Client Home Risk Assessment

Client Risk Assessment

Step 1 of 2

Office Details:
This client risk assessment is to be completed by managers or seniors when inside the client's home.
Date Client Check Completed:*
Date Format: DD dash MM dash YYYY
Home Care Manager:*
Senior Carer Completing Check:*
Client Details:
Client's Name:*
First Last
Client's Date of Birth:*
Date Format: DD slash MM slash YYYY

To be used as a unique identifier for the client - will be listed in their careplan.
Risk Assessments
How do carers gain access to client's home?
IE: Keypad or does the client let the carers in?
Does the client have Tiled/Carpet/Wooden floors or any mats within the home where we deliver care? detail here.*
Does the outside of the client's home have sufficient lighting for carers entering and leaving the home?
Detail if there is any potential tripping hazards or concerns on how carers have to enter the clients home.*
For example - steep steps to climb before gaining access. If none state no potential hazards.
1. Fire Safety/Risk Assessment
Is the client aged 60 or over?*
Have a disability or impaired mobility?*
either unable to walk or difficulty in walking for example in a wheelchair or requires a hoist for moving and handling.
Have a health condition that would impact upon their ability to acknowledge or respond to an emergency within the home?*
Such as a hearing or sight issue or suffers from a form of dementia.
Do they have a working smoke alarm in the house?*
either check or ask the client if they have a working smoke alarm fitted.
Detail:*
Detail above if there is any evidence or History of fires Client not careful with smoking materials Scorch marks on bedding, clothing and/or carpets Client Leaving cooking unattended Large quantities of loose papers/stored/hoarded items in rooms Use of candles unguarded/close to combustible materials.
Decision to refer to Northern Ireland Fire & Rescue Service?*
- Yes
- No
2. Internal risk assessment
Area Internal*
Detail the internal areas for example Hallways /Passageways, Rooms within the home where care is delivered.
Potential Hazards*
Where are the potential hazards such as obstruction/Mats/Tripping etc..
Risk*
Where is there potential risk for example Upstairs carpet,etc..
Potential risk to:*
who is the potential risk to for example is it the Care Staff/Client or both.

Save and Continue Later

Does the client have equipment in their home?*
- Yes
- No
Detail all equipment in client's home
Equipment Checked Date Due Maintenance on

enter each equipment item in the text box above - then click the plus button to add more.
Is the equipment maintained and checked?*
- Yes
- No
3. Client Movement Assessment/Mobility Assessment
detail below the movement of the client and whether its Unaided or with an aid? What Aid /Equipment? With Supervision? With support 1 or 2 persons?
Movement - Walking*
Movement - Washing*
Movement - Chair to standing*
Movement - Transfers Chair to bed, Bed to chair, Chair to toilet/commode*
Movement - Bed to standing*
Movement - Rolling bed*
Movement - Positioning in bed*
Movement - Wheelchair Transfers*
Client Name
First Last
Clients Signature*
please draw your signature like you would on a piece of paper in the box above. If client unable to sign please put an X above as the person completing the form.
Senior's Name*
First Last
Senior Carer Completing Form Signature:*
please draw your signature like you would on a piece of paper in the box above.

Save and Continue Later

Client Risk Assessment

Step 1 of 2

Office Details:

Client Details:

Risk Assessments

1. Fire Safety/Risk Assessment

2. Internal risk assessment

3. Client Movement Assessment/Mobility Assessment

Lydian Care

Lydian Healthcare

Lydian Temps

Equipment	Checked Date	Due Maintenance on

Client Home Risk Assessment

Client Risk Assessment

Step 1 of 2

Office Details:

Client Details:

Risk Assessments

1. Fire Safety/Risk Assessment

2. Internal risk assessment

3. Client Movement Assessment/Mobility Assessment

Lydian Care

Lydian Healthcare

Lydian Temps

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