HOME SAFETY CHECKLIST

Home Safety Checklist form

GENERAL INFORMATION

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OUTSIDE THE RESIDENCE

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INSIDE THE RESIDENCE

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THE PARTICIPANT

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MANUAL TASKS

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DECLARATION by the participant, or person completing this form on behalf of the participant

I declare that the information I have given is true and correct.

Thanks for submitting!

TO BE COMPLETED BY AABDS MANAGEMENT 

Are there any safety hazards/risks identified?
Has an Incident, Hazard or Risk assessement been completed for any identified hazard/risk?