CURA Work Health & Safety Home Assessment Full Client Name(Required)Client Address(Required)Client Date of Birth(Required) DD slash MM slash YYYY Main EntranceParking and Access(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Home Clearly Accessible(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Gate, door(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Broken Paths, Steps or Uneven(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Driveways/Paths Clear(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)At night pathway/door lit(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Lounge/DiningSmoke Detector(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Adequate Lighting(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Floors Clear of Obstructions(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Floors Walkways even/unbroken(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Obstructions pose tripping hazard(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Cords to be used in good condition(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Sockets/power points, condition(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Client's equipment safe(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Freedom of movement(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Flammable materials near heater(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Emergency Exit(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)KitchenCooking utensils safe(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Utensils Storage(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Floors even, clear of obstructions(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Are floors slip resistant(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Cords pose hazard(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Socket/power points condition(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Food stored properly(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Flammable materials near heat(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Evidence of Vermin/Pests(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Poison, baits or traps(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Stove free of flammable items(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Bathrooms/ToiletsFloors even and slip resistant(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Adequate lighting(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Freedom of movement(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Tripping risk(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Rails, bath secure(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Adequate drainage(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Water temperature(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)BedroomsFlammable materials near heater(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Adequate lighting(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Floors clear of obstructions(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Cords in good condition(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Freedom of movement(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)LaundryFloors even and slip resistant(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Adequate lighting(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Freedom of movement(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Tripping risk(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Adequate ventilation(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Adequate drainage(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Plumbing safe(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Clothes line accessible(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Personal CareHand washing facility(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Risk of cuts or pricks(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Contaminated articles/surfaces(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Blood, faeces or body fluids(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Foreseeable harmPhysically threatened(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Location of workplace a risk?(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Adequate light in workplace(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)History of aggresion(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Resistance to care(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Excessive reaching/stooping(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)EquipmentCleaning materials stored safely(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Individual equipment safe(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Vacuum/sweeper(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Mop/bucket(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Washing machine / dryer / ironing(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Broom(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Food equipment(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)EnvironmentalAdequate ventilation(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Pets(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Manual handling plan required(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Heat/cold exposure(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Firearms/weapons(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)SubstancesLabelled(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)In original container(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Stored safely(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Protective clothing required(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Emergency response known(Required) Safe or not applicable Not Safe If not safe, please explain the hazard or safety concerns(Required)Support Worker Name(Required) First Last Date(Required) DD slash MM slash YYYY Signature(Required)
