Community Health Nursing Practicum

Community Health Nursing Practicum

Home Safety Assessment

Student: ____________________
Date:_______________________

Assigned Agency:______________

 

Safety Hazard                                                                                                                                         Yes                          No

 

1. Are medications safely stored and adequately labeled? ___                            ___
2. Are throw rugs, area rugs, and flooring materials secured? ___                          ___
3. Is there adequate lighting in each room? ___                          ___
4. Are there telephone cords or electrical cords in walkways? ___                          ___
5. Do the entry doors locks with deadbolts? ___                          ___
6. Are combustibles, such as newspapers, stored ___                          ___

at least three feet from stove, fireplace or heater?

7. Is there adequate space around space heaters? ___                          ___
8. Are there exposed heating pipes? ___                          ___
9. Is the room/house heated cooled adequately and safely? ___                          ___
10. Is water heater set at 120F or lower?
11. Is there a portable fire extinguisher available in the kitchen? ___                          ___
12. Do occupants who are smokers demonstrate safe handling

of cigarettes, lighters and matches?                                                                                     ___                          ___

13. Does the gas at the stove, furnace , and space heater work properly? ___                          ___
14. Are walkways clear, sturdy and wide enough to walk safely (using assistive devices

if necessary)?                                                                                                                         ___                          ___

15. If burglar bars are present on doors and/or windows, will they bend for

Emergency exit or is the key close by?                                                                                  ___                          ___

16. Is there a phone within easy reach? ___                          ___
17. Is there a working smoke detector near the kitchen and near each sleeping area? ___                          ___
18. Dos the bathtub have a non-skid surface?                                 ___                          ___
19. If oxygen is in use in the hours, are all occupants aware of oxygen and cord safety? ___                          ___
20. Are all occupants able to safely exit the home in five minutes or less? ___                          ___
21. Are guns or weapons safely stored? ___                          ___
22. Are there secure handrails on stairs? ___                          ___
23. If a ramp is needed, is one present and safely constructed? ___                          ___

 

 

Sanitation Hazards

1. Is there indoor running water? ___                          ___
2. Is food stored properly? ___                          ___
3. Are there indoor toilet facilities? ___                          ___
4. Do the stove and/or microwave operate properly? ___                          ___
5. Is trash picked up on a regular scheduled basis? ___                          ___
6. Is the water in the kitchen, bathroom and utility are working properly

each room?                                                                                                                             ___                          ___

7. Are there signs of rodent or pest infestation? ___                          ___
8. Is there adequate refrigeration? ___                          ___
9. Comments:

 

 

 

 

 

 

 

 

 

Modifications recommended after your assessment_____________________________________________________________

 

 

 

 

 

 

 

 

 

 

What surprised you when doing your home safety assessment?

 

 

 

 

 

 

 

Why are home safety assessments important for a public health nurse to know and do?

 

 

 

 

 

 

What kind of teaching/topics can you see would be important for a public health nurse to do as a result of a home safety assessment?