Injury Prevention

Yes NoArea of Focus

General Home Safety Checklist for Individuals with Perceptual and Cognitive Problems

1. While cooking, is a timer available to help you keep track of items cooking on the flame? (attention and memory problems)

2. Do you use a “whistling” teakettle? (attention and memory problems)

3. Are commonly used items kept in the same location? (attention and memory problems)

4. Have commonly used telephone numbers been pre-programmed into the telephone and/or posted near the telephone? (memory problems, sequencing problems)

5. Do you use a calendar or scheduling book to help remind you of important events? (attention and memory problems)

6. If necessary, have you posted signs by the door to help remind you to:

Lock the front door when you leave

Turn off appliances when you finish using them

Take out the garbage

(attention, memory problems)

7. Is your front door house key color coded for easy identification? (memory problems, distractibility)

8. When the doorbell rings, do you use the peep hole to identify who it is before opening the door to let the person in? (impulsivity, decreased judgment)

9. When necessary, do you utilize checklists with correct steps and sequences for household tasks, such as the laundry or making a bed? (poor attention, memory problems, sequencing problems)

Home Safety Checklist This checklist focuses on safety issues that commonly apply to individuals with perceptual and cognitive problems.

How To Use This Checklist:

Take this checklist with you and as you WALK through your home with your service member/veteran, carefully check “yes” or “no” for each item on this list.

Any item scored “no” is a safety concern and should be corrected.

If you have answered “YES” to all these items on this checklist, your home appears to be relatively safe. Any items scored “NO” should be corrected to promote a safe home environment. Remember to check with your health care professional to identify any potential safety issues that might be particular to your individual needs.

Yes NoArea of Focus

General Home Safety Checklist for Individuals with Perceptual and Cognitive Problems

10. Are directions and steps for multi-step tasks posted at appropriate locations (e.g., near washing machine)? (sequencing problems, difficulty initiating tasks, attention and memory problems)

11. Are sharp utensils separated from other items and arranged in a kitchen drawer with handles pointing towards you? (perceptual impairments, impulsivity)

12. Are toxic household cleaning fluids kept separate from other items to avoid potential confusion? (perceptual impairments, attention problems)

13. Have unnecessary items been removed from the living environment to decrease confusion and distraction? (perceptual impairments, attention problems)

14. Are commonly used items kept in a consistent, prominent place? (memory and attentional problem)

15. Are cabinets labeled to assist in locating objects? (memory and attentional problems, safety)

16. If you are “neglectful” of one side of your body, are objects placed and positioned where you can see and reach them? (perceptual impairments)

17. Do you use a watch with an alarm and calendar display? (memory problems)

18. Are the most “taxing” household activities planned for the time of day when you feel most alert and attentive? (attentional problems, fatigue)

19. Do you have a “Medi-Alert” system in place? (safety, language difficulties)

20. Does a family member or friend have a key to your home in case of emergencies? (safety)