Environmental Fall Risk Assessment

Site: *

Other Site: *

Community Living Site #: *

Instructions for Use: Overall responsibility to ensure the completion of the environmental checklist lies with the home manager. This is necessary as remedial action may involve major and/or costly modifications to the area or changes in the operational activities within the area.

The checklist should be completed at least annually.

Bathroom & Shower Rooms*

	Yes	No	N/A	Remedial action required to address significant finding
Are floor coverings provided with a non-slip surface?
Are floor coverings free of defects?
Is a system in place to ensure spillages are cleaned up without delay to prevent slippage risks?
Are handrails positioned properly and securely next to toilet, shower and bath?
Are raised toilet seats available which are well fitting and secure?
Are non-slip mats used in bath/shower?
Are receptacles for soap/shampoo easy to reach and do not require user to bend over?
Do all shower chairs have adjustable legs, armrests and rubber stoppers on legs?
Do commode chairs have wheels, castors, brakes that work smoothly and effectively?
Do all shower chairs and commode chairs have seat belts or safety bars?
Is there room for a seat in/near shower?
Is suitable transfer equipment (Hoyer lift, transfer bench, etc.) provided for users?
Is bathroom/shower room free of stored materials that could present a tripping risk?
Is bathroom/shower room door able to be opened/closed easily by user?
Is bathroom/shower room free of a change in floor level?
Is bathroom/shower room provided with adequate lighting?

Passageways/ Hallways*

	Yes	No	N/A	Remedial action required to address significant finding
Are passageway floor coverings a different color from wall coverings?
Are floor coverings in passageways free of defects?
Is a system in place to ensure any spillages are cleaned up without delay?
Are passageways provided with adequate lighting?
Are passageways free of a change of floor level?
Are adequate handrails provided along length of the passageway?
Are passageways wide enough to allow people to pass each other?
Are passageways maintained free of stored materials?
Are all cables positioned so that they do not present a tripping hazard to users?

Dining Area*

	Yes	No	N/A	Remedial action required to address significant finding
Are floor coverings of dining area a different color from wall coverings?
Are floor coverings in dining area free of defects?
Is a system in place to ensure any spillages are cleaned up without delay?
Is the dining area provided with adequate lighting?
Is floor covering in dining area free of change of floor level?
Is dining area maintained free of stored materials?
Are all cables positioned so that they do not present a tripping hazard to users?

Are there stairs or ramps in the building/home?*

YesNo

Stairs & Internal Ramps*

	Yes	No	N/A	Remedial action required to address significant finding
Is the height of the steps the same throughout the whole length of the stair or stairwell?
Are the nosing’s (edge of step) square edged, highly visible and provided with a non-slip finish?
Are steps of stairs free of defects and provided with a non-slip finish?
Are suitable handrails provided on stairs?
Are stairs provided with adequate lighting?
If an internal ramp is provided has it been clearly identified?
Is the floor covering on the ramp free of defects?
Is the slope of the ramp suitable?
Is ramp provided with adequate lighting?
Is ramp provided with suitable handrails?

Is there an elevator/ lift in the building/home?*

YesNo

Elevators/ Lifts*

	Yes	No	N/A	Remedial action required to address significant finding
Is the lift floor covering a different color from the wall coverings?
Is floor covering in lift free of defects and provided with a non-slip finish?
Are suitable handrails provided in lift?
Are call buttons arranged so that they can be easily reached by users?
Does the lift stop level with floor landing?
Is the lift provided with adequate lighting?

Exterior *

	Yes	No	N/A	Remedial action required to address significant finding
Are external footpaths/areas used by residents (e.g. car park) even and free of defects?
Is a system in place to ensure external routes are maintained free of slipping/tripping hazards e.g. falling leaves, moss, uneven paving, pot holes
Is a winter maintenance procedure in place that monitors footpaths/roadways to ensure they remain free of contaminants eg ice?
Are footpaths/roadways free of a change of level that present a tripping hazard?
If a ramp is provided is the slope of the ramp suitable?
If a ramp is provided is the surface free of defects?
If a ramp is provided are suitable handrails provided?
Are external footpaths, roadways and ramp provided with suitable lighting?
Are door mats to remove possible contaminants from feet suitable?

Comments/ Concerns/ Remediation needed or completed:

Completed By: *

First NameLast Name

Title: *

Date*

Date

Email Address: *

example@example.com