This survey is provided as an educational service and is not intended to be exhaustive or certify a residence as safe or unsafe. We advise occupants to seek additional information if questions arise.
OK | Needs Improvement | |
Bathroom | ||
Non-skid mats or decals in tub |
☐ | ☐ |
Stairs (inside and outdoors) | ||
Well-lit | ☐ | ☐ |
Sturdy handrail along length of stairs |
☐ | ☐ |
Bedroom | ||
Phone next to bed (may be by report) |
☐ | ☐ |
General | ||
Secure carpeting on floors and staircases |
☐ | ☐ |
Fire Safety | ||
Smoke detector functional | ☐ | ☐ |
Fire extinguisher (in kitchen or nearby) |
☐ | ☐ |
Child Safety (if applicable) | ||
Plastic plugs in unused electrical outlets | ☐ | ☐ |
Cleaners out of reach or in locked cabinets | ☐ | ☐ |
Medicines out of reach or in locked cabinets | ☐ | ☐ |
Child safety gates installed around hazards | ☐ | ☐ |