Free Home Safety Assessment Form

Use this quick assessment form to evaluate the safety of your home and identify any areas needing improvement.
Personal Details
Name
Address
Phone Number
Safety Checklist
1. Smoke Alarms
Installed and Working
Batteries Checked Regularly
Positioned in Key Areas (e.g., kitchen, bedrooms)
Not Covered or Blocked
2. Fire Extinguisher
Accessible and Up to Date
Located in Key Areas (e.g., kitchen, garage)
Instructions for Use are Visible
Free of Damage or Corrosion
3. Electrical Safety
Cords and Wires in Good Condition
Circuit Breakers Accessible and Labeled
Outlets Not Overloaded
Unused Outlets Covered (if children are present)
4. Kitchen Safety
Knives Stored Safely
Stove and Appliances Turned Off When Not in Use
Hazardous Materials Kept Away from Heat Sources
Fire Blanket or Fire Extinguisher in Kitchen
Cooking Area Free of Flammable Items
5. Emergency Exits
Clear and Unobstructed
Exit Doors Can Be Opened Easily
Emergency Evacuation Plan Displayed
Flashlights Available Near Exits
6. Lighting and Pathways
Sufficient Lighting in Staircases and Halls
Walkways Free from Clutter and Tripping Hazards
Outdoor Pathways Well-Lit
Stairs Equipped with Secure Handrails
7. First Aid Kit
Complete and Easily Accessible
Includes Essential Items (bandages, antiseptics, etc.)
Regularly Restocked and Checked for Expired Items
Emergency Contact Numbers Included
Action Items
Write any issues or hazards identified.
Home Safety Rating Scale
Rate the overall safety of your home.
Assessment Form Templates @ Template.net
- 100% Customizable, free editor
- Access 1 Million+ Templates, photo’s & graphics
- Download or share as a template
- Click and replace photos, graphics, text, backgrounds
- Resize, crop, AI write & more
- Access advanced editor
Ensure a safe environment for innovation with our Home Safety Assessment Form Template, available on Template.net. This fully customizable tool is tailored for professionals, offering easy integration into your safety protocols. With editable features in our Ai Editor Tool, streamline your assessments efficiently. Enhance your startup’s safety measures today, safeguarding your projects and peace of mind.