Environmental Risk Assessment
NDIS Participant?
*
Yes
No
Unsure
Participant/ Client's Name
*
Participant/ Client's Address
Street address
Street address line 2
City
State
Please select
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
Country
Please select
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Boorn Assessor's Name
Boorn Assessor's Email Address
Boorn Employee attending the home as support worker's name? (if different from assessor)
Boorn Support Worker attending the home has access to mobile calls and internet?
Yes
No
Boorn Support Worker has access to safe transport, that is insured?
Yes
No
Boorn Support Worker has valid driver's license?
Yes
No
Does the participant consent to the home visit?
Yes
No
Has this risk assessment been completed with the participant and/or carer?
Yes
No
Type of residence
House
Unit
Private Rental
Specialist Disability Accommodation
Office Housing
Caravan Park
Home Assessment
Access
Hazard Identified (details)
1. Is there difficulty finding the property or number?
Safe
Unsafe
1.
2. Ample and Safe Parking- Is there difficulty or a distance to a car park?
Safe
Unsafe
2.
3. Gated Access, is the gate difficult to open/ other access available?
Safe
Unsafe
3.
4. Pets, are there any animals with open access to the front of the property?
Safe
Unsafe
4.
5. Driveways/pathways e.g. shared driveway?
Safe
Unsafe
5.
6. Gardens and lawn?
Safe
Unsafe
6.
7. Steps and railings?
Safe
Unsafe
7.
8. Entryway/doorway?
Safe
Unsafe
8.
9. Is there a Key safe, doorbell or knocker?
Safe
Unsafe
9.
10. Is the participant able to open the door?
Safe
Unsafe
10.
11. Is there difficulty with mobile phone reception and/or working land line?
Safe
Unsafe
11.
12. Floor Surface?
Safe
Unsafe
12.
13. Rugs/carpet (free of curled edges)?
Safe
Unsafe
13.
14. Sufficient Space around furniture?
Safe
Unsafe
14.
15. Temperature?
Safe
Unsafe
15.
16. Aids/equipment (accessible and working)?
Safe
Unsafe
16.
17. Ease of exit?
Safe
Unsafe
17.
18. Is there adequate lighting inside?
Safe
Unsafe
18.
19. Are there any fire hazards?
Safe
Unsafe
19.
20. Are smoke detectors present and maintained?
Safe
Unsafe
20.
21. Are there any known infectious illnesses in the house? E.g. Covid-19, Gastro, Measles, chicken pox
Safe
Unsafe
21.
22. Walkways free of clutter?
Safe
Unsafe
22.
23. Stairwell safe and free of clutter?
Safe
Unsafe
23.
24. Environment is free from vermin and insects?
Safe
Unsafe
24.
25. Are there any other occupants or visitors likely to be present during home visits?
*
Safe
Unsafe
25.
*
26. Does anyone in the home smoke?
Safe
Unsafe
26.
27. Does the client or others in the home have mobility issues?
Safe
Unsafe
27.
28. Are there any particular religious or cultural sensitivities to be are of?
Safe
Unsafe
28.
29. Is there anyone in the home likely to be alcohol or drug affected?
Safe
Unsafe
29.
Details of Corrective Action
If urgent do not commence work until environment is safe and contact your NDIS Supervisor.
Final Comments
Date Assessment Occurred
Signature
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