Community Health Nursing Practicum
Home Safety Assessment
Student: ____________________
Date:_______________________
Assigned Agency:______________
Safety Hazard Yes No
- Are medications safely stored and adequately labeled? ___ ___
- Are throw rugs, area rugs, and flooring materials secured? ___ ___
- Is there adequate lighting in each room? ___ ___
- Are there telephone cords or electrical cords in walkways? ___ ___
- Do the entry doors locks with deadbolts? ___ ___
- Are combustibles, such as newspapers, stored ___ ___
at least three feet from stove, fireplace or heater?
- Is there adequate space around space heaters? ___ ___
- Are there exposed heating pipes? ___ ___
- Is the room/house heated cooled adequately and safely? ___ ___
- Is water heater set at 120F or lower?
- Is there a portable fire extinguisher available in the kitchen? ___ ___
- Do occupants who are smokers demonstrate safe handling
of cigarettes, lighters and matches? ___ ___
- Does the gas at the stove, furnace , and space heater work properly? ___ ___
- Are walkways clear, sturdy and wide enough to walk safely (using assistive devices
if necessary)? ___ ___
- If burglar bars are present on doors and/or windows, will they bend for
Emergency exit or is the key close by? ___ ___
- Is there a phone within easy reach? ___ ___
- Is there a working smoke detector near the kitchen and near each sleeping area? ___ ___
- Dos the bathtub have a non-skid surface? ___ ___
- If oxygen is in use in the hours, are all occupants aware of oxygen and cord safety? ___ ___
- Are all occupants able to safely exit the home in five minutes or less? ___ ___
- Are guns or weapons safely stored? ___ ___
- Are there secure handrails on stairs? ___ ___
- If a ramp is needed, is one present and safely constructed? ___ ___
Sanitation Hazards
- Is there indoor running water? ___ ___
- Is food stored properly? ___ ___
- Are there indoor toilet facilities? ___ ___
- Do the stove and/or microwave operate properly? ___ ___
- Is trash picked up on a regular scheduled basis? ___ ___
- Is the water in the kitchen, bathroom and utility are working properly
each room? ___ ___
- Are there signs of rodent or pest infestation? ___ ___
- Is there adequate refrigeration? ___ ___
- 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?