Home Visit Checklist

IMPORTANT NOTE:

Please note when filling in the form that any selection of "Fair" or "Poor" will require you to make a comment below referencing why you have scored it as "Fair" or "Poor".

Participant Observations*

Rows	Excellent	Good	Fair	Poor	N/A
Participants general well-being (appearance, hygiene mood)
Engagement with Auditor
Engagement in activities with Support Worker
Engagement in Activities - In community
Engagement in Activities - Daily living
Dietary & Nutritional Needs (Adequate intake, restrictions followed)
Physical Health Observations
Mental Health Observations
Feedback on Support Services

Participant Observation Comments

Participant 2 Observations

Rows	Excellent	Good	Fair	Poor	N/A
Participants general well-being (appearance, hygiene mood)
Engagement with Auditor
Engagement in activities with Support Worker
Engagement in Activities - In community
Engagement in Activities - Daily living
Dietary & Nutritional Needs (Adequate intake, restrictions followed)
Physical Health Observations
Mental Health Observations
Feedback on Support Services

Participant 2 Observation Comments

Environmental Safety & Cleanliness*

Rows	Excellent	Good	Fair	Poor	N/A
Walkways (Clean, dry, hazard-free)
Floors (Clean, dry, hazard-free)
Furniture & Appliances (Safe, functional, in good repair)
Windows, Doors & Locks (Secure and functional)
Emergency Exits & Pathways (Clear of obstructions)
Fridge & Pantry (No expired food, properly sorted, clean)
Pantry (Neat and Tidy)

Environmental Safety & Cleanliness Comments

Kitchen*

Rows	Excellent	Good	Fair	Poor	N/A
Oven (Working condition, clean)
Stove Top (Working condition, clean)
Benches (Clean, tidy)
Kettle (Working condition, clean)
Microwave (Working condition, clean)
Cooking Appliances (Working condition, clean, safe for usage)
Food hygiene / Storage Practices (Proper labeling, safe handling)
Fridge (Working condition, clean, thermometers working)

Kitchen Comments

Toilets, Bathrooms and Laundry*

Rows	Excellent	Good	Fair	Poor	N/A
Toilet (Clean, accessible, no hazards)
Toilet Exhaust Fan (Working condition, clean)
Shower (Clean, accessible, no hazards)
Shower Exhaust fan (Working condition, clean)
Basin (Clean, good working condition)
Mirror and surfaces
Under Shower Mat (clean)
Washing Machine (Clean, good working condition)
Clothes Dryer (Clean, good working condition, filter cleaned)
Cupboards (Clean, tidy)

Toilets, Bathrooms and Laundry Comments

Miscellaneous*

Rows	Yes	No (Provide comment below)	N/A
Chemical Storage (Secure and labelled)
Fire Extinguishers (Functional and tested)
Smoke Alarms (Functional and tested)
Emergency Evacuation Plan (Visible and understood)
Security - Cover Locks
Car Log Book Appropriately Stored and Completed
Office Car - Fuel Card
Air Conditioning Remote (Functional and tested)
TV Remote (Functional and tested)
Garage Remote (Functional and tested)

Rows	Excellent	Good	Fair	Poor	N/A
Office Car Condition

Miscellaneous Comments

Participant Support & Care Plan Compliance*

Rows	Yes	No (Provide comment below)	N/A
Current Support & Care Plans (Reviewed and accessible)
Daily Living Assistance (Personal care, meal prep, mobility support documents up to date)
Current Medication Profile
Webster Pack Stored Properly
Empty Webster Packs Disposed Appropriately
Medication Signing Sheets Correctly Stored and Appropriately Signed
Any Other Charts Correctly Correctly Stored Appropriately Signed (Sleep charts, BP, BGL etc)

Participant Support & Care Plan Compliance Comments

Staff Interaction*

Rows	Excellent	Good	Fair	Poor	N/A
Participant Goals & Skill-building Activities (Encouraged and documented)
Support Worker On Shift
Staff Interaction with Participants (Respectful, engaging, professional)
Staff Dress Code (Compliant with provider policies)
Feedback From Staff Regarding Participant Needs

Staff Interaction Comments

Documentation & Compliance Checks*

Rows	Yes	No (Provide comment below)	N/A
Safety Policies are Visible and Understood by Residents
House Rules are Visible and Understood by Residents

Documentation & Compliance Checks Comments

External Environment*

Rows	Excellent	Good	Fair	Poor	N/A
Security of Outdoor Areas (Fences, gates, lighting functional)
Gardens & Outdoor Spaces (Maintained, hazard-free)
Transport and Accessibility (Safe transport options available)
Letterbox (Clean, functional)
Clothes Line (Maintained, functional)

External Environment Comments

Follow-Up Actions & Next Steps*

Rows	Yes (Provide comment below)	No	N/A
Urgent Repairs or Compliance Issues?
Additional Participant Needs Identified?
Referrals Required?

Follow-Up Actions & Next Steps Comments

Photo Upload (Damage, repairs required, hazards etc)