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Bedroom Checklist Living Areas Checklist Kitchen Checklist Hallways and Stairs Checklist Porch and Yard Checklist Personal Risk Factors Checklist

Answer all 7 questions and press GO!

1. Is the path from the bedroom to the bathroom dark?
Yes     No
2. Are towel racks used to balance or grab onto while getting in or out of the bathtub/shower?
Yes     No
3. Is it difficult to stand during a shower?
Yes     No
4. Is the shower floor and/ or bathtub slippery?
Yes     No
5. Is there any water on the floor after a bath/ shower? Are there leaks from the tub/ shower?
Yes     No
6. Is it necessary to reach far or turn around to get towels, shampoo, and soap?
Yes     No
7. Is it difficult to get on and off the toilet?
Yes     No
 


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