AkinCare Risk Assessment Form
Welcome to the AkinCare Risk Assessment Form. This digital assessment must be submitted prior to the delivery of any services.Where a risk has been identified, please proceed to the final section of this form regarding Identified Risks and Control Measures. Staff are required to detail the specific risk, provide an accurate risk rating, and document the implemented control measures. Should any risk be rated as a 1, 2, or 3, please refer the matter directly to management for further review and guidance in accordance with Risk Management Policy ACP105.
PERSONAL INFORMATION
TODAY'S DATE
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant Name:
First Name
Last Name
NDIS/DVA/AC #
Service Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Assesment
This section focuses on ensuring safe access to the property for our staff. Whether you are arriving on-site or completing this assessment over the phone, you must evaluate the environment from the street to the front door. If on-site, actively observe; if on the phone, ask the client or family directly to describe the access. You need to determine if parking is accessible, note the number of steps and presence of sturdy railings, and confirm if outdoor lighting is adequate. Always ask about exterior slip or trip hazards, and explicitly check for any pets on the premises so you can document their type and any potential safety concerns.
Pre-Assesment Questions
*
Rows
Present?
Details & Notes
Parking Accessible and close to house?
Steps/stairs/ramps How may? Railings?
Lighting Appropriate/safe lighting
Pets Type, number and issues identified.
Surfaces slippery floors, trip hazards, clutter etc
Other Risks:?
BEHAVIOURS
When evaluating potential behavioral risks, it is essential to approach the client and their support network with empathy, respect, and a non-judgmental tone. Rather than reading these sensitive topics like a checklist, begin by reviewing the client's existing care plans, medical history, and handover notes for any documented history. During your visit, actively observe the client’s current mood, body language, and interactions. If you need to ask directly, frame your questions gently to ensure the client feels safe, using open-ended prompts such as, "Are there times when you feel overwhelmed or unsafe?" For highly sensitive topics like self-harm, aggression, or sexual behavior, you may need to rely on factual, calm conversations with family members or previous carers. Your goal is to gather accurate information to ensure everyone's safety while maintaining the individual's dignity and trust.
Behaviours Checklist
Suicide
Self-Harm
Absconding Behaviour
History of aggression/violence - physical or verbal
Challenging Behaviour
Inappropriate Sexual Behaviour
Risk of infection
MEDICAL CONDITIONS & DIAGNOSIS
When documenting a client’s medical profile, begin by reviewing any provided health summaries, recent hospital discharge papers, or existing care plans for officially documented diagnoses. When discussing health with the client or their family, adopt a collaborative and supportive approach. You might ask, "Are there any current medical conditions, recent health changes, or upcoming treatments we should be aware of to ensure we support you safely?" It is important to go beyond just listing the name of a disease or condition; gently inquire about how these diagnoses actually impact their daily life, mobility, or medication needs. Ensure all conditions are documented accurately, specifically noting any warning signs, physical limitations, or health triggers that our staff should actively monitor during service delivery.
Medical Conditions & Diagnosis Checklist
Anaphylactic
Stoma
PEG tube
Anxiety Disorder
Major depression
Bowel Care
Asthma
Speech difficulty
Diabetes
Dysthymia
Urinary Catheter
Autonomic dysreflexia
Other/Mental Health
PRIMARY DIAGNOSIS
Identifying a client’s primary diagnosis helps us tailor our care, but it is deeply personal information. Start by reviewing existing referrals or health summaries to avoid making the client repeat their medical history. If asking directly, frame it gently: "Is there a main health condition you'd like us to know about so we can best support you?" Please remember that clients have the right to privacy and may choose not to disclose their diagnosis, and that is completely okay. If they decline, do not pressure them; respectfully accept their boundary, document that they preferred not to answer, and focus the rest of the conversation purely on their practical, daily support needs.
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Any Allergies or Sensitivities?
Identifying allergies is a critical safety measure. Begin by reviewing medical summaries and care plans for documented allergies. When speaking with the client, explicitly ask about a wide range of triggers—including medications, foods, pets, and materials like latex—as people often forget non-food sensitivities. Ask directly, "Do you have any allergies, and what happens if you are exposed?" You must document the specific allergen, the exact severity of the reaction (e.g., a mild intolerance versus life-threatening anaphylaxis), and the specific location of any emergency treatments, such as an EpiPen, within the home.
MONEY & PROPERTY
When evaluating risks related to a client’s finances and home security, it is vital to be discreet and highly respectful of their privacy and independence. Begin by quietly observing the environment for vulnerabilities, such as large amounts of unsecured cash, valuables left in plain sight, or property maintenance issues that could impact security (like broken locks). If our staff will be assisting with shopping or paying bills, discuss these arrangements practically and transparently. You might ask, "How do you usually prefer to manage money for groceries, and is there a secure place you keep your cash or cards?" Be gently observant for any signs of financial vulnerability, confusion about expenses, or potential financial exploitation by others. Accurately document any specific boundaries, safe storage locations, and exact procedures staff must follow when handling the client’s money to ensure everyone's protection.
MONEY & PROPERTY
Rows
Present?
Details & Notes
Are there any cash/wallets/jewellery/other personal valuables visible? (Advisable for the client to put these items away.) If YES, provide details
Are the premises securely lockable before and after the service? If NO, provide details
INTERIOR HOME ASSESMENT
Conducting an interior home assessment requires balancing occupational health and safety with deep respect for the client’s personal space and sanctuary. Rather than treating it like an inspection, begin by politely asking the client or their family for a guided tour, focusing primarily on the rooms where care will be provided (such as the bathroom, bedroom, and kitchen). As you walk through, actively observe the environment for potential slip and trip hazards (like loose rugs, clutter, or trailing cords), adequate lighting, and clear pathways for mobility equipment. Frame your safety questions collaboratively, asking, "Are there any areas in the house that you find difficult to navigate, or any steps that feel unsafe?" Carefully document any environmental risks, hygiene concerns, or fire hazards (like unsafe heaters or blocked exits), and note any immediate modifications required to ensure the physical safety of both the client and our staff during service delivery.
INTERIOR HOME ASSESMENT
Rows
Present?
Details & Notes
Internal/External Stairs
Bedrooms
Bathrooms
Kitchen
Domestic Assistance: If we are to use participants products/equip are the accessible & Safe
Fire Protection: Smoke Alarms? Fire Extinguisher?
Other Risks?
Rows
IDENTIFIED RISK
RISK LEVEL
IDENTIFIED RISK
1
Lvl 1
Lvl 2
Lvl 3
Lvl 4
Lvl 5
Lvl 6
2
Lvl 1
Lvl 2
Lvl 3
Lvl 4
Lvl 5
Lvl 6
3
Lvl 1
Lvl 2
Lvl 3
Lvl 4
Lvl 5
Lvl 6
4
Lvl 1
Lvl 2
Lvl 3
Lvl 4
Lvl 5
Lvl 6
Very Likely:
Could happen any time. Notify Wellways Care Gateway Team Leader immediately. Corrective action should be taken immediately. Cease activity.
Likely:
Could happen sometime. Notify Wellways Carer Gateway Team Leader immediately. Corrective actions should be taken within 48 hours of notification.
Unlikely:
Could happen but very rarely. Notify Wellways Care Gateway Team Leader. Corrective action should be taken within a reasonable time.
Very Unlikely:
Could happen but probable never will. Notify Wellways Carer Gateway Team Leader and review at next assessment.
SIGNATURE OF PERSON COMPLETING RISK ASSESMENT
*
By signing this digital assessment, I declare that I have conducted this risk evaluation accurately and to the best of my knowledge, utilizing direct observation, client consultation, and a review of available history. I confirm that all identified risks—including behavioral, medical, financial, and environmental factors—have been thoroughly documented alongside their necessary control measures. I understand my professional responsibility to implement these safeguards during service delivery and to formally escalate any risks rated 1-3 to management in accordance with Risk Management Policy ACP105 prior to commencing care. I acknowledge that the safety of both AkinCare clients and staff relies on the factual and comprehensive information provided within this document.
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