral indicate specific cultural or religious background?*

  • Section 2: Pre-Visit Risk and Access Assessment

  • The following questions are to be completed during the phone call conversation with the participant or NOK, PRIOR to initial home visit. If the participant or NOK are not available discuss the following questions with the Support Coordinator.

  • Do you have religious or cultural needs that staff should be informed about? e.g. head coverings, removing shoes prior to entry?

  • Who lives at the family residence with the participant?

  • Will there be anyone else home during the Risk Assessment home visit?

  • What kind of accommodation do you live in? e.g. house, flat/unit, lift access, stairs

  • Will staff be required to enter the premises via a door other than the front door? e.g. side door?

  • Are there any access problems? e.g. clear pathway, gates, driveway, stairs?

  • What are the parking arrangements in your street?

  • Are there any pets/animals on the premises?

  • Are there any smokers in the household?

  • Are there any firearms/weapons on the premises? If so, are they locked away safely during the visit?

  • Is there any difficulty with mobile phone coverage and/or working landline at the premise?

  • Is your house in a remote area? If isolated list any identifying features of the house.

  • Select save to return to Section 1: Information from the referral & Section 2: Pre-Visit Risk and Access Assessment at a later time.
    Select next to continue to Section 3: Decision.

  • Section 3: Decision

  • Admin staff's decision based upon their assessment of Section 1 & 2.

  • Considering the above assessment, how would you rate the risks of visiting this client?*

  • Assessment Decision

  • Risk assessment indicated that it will be appropriate for one staff member to attend initial home visit*
  • Risk assessment indicated that it will be appropriate for two staff members to attend initial home visit*
  • Risk assessment indicated that issues identified need to be addressed before a staff member can attend initial home visit*
  • Date*
     / /

  • Select Back to return to section Section 1 & 2.
    Select Save to return to complete Section 3 at a later time or date.

    If admin staff have determined it is safe to attend the Participant’s or NOK’s premises, please complete Section 4 after your visit.
    Select Continue to proceed to Section 4.

  • Section 4

  • To be completed only after Section 1: Information from the referral, Section 2: Pre-Visit Risk and Access Assessment, and Section 3: Decision, have been finalised and the home visit has taken place.

  • Did you have any parking issues during the visit?

  • Did you notice any hazards accessing the property?

  • Were there any hazards inside or outside the property? e.g. flooring, weapons, biological waste?

  • Date*
     / /

  • Select Back to return to section Section 3.
    Select Save to return to complete Section 4 at a later time or date.
    Select Submit to complete the form.

  • Should be Empty: