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YESNOHousekeepingDo you clean up spills as soon as they occur?________Do you keep floors and stairways clean and free of clutter?________Do you put away books, magazines, sewing supplies, and other objects as soon as you're through with them and never leave them on floors or stairways? ____ ____Do you store frequently used items on shelves that are within easy reach?________FloorsDo you keep everyone from walking on freshly washed floors before they're dry? ____ ____If you wax floors, do you apply two thin coats and buff each thoroughly or use self-polishing, nonskid wax? ____ ____Do all small rugs have nonskid backings?________Have you eliminated small rugs at the tops and bottoms of stairways?________Are all carpet edges tacked down?________Are rugs and carpets free of curled edges, worn spots, and rips?________Have you chosen rugs and carpets with short, dense pile?________Are rugs and carpets installed over good-quality, medium-thick pads?________BathroomDo you use a rubber mat or no slip decals in the tub or shower?________Do you have a grab bar securely anchored over the tub or on the shower wall? ____ ____Do you have a nonskid rug on the bathroom floor?________Do you keep soap in an easy-to-reach receptacle?________Traffic lanesCan you walk across every room in your home, and from one room to another, without detouring around furniture? ____ ____Is the traffic lane from your bedroom to the bathroom free of obstacles?________Are telephone and appliance cords kept away from areas where people walk? ____ ____LightingDo you have light switches near every doorway?________Do you have enough good lighting to eliminate shadowy areas?________Do you have a lamp or light switch within easy reach of your bed?________Do you have night-lights in your bathroom and in the hallway leading from your bedroom to the bathroom? ____ ____Lighting (continued)Are all stairways well lighted?________Do you have light switches at both the tops and bottoms of stairways?________StairwaysDo securely fastened handrails extend the full length of the stairs on each side of stairways? ____ ____Do rails stand out from the walls so you can get a good grip?________Are rails distinctly shaped so you're alerted when you reach the end of a stairway? ____ ____Are all stairways in good condition, with no broken, sagging, or sloping steps? ____ ____Are all stairway carpeting and metal edges securely fastened and in good condition? ____ ____Have you replaced any single-level steps with gradually rising ramps or made sure such steps are well lighted? ____ ____Ladders and step stoolsDo you have a sturdy step stool that you use to reach high cupboard and closet shelves?  ____ ____Are all ladders and step stools in good condition? ________Do you always use a step stool or ladder that's tall enough for the job? ________Do you always set up your ladder or step stool on a firm, level base that's free of clutter?  ____ ____Before you climb a ladder or step stool, do you always make sure it's fully open and that the stepladder spreaders are locked?  ____ ____When you use a ladder or step stool, do you face the steps and keep your body between the side rails?  ____ ____Do you avoid standing on top of a step stool or climbing beyond the second step from the top on a stepladder? ____ ____Outdoor areasAre walks and driveways in your yard and other areas free of breaks? ________Are lawns and gardens free of holes?________Do you put away garden tools and hoses when they're not in use?________Are outdoor areas keep free of rocks, loose boards, and other tripping hazards? ____ ____Do you keep outdoor walkways, steps, and porches free of wet leaves and snow?  ____ ____Do you sprinkle icy outdoor areas with deicers as soon as possible after a snowfall or freeze? ____ ____Do you have mats at doorways for people to wipe their feet on?________Do you know the safest way of walking when you can't avoid walking on a slippery surface? ____ ____FootwearDo your shoes have soles and heels that provide good traction?________Do you wear house slippers that fit well and don't fall off?________Do you avoid walking in stocking feet?________Do you wear low-heeled oxfords, loafers, or good-quality sneakers when you work in your house or yard? ____ ____Do you replace boots or galoshes when their soles or heels are worn too smooth to keep you from slipping on wet or icy surfaces? ____ ____Personal precautionsAre you always alert for unexpected hazards, such as out-of-place furniture? ____ ____If young grandchildren visit, are you alert for children playing on the floor and toys left in your path? ____ ____If you have pets, are you alert for sudden movements across your path and pets getting underfoot? ____ ____When you carry bulky packages, do you make sure they don't obstruct your vision? ____ ____Do you divide large loads into smaller loads whenever possible?________When you reach or bend, do you hold onto a firm support and avoid throwing your head back or turning it too far? ____ ____Do you always use a ladder or step stool to reach high places and never stand on a chair? ____ ____Do you always move deliberately and avoid rushing to answer the phone or doorbell? ____ ____Do you take time to get your balance when you change position from lying down to sitting and from sitting to standing? ____ ____Do you hold onto grab bars when you change position in the tub or shower? ____ ____Do you keep yourself in good condition with moderate exercise, good diet, adequate rest, and regular medical checkups? ____ ____If you wear glasses, is your prescription up-to-date?________Do you know how to reduce injury in a fall?________If you live alone, do you have daily contact with a friend or neighbor?________ SCORE = Total number of “NO” answers:________ Show this list to your doctor. What does your SCORE mean? 1- 7 = Excellent 8-14 = Good 15 or higher = Hazardous. Changes need to be made in your home to make it safer. 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