Risk Reporting

Client Name

File Number

Address

Phone

Person completing assessment

Date

Disability

Disability Date

	Yes/ No	Hazards identified & actions required	Completed(date)
Communication
Hearing OK	YesNo
Speech OK	YesNo
Able to write	YesNo
English language skills	YesNo
Cognition
Participant willing to participate and assist in care	YesNo
Oriented in time and place	YesNo
Participant able to accept direction and instruction	YesNo
Short-term memory issues	YesNo
Mobility
Walk unaided	YesNo
Manages stairs unaided	YesNo
Uses walking aid to walk	YesNo
Uses self-propelled wheelchair	YesNo
Uses electric wheelchair/scooter	YesNo
Transfers independently	YesNo
Transfers with supervision	YesNo
Transfers with hoist	YesNo
Personal Care assistance required
Bed mobility	YesNo
Showering	YesNo
Toileting	YesNo
Grooming	YesNo
Repositioning in bed	YesNo
Repositioning in chair	YesNo
Mouthcare	YesNo
Eating	YesNo
Skin care	YesNo
Manual handling
Worker able to adopt safe work postures	YesNo
Are manual handling tasks risk assessed	YesNo
Is manual handling equipment in place and used	YesNo
Have safe work procedures been developed	YesNo
Has training been provided to support staff for specific client handling techniques	YesNo
Can all manual handling tasks be undertaken safelywith current staff and equipment	YesNo
Can vehicle transfers be undertaken safely if required	YesNo
Violence risk
Physical aggression to support worker	YesNo
Verbal aggression to support worker	YesNo
Aggression to other clients	YesNo
Aggression with/against objects	YesNo
Self harm	YesNo
Substance abuse	YesNo
Sexual abuse	YesNo
Threats to staff in any way	YesNo
Use of emotions to achieve goals	YesNo

Notes