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Medical Equipment Checklist

Elderly Home Safety Checklist

Use this checklist to determine whether or not a senior citizen is safe living home alone given the current state of the home. Any NO response indicates an area of concern. A “NO” responses do not necessarily mean that the person can no longer remain home, but indicates areas in which the home may require modifications, or assistance may need to be brought in to ensure safety.

If the senior is unable to perform the task independently mark NO; if a caregiver is available to assist with the task mark CAREGIVER. This will help determine whether the care recipient is safe without a caregiver present.

Download checklist here.