Stairs, Entrances And Halls:

Can you clearly see the outline of each step?

Yes

No

Lights and switches at the bottom and top of the stairs?

Securly Fixed Handrails On Both Sides?

Does your hand wrap completely around the rail?

Yes

No

Carpets and runners securely affixed to floor?

Do stairs have even surfaces?

Stairs free of clutter?

Outdoor stairs free of cracks and holes?

Mobility Issues:

After sitting up or standing up, do you take the proper time to regain your balance?

Yes

No

Do you wear low heeled shoes or slippers with soles that provide traction?

Should you feel dizzy, do you use a cane, walker, or other mobility aid?

Yes

No

Are you always alert to hazards in your path i.e. pets or toys?

Do you avoid walking on stairs in poorly lit public spaces?

When you carry cumbersome packages, do you ensure they don't block your view?

When carrying packages and walking up stairs, do you ensure one hand is free to hold the handrail?

Do you avoid rushing to answer the doorbell or phone?

Does a friend, neighbor, or relative check up on you at least once a day?

Do you avoid rushing across streets during rainy or snowy weather?

If you start to fall, do you know instantly how to reduce your chances of being injured?

Do you always use a stepping stool when reaching for high places?

Can you easily turn on a light without having to actually walk into a room?

Yes

No

Do your chairs have proper arm rests to support you when standing or sitting down?

Should you lean against any of your tables or chairs, are they stable enough to support your weight?

Yes

No

Small rugs and runners securly fastened to the floor with double-sided tape?

Do you use non-skid wax (or no wax at all) on wooden floor surfaces?

Living Areas: General

Do your tubs and showers have non-skid mats, strips, or surfaces?

Yes

No

Do you have proper grab bars on the wall or side of your tubs and showers?

Yes

No

Do you have proper grab bars for getting up / sitting on the toilet seat?

Bathroom:

Is the floor in the bathroom generally safe, with non-slipperly surfaces and properly affixed bath mats?

Do you have an easily accessible light source (i.e. flashlight) beside your bed?

Yes

No

Yes

No

Do you have proper night lights between your bedroom and bathroom?

Bedroom: