Take a walk around where you currently live. Complete the attached home safety checklist. Could you age in place in your current housing? Based on what you have learned this week, what modifications or services would be needed for you to remain in your current housing? 

HOW TO USE HSSAT CHECKLIST TO IDENTIFY HOME HAZARDS TO

PREVENT FALLS

Use the checklist to find and correct/fix the hazards for every room/area in your home that might
cause you to trip or fall.

All items are potential risks for falls but if a wheelchair is not used, some
items may not apply. For an expedited evaluation, access only places that you use frequently.

Steps to use the checklist

Step 1:

Go to each room/area of your home with this checklist; look for the hazards/items that are listed
below the picture on each page (Some items may not relate to your home).

Step 2:

If the problem is present in your room/area, check off the appropriate box. After checking all the
problems, add them and write the total in the big box (Each item that gets a checkmark is a
potential hazard).

Step 3:

Then go through the solutions and take the necessary action to fix those problems that are a
potential hazard. Make sure that you look at assistive devices and helpful products that are
indicated in the solutions section. Having them can make your home safer.

Step 4:

Add the total number of hazards in all the rooms/areas to get a grand total.

Step 5:

Write down what actions you are planning to take or have already taken to prevent falls in the

Action Log for your records.

Step 6:

It may be a good idea to ask your family and friends for a home safety modification or an assistive

device for your birthday or holiday present. Also, talk with your friends about home safety. It can be

a great gift for them to know how to prevent future falls.

3

Entrance to Front Door and Front Yard

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below.

1. Lack of railings or unstable railing 5. Lack of a ramp for a wheelchair

2. Unsafe steps (too steep/cracked) 6. Uneven/cracked pavement

3. Unmarked or raised threshold 7. Ice or snow on driveway/walkway

4. Lack of lighting at night 8. Lack of an outdoor grab bar

Other__________________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page

Solutions for the Problems

in Entrance to Front Door and Front Yard

1. Lack of railings or unstable railing

Add at least one railing, ideally one on each wall. (See page 24, item 1)
Have unstable railing stabilized.

2. Unsafe steps (too steep, cracked, chipped, etc.)

Have damaged or broken steps repaired.

3. Unmarked or raised threshold

Mark end of steps or thresholds with contrasting tape or paint color to increase
awareness of changes in height. (See page 24, item 2)

4. Lack of lighting at night

Add an outdoor light fixture if not present.
Add a sensor light that automatically turns on and off. (See page 24, item 3)

5. Lack of a ramp for a wheelchair

Have a remodeler or home contractor construct a ramp that will allow wheelchair
access in and out of the home. (See page 25, item 4)

6. Unsafe pavement (uneven or cracked)

Have uneven or cracked pavement repaired.
Avoid these areas if possible when walking to and from the home.
You may contact local government for repair if it is a sidewalk or driveway end.

7. Ice or snow on driveway or walkway

Use snow melter.
Have snow/ice removed by a neighbor or service. (See page 25, item 5)

8. Lack of an outdoor grab bar

Add an outdoor grab bar next to the door. (See page 25, item 6 & page 35, item 1)

For information on additional devices, see page 31, item 33.

Entrance to Back/Side Door

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below

1. Lack of railings or unstable railing 5. Lack of a ramp for a wheelchair

2. Unsafe steps (too steep/cracked/chipped) 6. Uneven/cracked pavement

3. Unmarked or raised threshold 7. Ice or snow walkway

4. Lack of lighting at night 8. Lack of a outdoor grab bar

Other__________________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page

Solutions for the Problems
Entrance to Back/Side Door
1. Lack of railings or unstable railing

Add at least one railing, ideally one on each wall. (See page 24, item 1)
Have unstable railing stabilized.

2. Unsafe steps (too steep, cracked, chipped, etc.)

Have damaged or broken steps repaired.

3. Unmarked or raised threshold

Mark end of steps or thresholds with contrasting tape or paint color to increase
awareness of changes in height. (See page 24, item 2)

4. Lack of lighting at night

Add an outdoor light fixture if not present.
Add a sensor light that automatically turns on and off. (See page 24, item 3)

5. Lack of a ramp for a wheelchair

Have a remodeler or home contractor construct a ramp that will allow wheelchair
access in and out of the home. (See page 25, item 4)

6. Unsafe pavement (uneven or cracked)

Have uneven or cracked pavement repaired.
Avoid these areas if possible when walking to and from the home.
Contact local government for repair if it is a sidewalk or driveway end.

7. Ice or snow on walkway

Use snow melter.
Have snow/ice removed by a neighbor or service. (See page 25, item 5)

8. Lack of an outdoor grab bar

Add grab bar next to the door. (See page 25, item 6)

Hallway or Foyer

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below.

1. Uneven or slippery flooring 3. Dark or poor lighting

2. Cluttered area 4. Lack of access to ceiling light

Other_______________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page

Solutions for the Problems

in Hallway or Foyer

1. Unsafe flooring (slippery, uneven carpeting, etc.)

Make sure floor surfaces are dry.
If you have a carpet, make sure that the patterns are not too busy.
Have carpet stretched or removed to eliminate wrinkles or bumps.
Add a carpet runner to slippery hallways or foyers and secure to the floor.

(See page 28, item 17)

2. Cluttered area

Eliminate clutter on floors by removing and/or organizing items.
Example: shoe tray, hooks for umbrella.

3. Dark or poor lighting

Increase wattage to allowable limits in lights.
Add additional overhead or wall lighting.

4. Lack of access to ceiling light

Ask another person to change the light.
Add removable wall lights to poorly lit areas. (See page 25, item 7)

Living Room

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below.

1. Presence of throw or scatter rug 5. Presence of unstable furniture

2. Presence of clutter 6. Presence of unstable chair

3. Presence of electric cords across the floor 7. Difficult to access light switches

4. Poor lighting 8. Not enough space to move around

Other_______________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page.

Solutions for the Problems in Living Room

1. Presence of throw or scatter rug (See page 26, item 8)

Remove a scatter rug or use a double sided rug tape or a rug pad to secure the rug
to the floor.

2. Presence of clutter

Eliminate clutter on floor surfaces by placing items on shelves or storage.

Consider donating or throwing out the items you no longer use.
Avoid carpets with confusing patterns.

3. Presence of electric cords across the floor

Run your cords behind furnishings. Use extension cords to accomplish this.

Rearrange items that must be plugged in to areas near an outlet.
(See page 26, item 9 & page 38, item 7)

4. Poor lighting

Increase wattage to allowable limits in lamps/lights.

Add additional lamps or wall/overhead lights. (See page 36, item 4)

5. Presence of unstable furniture (chair, table, etc.)

Place a block under the shorter leg.

If the chair or table is broken, have it repaired or replaced.

6. Presence of unsafe chair (too low, too high, without arms)

If the chair is too low, add a furniture leg riser to raise the height.

A chair that is too high or without arms should not be used, as it will not provide
you with sufficient stability to get in and out of the chair. (See page 26, item 10)

7. Difficult to access light switches

Add “clapper” light switch control to lamps. There are other remote control switching
options for operating the lights.
Rearrange furnishings to allow quick access to wall switch or lamps.

8. Not enough space to move around

Remove clutter or excess furniture that prevent you from moving around the
room easily.

Some items may be rearranged, but you may want to donate or throw out
other items you don’t really need or use.

For information on additional device, see page 26, item 11

Kitchen

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below

1. Cabinet too high or low 5. Presence of throw/ scatter rug

2. Not enough counter space 6. Presence of slippery floor

3. Using a stool or a chair to reach things 7. Poor lighting

4. Not enough room to maneuver 8. Presence of a pet underfoot when
preparing meals

Other________________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page

Solutions for the Problems in Kitchen

1. Cabinet too high or too low

Move items to the shelves closest to the counter.
Add hooks to the wall for pots and pans you use frequently.

2. Not enough counter space

Make sure available counter space is cleared of clutter. Use Lazy Susan.
(See page 27, item 14)

Move kitchen table closer to counter for additional work space.
Use a rolling cart for added work space.

3. Using a stool to a chair to reach things

Move items to lower shelves.
Replace the stool with a sturdy step ladder. (See page 27, item 12)

4. Not enough room to maneuver

Eliminate clutter or excessive furniture (extra kitchen chairs, etc.) to add space.
Remove a leaf from the table and push it closer to the wall.

5. Presence of a throw/scatter rug

Remove a scatter rug or use a double sided rug tape or a rug pad to secure the
rug to the floor. (See page 26, item 8)

6. Presence of slippery floor

Do not walk on a wet floor.
Wear comfortable and fit shoes or socks with a non-skid sole.
(See page 27, item 13)
Change flooring surface to one that is less slippery.

7. Poor lighting

Increase wattage of bulbs to allowable level.
Add under counter lighting.
Add additional overhead lighting.

8. Presence of a pet underfoot when preparing meals

Remove the pet from the kitchen while cooking and add a pet gate to the entry
ways of the kitchen. (See page 27, item 15)
Put the pet outside or in a crate.

For information on additional device, See page 28, item 16

Bedroom

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below

1. Presence of clutter 6. Lack of a telephone near the bed

2. Presence of electric cords across the floor 7. Lack of nightlight

3. Unsafe carpet (uneven, torn, curled up) 8. Arrangement that causes difficulty
reaching items (TV remote, lamp)
4. Presence of throw/scatter rug 9. Lack of device to get in/out of bed

5. Height of bed (too low/high)

Other _________________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page

Solutions for the Problems In Bedroom

1. Presence of clutter

Eliminate clutter on floor surfaces by placing items on shelves or storage.

Consider donating or throwing out the items you no longer use.

2. Presence of electric cords across the floor (See page 26, item 9)

Run your cords behind furnishings. Use extension cords to accomplish this.

Rearrange items that must be plugged in to areas near an outlet.

3. Unsafe carpet (uneven, torn, curled up, etc.) (See page 28, item 17)

Have carpet stretched or removed to eliminate wrinkles or bumps.

4. Presence of throw/scatter rug (See page 26, item 8)

Remove all scatter and throw rugs or use a double sided rug tape or a rug pad to

secure the rug to the floor.

5. Height of bed (too high or low) (See page 26, item 10)

Too low (your knees are above the hips when sitting a the edge of the bed) : Use
bed risers below bed legs to raise height.
Too high (your legs do not touch the floor when sitting at the edge of the bed):
Remove bed frame or use a lower profile mattress or box spring.

6. Lack of a telephone near the bed (See page 28, item 18)

Place a cordless type or cell phone next to your bed at night or during naps.
Use a remote control for TV and VCR. (See page 26, item 19)

7. Lack of a nightlight (See page 25, item 7)

Place at least two nightlights in the bedroom to illuminate the room at night.
Add additional nightlights along the hall or path to the bathroom. Also add one
nightlight in the bathroom.

8. Arrangement that causes difficulty to reach commonly used items such as

a TV remote, medications, lamp, glasses, magnifier, etc. at night

Place these items on your bedside table. If you don’t have a table, you may put
a rolling cart or shelving unit next to the bed.

9. Lack of a device to help get in and out the bed (See page 29, item 20)

Purchase a half bedrail or a bed cane that can slide between mattress and box spring.

Bathroom

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below

1. Presence of unsafe bath rugs 6. Slippery tub (lack of bath mat, etc.)

2. Lack of grab bars in the tub 7. Claw foot/tub that is high to get into

3. Lack of grab bars in the shower area 8. Lack of bath chair in the shower area

4. Lack of grab bars near the toilet 9. Clutter

5. Toilet is too high or low 10. Incorrect placement of grab bars

Other ____________________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page

Solutions for the Problems in Bathroom

1. Presence of unsafe bath rugs.

Use a bath rug with non-skid bottom.

2. Lack of grab bars in the tub (See page 29, item 21)

Add a bath grab bar on the wall or a clamp-on grab bar to the tub.

3. Lack of grab bars in the shower area

Add grab bars to the wall near the shower and on the wall where the bath faucets are.

4. Lack of grab bars near the toilet (See page 29, item 22)

Add a grab bar on the wall next to the toilet or toilet safety grab bars that attach at the
toilet seat screws.

5. Toilet is too high or too low (See page 29, item 23)

Add a raised toilet seat for seats that are too low.
Consider a lower profile toilet if it is too high.

6. Slippery tub (lack of bath mat, etc.) (See page 30, item 24)

Add a rubber bath mat or adhesive non-skid decals to the bottom of the tub.

7. Claw foot or other type of tub that is too high to get into easily

Add a tub transfer bench to slide into the tub area or replace with a lower tub.

8. Lack of bath chair in the tub or shower area or tub transfer bench

Add a bath chair along with grab bars to the tub or shower area. A tub transfer
bench is helpful if you have difficulty stepping into the tub area, because you
can sit and slide over into the tub area.

9. Clutter
Remove clutter from all floor areas to drawers or closets. Inexpensive plastic
cabinets or rolling units can be purchased to store bath items.

10. Incorrect placement of grab bars

If permanently installed, hire a qualified professional to change the grab bars to
the correct location and angle.

* See page 30 items 25 & 26 and page 31, item 31

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below

.

1. Poor or lack of lighting 4. Steps too steep

2. Lack of railings 5. Slippery steps without tread/ carpet

3. Clutter

Other_________________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page.

Staircases

Solutions for the Problems

in Staircases

1. Lack of or poor lighting (See page 31, item 30)

Increase wattage to allowable limits in lights.
Add additional overhead or wall lighting.

2. Lack of railings (See page 30 & 31, items 27 & 28, & page 40, item 11)

Add at least one railing the entire length of the wall, ideally one on each side.

3. Clutter (See page 42, item 16)

Eliminate clutter on floors by removing and/or organizing items in areas near the
stairs.

4. Steps too steep

Use railings for stability.
Walk slowly up and down stairs with lights on.
Have others carry heavy or large items up or down the stairs.
Reduce daily use of stairs to reduce risk of falls.

5. Slippery steps without tread or carpet or luminous light (See page 31, items 29 and 30
page 39, item 9)

Add adhesive stair treads or carpet runner.

Laundry Room/Basement

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below

1. Poor or lack of lighting 5. Slippery steps without carpet /luminous light

2. Lack of railings 6. Presence of cords across the floor

3. Clutter 7. Same colored floor at bottom of stairs

4. Steps too steep

Other_________________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page

Solutions for the Problems

in Laundry Room

1. Lack of or poor lighting

Increase wattage to allowable limits in lights.
Add additional overhead or wall lighting.

2. Lack of railings

Add at least one railing the entire length of the wall, ideally one on each side.

3. Clutter

Eliminate clutter on floors by removing and/or organizing items in areas near the
stairs.

4. Steps too steep

Use railings for stability.
Walk slowly up and down stairs with lights on.
Have others carry heavy or large items up or down the stairs.
Reduce daily use of stairs to reduce risk of falls.

5. Slippery steps without tread or carpet or luminous light (See page 31, item 30)

Add adhesive stair treads or carpet runner.

6. Presence of cords across the floor (See page 26, item 9)

Run your cords behind furnishings. Use extension cords to accomplish this.

Rearrange items that must be plugged in to areas near an outlet.

7. Same colored floor at bottom of stairs

Have the bottom of the stairs painted a different color so that you aware of the last
step.

Garage

The list identifies all the potential home hazards that may cause a fall. If the item applies to your
home place a check in the box. Then add the total number of checks and enter it in the box below

1. Poor or lack of lighting 5. Unsecured/loose items

2. Uneven/cracked floor 6. Presence of shoes near the door

3. Slippery floor 7. Unmarked or raised threshold

4. Clutter

Other_________________________________________________________

Total number of problems

* The numbers correspond to the hazard in the picture and solutions on the following page

Solutions for the Problems

in Garage

1. Lack of or poor lighting

Increase wattage to allowable limits in lights.
Add additional overhead or wall lighting. (See page 24, item 3)

2. Uneven/cracked floor

Have uneven or cracked pavement repaired.

3. Slipper floor

Careful when you get in and out of a car.

4. Clutter

Eliminate clutter by removing and/or organizing items in the path to the inside of home.

5. Unsecured/loose items

Remove or move unsecured loose items to a lower shelf and make sure them will not fall
off the shelf.

6. Presence of shoes near the door

Shoes should not be placed near the door to the garage.

Arrange a digitated place to put shoes inside the garage or the home where you will
not step on shoes.

7. Presence of threshold at the door

Mark end of steps or thresholds with contrasting tape or paint color to increase
awareness of changes in height. (See page 24, item 2)

23

Total Number of Home Hazards

Transfer all the total scores of each room/ area from pages 4-23 to the appropriate boxes and add

all the scores to get a grand total. Three blocks for each area are provided for you to keep records

of your assessments and improvements for three occasions.

Date _________ __________ __________

Entrance to Front Door and Front Yard

Entrance to Back/Side Door …………..

Hallway or Foyer ………………………..

Living Room ……………………………..

Kitchen …………………………………..

Bedroom …………………………………

Bathroom ………………………………..

Staircases ……………………………….

Laundry Room/Basement …………….

Garage ………….……….….…………….

Grand Total ………….

To record your home modification improvement use action log on page 56 and 57.

32

ACTION LOG:

ACTION TAKEN TO PREVENT FALLS AT MY HOME

The
Problem/Hazard:

I will do:

I have done:
(mm/dd/yyyy)

Resources used/Cost

1.

2.

3.

4.

5.

6.

7.

Continued from page 46

ACTION LOG:

ACTION TAKEN TO PREVENT FALLS AT MY HOME

The
Problem/Hazard:

I will do:

I have done:
(mm/dd/yyyy)

Reduces used/cost

8.

9.

10.

11.

12.

13.

14.