IHC Home Safety Update

Educator First Name*
Please enter educator's first name.
Please enter educator's first name.
Educator Last Name*
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Please enter educator's last name.
Educator Email*
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Please enter educator's email.
Client First Name*
Please enter client's first name.
Please enter client's first name.
Client Last Name*
Please enter client's last name.
Please enter client's last name.

In conjunction with your client, please discuss and fill out the following regarding safety in the client's home

Is the first aid kit stored in a locked cupboard or out of reach of children?*
Please answer the question.
Please answer the question.
Is all medication stored in a locked cupboard or out of reach of children?*
Please answer the question.
Please answer the question.
Are all medication stored in their original containers or labelled clearly?*
Please answer the question.
Please answer the question.
For more info about medicine safety, click here.
Is all poison stored in a locked cupboard or out of reach of children?*
Please answer the question.
Please answer the question.
Are all poisons stored in their original containers or labelled clearly?*
Please answer the question.
Please answer the question.
Is all alcohol stored in a locked cupboard or out of reach of children?*
Please answer the question.
Please answer the question.
Are all cleaning products stored in a locked cupboard or out of reach of children?*
Please answer the question.
Please answer the question.
Are all cleaning products stored in their original containers or labelled clearly?*
Please answer the question.
Please answer the question.
Are all matches, oil burners, incense and lighters out of reach of children?*
Please answer the question.
Please answer the question.
Are all knives, razors, scissors and other sharp cut objects out of reach of children?*
Please answer the question.
Please answer the question.
Are all kitchen appliances (toaster, kettle etc.) out of reach of young children?*
Please answer the question.
Please answer the question.
Are all plastic bags or similar out of reach of young children?*
Please answer the question.
Please answer the question.
Are all toiletries, perfumes, jewellery or similar out of reach of young children?*
Please answer the question.
Please answer the question.
Are all curtain and blind cords out of reach of young children?*
Please answer the question.
Please answer the question.
Are all garden/pool/tool sheds securely locked and inaccessible by children?*
Please answer the question.
Please answer the question.
Are all pool gates child-locked?*
Please answer the question.
Please answer the question.
For more info about pool safety, click here.
I have checked all of the above and discussed the importance of the above with my client*
Please confirm.
Please confirm.
Are there any improvements that were made to the safety of the client’s home during this process?*
Please answer the question.
Please answer the question.
Are there any improvements that need to be made to the safety of the client’s home?*
Please answer the question.
Please answer the question.
If yes, detail an action plan for these improvements (when will they be made, and by who etc.)
Field is required!
Field is required!
I confirm that all information provided is true, accurate and current.*
Please confirm.
Please confirm.