Home Assessment Checklist

8/7/2019 Home Assessment Checklist

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HOME ASSESSMENT CHECKLIST

Name: Maryanne Chua

Address:

Diagnosis: Visually Impaired in both eyes Corneoscleral Laceration

Mobility Status : No ambulatory device

ENTRANCE

Steps Number 1

Height 5

Width N.A.

Length 32

Handrails? Y / N

If Y, where are they located? ____________N.A.____________________________________

If N, how much room is available f or handrails? ______________N.A._________________

Light level at entrance? Minimal, may consider installing doorway light

Note ability to use knob, lock, key, mailbox, peephole.

Searches for correct keys, require adaptive devices for easier identification of keys.

Are the locks secure? (Y/N)

_________________________________________________________________________________

LIVING ROOM

Is furniture arranged for easy maneuverability? ( Y / N )

Is frequently used furniture accessible? ( Y / N )

Type of floor covering: Marble, glare from windows

Lighting? Yellow light used

Comments:


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y Needs to shift furniture to increase maneuverabilityy Change lightingy Glare from window install window blinds

HALLWAYS

Is there widen and clear pathways? ( Y / N )

Hallway path width __________________

Hallway path length __________________

Sharp turns? ( Y / N )

Steps? ( Y / N )

Handrails? (Y / N )

If Y, where are they located? ______________________N.A.___________________________

Lightings? Yellow Lightings used

Clutter Free? Yes, but narrow walkway

Comments:

y Change yellow lightingsy Night lights may be needed to light up pathway to kitchen at nighty Needs to move furniture to increase walkway space

BEDROOM (MARYANNES ROOM)

Is the bed room single or shared? Single

Door width: 31

Bed:

Width 38

Length 81

Height 21.5

Lighting: White lights

Do rugs have no-slip pad or rug-tape? (Y / N)

Able to reach for phone from bed?( Y / N )

Indicated on floor plan.


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Able to switch on lights from bed? ( Y / N )

Pathway clear of clutter? (Y / N )

Cord Hazards? (Y / N)

Comments:

y Chord hazard from standing fany Narrow walkway from bed to toilet (measurements in floor plan)y Install night lightsy Glare from window install window blindsy Light switch should be available from bedy Optic device not easily reachable from table to bed.

BEDROOM (CARRIES ROOM)

Is the bed room single or shared? Single

Door width: 31

Bed:

Width 38

Length 81

Height 21.5

Lighting: White lights

Do rugs have no-slip pad or rug-tape? (Y / N) N.A-

Able to reach for phone from bed?( Y / N )

Able to switch on lights from bed? ( Y / N )

Pathway clear of clutter? (Y / N )

Cord Hazards? (Y / N)

Comments:

y Chord hazard from standing fan and recording sety Narrow walkway from bed to toilet (measurements in floor plan)y Install night lights from bedroom to dining areay Glare from window install window blindsy Light switch should be available from bed


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TOILET (MASTER ROOM)

Door width 31

Steps? ( Y / N )

Width 2

Length 18.5

Height 3

Shower / Bathtub? Shower

Tub:

Height, floor-rim _____N.A._______

Height, tub bottom rim _____N.A._______

Tub width inside _____N.A._______

Shower space:

Door type? Sliding Door

Door width 16

Door Height 73

Width 31

Length 31

Sink:

Height 33

Faucet Type Disc type (refer to appendix)

Accessible? ( Y / N )

Grab bars? (Y / N )

Location of Grab bars? ____________________________N.A._________________________

Location of toilet roll? Right infront of toilet bowl. Within reach.

Appropriate mirror height? (Y / N )


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Flooring:

Non-slip flooring? ( Y / N )

Lighting? Yellow lightings

Clutter free? Yes

Comments:

y Lightings need to be changedTOILET (KITCHEN)

Door width 34

Steps? ( Y / N )

Width 3

Length 34

Height 3

Shower / Bathtub? Shower

Tub:

Height, floor-rim _____N.A._______

Height, tub bottom rim _____N.A._______

Tub width inside _____N.A._______

Shower space:

Door type? Sliding Door

Door width 25

Door Height 70

Width 24

Length 53


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Additional step into shower area

Width 3

Length 53

Height 2

Sink:

Height 34

Faucet Type Disc type (refer to appendix)


Grab bars? (Y / N )

Location of Grab bars? ____________________________N.A._________________________

Location of toilet roll? Outside shower area

Appropriate mirror height? (Y / N )


Flooring:

Non-slip flooring? ( Y / N )

Lighting? Yellow lightings

Clutter free? Yes

Comments:

y Lightings need to be changedy Toilet roll dispenser cannot be rel ocated within shower area because it is wet.

Client will have to take needed toilet paper before going into the shower

area.

y Client need organizational techniques to differentiate facial products fromhand soaps etc.


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KITCHEN

Steps? ( Y / N )

Length 34

Height 3

Door

Width 34

Height 80

Stove

Width 29

Height 32

Is stove accessible for use? ( Y / N )

Sink

Type Disc Type

Cupboards Locations?

Below counter tops

Refrigerator

Hinges from []Left []Right

Switches / Outlets


Lighting? White lights

Clutter free? ( Y / N )

Comments:

y Button switch for the kitchen are located together with light switches for thedining area and kitchen toilet. Client is confused which buttons to press.

LAUNDRY

Clothesline type? Overhead, needs to be lowered by pulling on string


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Accessible? yes

Location? Outside kitchen toilet (refer to appendix)

Washer

[]Topload [] Front load


Comments:

y Overhead hanging clothesline is difficult for client to use. Other alternatives tobe suggested.

OTHERS

y Emergency phone list ( Y / N )Comments: Larger size prints and pasted in every room near the telephone

y PhonesAccessible? ( Y / N )

Comments: Phones are accessible but may need to change to bigger button

phones for easier usage.

y Medicine/First aid box? (Y / N )y Comments: Kept in the cupboard at the dinning area.

Documents

Home Assessment Checklist