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Home Safety Screening

 

 

Any answer marked “No” indicates a home safety risk.

 

 

 

Yes

No

Walkways into home are clear and accessible (stairs).

 

 

 

Adequate lighting (between bed and bath).

 

 

 

All walkways clear, sturdy, and wide enough to walk through safely (rugs, electrical cords).

 

 

 

Frequently used items are placed within reach (kitchen, bathroom, bedroom).

 

 

 

Stove and microwave operating properly.

 

 

 

Fire extinguisher / smoke detector present and working properly.

 

 

 

Bathtub has non-skid surface.

 

 

 

Tap water is 120 degrees or lower.

 

 

 

Medications properly stored and clearly labeled.

 

 

 

Emergency phone numbers easily read and visible. 

 

 

 

 

index_left Telephone: 507-288-0064 FAX: 507-288-3993  Postal address: 2746 Superior Dr. NW, Suite 300, Rochester, MN 55901 Electronic mail: info@sjatherapyservices.com