CDC Home Safety Checklist For The Elderly - FREE PDF Template

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CDC home safety checklist for the elderly template

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Use this template with Lumiform

Customize this template or build your own
Fill out templates via mobile app
Get reports and analyse your data

Prices start from ░░░ per month

Book a demo

Learn more

The CDC home safety checklist for the elderly template provides a comprehensive framework for identifying and addressing potential hazards in seniors’ living environments. Based on the CDC’s STEADI initiative (Stopping Elderly Accidents, Deaths & Injuries), this template helps you conduct thorough room-by-room assessments focused on fall prevention.

According to the CDC, more than one in four older adults report falling each year, with over 37% of those falls resulting in injuries requiring medical treatment. We created this template to help healthcare providers, facility managers, and family caregivers systematically evaluate and document safety concerns, creating actionable prevention plans that can significantly reduce fall risks and enhance elderly independence at home.

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Preview of the template

Page 1

Entryways & Walkways

Are all walkways and entryways well-lit?

Are walkways and entryways free of clutter and tripping hazards?

Are handrails installed on both sides of stairways?

Are stairs in good repair with non-slip treads?

Is the front door easy to unlock and open?

Floors & Carpets

Are floors and carpets in good condition, with no loose or torn areas?

Are area rugs secured with non-slip mats or double-sided tape?

Are cords and wires secured and out of walkways?

Lighting

Are all living areas, stairways, and entrances well-lit?

Are light switches easy to reach and operate?

Are nightlights installed in hallways and bathrooms?

Bathrooms

Are grab bars installed near the toilet, shower, and bathtub?

Is the floor non-slip, with a non-slip mat or textured surface?

Are all items within easy reach in the shower and near the sink?

Kitchen

Are frequently used items stored within easy reach?

Are pot handles turned inward to avoid accidental bumping?

Are appliances in good working order with easy-to-use controls?

Bedrooms

Is the bed at a comfortable height for easy getting in and out?

Is there a clear path to the bathroom and exit?

Are frequently used items within easy reach?

Emergency Preparedness

Are emergency numbers posted in a visible location?

Is there a working flashlight and extra batteries available?

Is there a fire extinguisher that is easily accessible?

Frequently asked questions

What specific areas of the home does the CDC checklist cover?

The checklist covers all critical living areas where falls commonly occur: stairs and steps (both indoor and outdoor), floors throughout the home, kitchen spaces, bathrooms, and bedrooms. For each area, it guides you through identifying specific hazards like poor lighting, loose rugs, cluttered pathways, and missing grab bars or handrails.

How can I use this checklist to document compliance for our senior care facility?

Document completion dates, assessment findings, planned interventions, and follow-up timelines. Take photos of identified hazards and subsequent modifications. Store completed checklists in resident files and facility safety records, noting staff participation. This documentation demonstrates your proactive approach to fall prevention during inspections or audits.

What’s the best way to discuss safety modifications with elderly residents who resist changes?

Frame the conversation around maintaining independence rather than highlighting limitations. Show how specific modifications like grab bars or improved lighting help preserve autonomy. Involve them in decisions, start with less intrusive changes, and when possible, make modifications that blend with existing decor to increase acceptance.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.