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Home Safety Checklist

Client(s) Present
Address of Home
Date Competed

Item	Status	Plan	Follow Up
The yard is free of broken glass, trash, debris, and animal feces	Select Yes No N/A
Walkways are free of debris and in good repair	Select Yes No N/A
Entrance is free of clutter and debris	Select Yes No N/A
Trash is kept in covered containers and/or bagged	Select Yes No N/A
Screen doors have guards and/or locks	Select Yes No N/A
Doors have locks (out of reach of children, age dependent)	Select Yes No N/A
There are 2 easily accessible exits (at least 1 door and 1 window) free of debris in separate parts of the home	Select Yes No N/A
Safety gates at top/bottom of stairs	Select Yes No N/A
Basement doors are locked (or have safety gate)	Select Yes No N/A
Space heaters are out of reach of children, and are not near furniture, curtains, or trash cans	Select Yes No N/A
The fireplace has a cover	Select Yes No N/A
The second floor has a window ladder for escape and/or plan of escape from 2nd story	Select Yes No N/A
Family has emergency plans for fires that includes a meeting spot	Select Yes No N/A
Family has an emergency plan for tornados	Select Yes No N/A
Home has operational smoke/CO detectors on every level	Select Yes No N/A
Emergency phone numbers are posted in/near the phone; children know 911	Select Yes No N/A
Lighters/matches/ashtrays are kept out of reach of children	Select Yes No N/A
Has a fire extinguisher and is out of reach of children	Select Yes No N/A
Windows are not broken or boarded	Select Yes No N/A
Opening windows have screens	Select Yes No N/A
Blind and drapery cords are secured and out of reach	Select Yes No N/A
Windows are not opened more than 4 inches or have guards	Select Yes No N/A
Hallways and stairways are well lit	Select Yes No N/A
Unused outlets have outlet covers or are inaccessible to small children	Select Yes No N/A
Outlets and cords are not overloaded	Select Yes No N/A
Electrical cords are in good condition and are kept out of reach of children	Select Yes No N/A
Home has a heat source	Select Yes No N/A
Home has ventilation (air conditioning or windows that can open)	Select Yes No N/A
Fans have guards and are out of reach of children	Select Yes No N/A
All medications have child-proof lids and are out of reach of children	Select Yes No N/A
All purses are out of reach of children	Select Yes No N/A
Houseplants are kept out of reach of small children	Select Yes No N/A
Houses build before 1978 are tested for lead	Select Yes No N/A
Home has running water or access to water	Select Yes No N/A
Basement is free of debris or standing water	Select Yes No N/A
There is a working toilet (or outhouse as appropriate)	Select Yes No N/A
There is hot water (under 120° F) or a means to heat it	Select Yes No N/A
Infants and toddlers are not left in tubs/pools/bathrooms unsupervised	Select Yes No N/A
Heavy appliances are on a broad basis to avoid tipping	Select Yes No N/A
Scissors, knives and other sharp objects are kept out of reach of children	Select Yes No N/A
Hot pans are kept to the back of the stove and handles turn to the side	Select Yes No N/A
All cleaning products are stored in locked cabinets or out of children’s reach	Select Yes No N/A
Tools are stored in locked areas or kept out of children’s reach	Select Yes No N/A
Safe sleeping practices are used for infants/toddlers	Select Yes No N/A
All children have their own appropriate sleeping space	Select Yes No N/A
Sleepwear and bedding are seasonally and age appropriate	Select Yes No N/A
No bumper pads, pillows, soft bedding or stuffed animals in crib	Select Yes No N/A
Toys are age appropriate	Select Yes No N/A
Toys are checked for loose parts, sharp edges, or small parts – broke toys are thrown away	Select Yes No N/A
Car seats are age/weight appropriate and installed correctly	Select Yes No N/A
Infants/children are not left unattended in vehicles, especially in warmer weather	Select Yes No N/A
Litter boxes/ cages are out of reach of children	Select Yes No N/A
If animals are kept indoors, floors are free of feces	Select Yes No N/A
Home is free of pests (rodents/bugs)	Select Yes No N/A
There is a three-day food supply in the home	Select Yes No N/A
Home is free of structural concerns and other health hazards	Select Yes No N/A
Breakable items are kept out of reach of children	Select Yes No N/A
Guns have locks or stored in locked cabinets. Ammunition is stored separately and out of the reach of children	Select Yes No N/A
Floors are free of small debris which can be placed in toddler’s mouth	Select Yes No N/A
Food given to children are cut into small non-choke able pieces	Select Yes No N/A
Infants are not left alone on changing tables, beds, sofas, or chairs	Select Yes No N/A
Parents keep hot liquids out of reach of children and do not hold children while carrying hot liquids	Select Yes No N/A
Check frequently for product recalls on toys, food, furniture, etc.	Select Yes No N/A

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