Home Safety Assessment Form

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

        Email

          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