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MC-FRM-RSK-001 · Home Visit & Safe Environment Risk Assessment

Mayim Group Pty Ltd trading as Mayim Care
Information collected in this form is to ensure the participant's safety and the safety of Mayim Care staff. It combines the In Home Inspection Checklist and the Participant Safe Environment Risk Assessment. Complete it before a home visit proceeds and before services commence in the home.
For each hazard you identify, note the control to be put in place. If you have any concern about the risk, do not proceed with the visit. Refer to your Mayim Care manager for review of controls or alternative means of service provision.

1. Participant and visit details

Participant's name

Participant's address

Participant's phone number

Assessor / staff member name

Date of assessment

Does the participant consent to the home visit?

A
B