Step 1 of 10 10% Please note that this is a long form that may take some time to complete. You can save your progress at any time by using the orange 'SAVE YOUR PROGRESS AND CONTINUE LATER' button towards the bottom. This will allow you to save your progress and return to complete the form at a later time/date.Service User:*Date of Birth:Address: Street Address Address Line 2 Town or City Postcode Required Support Needs:Family/Next of Kin:Contact Number:Date: Date Format: DD slash MM slash YYYY Due for review: Date Format: DD slash MM slash YYYY This risk assessment will be completed with the service user and/or Parent/Guardian if possible, a FSW service manager and support worker will be involved in line with Family Support Wales policies and procedures to ensure the safety of staff and service users. This risk assessment is divided into three sections: a) The service user and how they interact with the support workers b) Proposed activities and social engagements c) Home Assessment Each section asks for any hazards to be identified, discussion with the family of how they normally manage these hazards and an agreement as to how it will be managed when the worker(s) work with the family. This risk assessment is a dynamic document in respect of its purpose and will be regularly reviewed to ensure the needs of the service user are met and safe environment is maintained. SECTION C – Home Assessment A home risk assessment should be completed to identify any hazards around the home and how these may relate to the service provided by the worker(s). If the support requirements are community based it would still be beneficial for us to undertake a home risk assessment so that we have the future option of home sit in sessions. Are you happy for us to undertake a home risk assessment?YesNo Area of risk Location (Levels of street lighting and parking availability) Risk Details (Location):Risk and Control Measures (Location):Severity of risk (Location): High Medium Low Entrance / Exit (Approach, trees, gates, slopes, ramps or steps) Risk Details (Entrance / Exit):Risk and Control Measures (Entrance / Exit):Severity of risk (Entrance / Exit): High Medium Low Entry system (key code pad / burglar alarm, door /garage keys) Risk Details (Entry system):Risk and Control Measures (Entry system):Severity of risk (Entry system): High Medium Low Kitchen and or Utility room Risk Details (Kitchen and or Utility room):Risk and Control Measures (Kitchen and or Utility room):Severity of risk (Kitchen and or Utility room): High Medium Low Living Areas Risk Details (Living Areas):Risk and Control Measures (Living Areas):Severity of risk (Living Areas): High Medium Low Hall / Stairs / Landing Risk Details (Hall / Stairs / Landing):Risk and Control Measures (Hall / Stairs / Landing):Severity of risk (Hall / Stairs / Landing): High Medium Low Bathrooms / Toilets Risk Details (Bathrooms / Toilets):Risk and Control Measures (Bathrooms / Toilets):Severity of risk (Bathrooms / Toilets): High Medium Low Sleeping areas (that carers may enter) Risk Details (Sleeping areas):Risk and Control Measures (Sleeping areas):Severity of risk (Sleeping areas): High Medium Low Outside Areas Gardens/ Balconies/ Sheds/Garage, etc.) Risk Details (Outside areas):Risk and Control Measures (Outside areas):Severity of risk (Outside areas): High Medium Low Fire Safety Sources of ignition are not always as obvious as a naked flame and some may only be a problem if misused or they malfunction. Please inform us of anything that you consider could be a source of ignition within your home. Sources of ignition List anything that you consider could be a source of ignition within your home (Oxygen cylinders / smokers in the household)Risk Details (Sources of ignition):Risk and Control Measures (Sources of ignition):Severity of risk (Sources of ignition): High Medium Low Smoke alarms and escape plan in placeRisk Details (Smoke alarms and escape plan in place):Risk and Control Measures (Smoke alarms and escape plan in place):Severity of risk (Smoke alarms and escape plan in place): High Medium Low Location of utilities / precautions Gas / Electric meterRisk Details (Gas / Electric meter):Risk and Control Measures (Gas / Electric meter):Severity of risk (Gas / Electric meter): High Medium Low Water stop cockRisk Details (Water stop cock):Risk and Control Measures (Water stop cock):Severity of risk (Water stop cock): High Medium Low Food handling including drinks Preparation, cooking and reheatingRisk Details (Preparation, cooking and reheating):Risk and Control Measures (Preparation, cooking and reheating):Severity of risk (Preparation, cooking and reheating): High Medium Low Are appliances in a suitable state of repair?Risk Details (Are appliances in a suitable state of repair):Risk and Control Measures (Are appliances in a suitable state of repair):Severity of risk (Are appliances in a suitable state of repair): High Medium Low Pets/Animals Are there pets on the premises? Do they pose a risk?Risk Details (Are there pets on the premises? Do they pose a risk?):Risk and Control Measures (Are there pets on the premises? Do they pose a risk?):Severity of risk (Are there pets on the premises? Do they pose a risk?): High Medium Low Level of staff involvement e.g. walking, feedingRisk Details (Level of staff involvement e.g. walking, feeding):Risk and Control Measures (Level of staff involvement e.g. walking, feeding):Severity of risk (Level of staff involvement e.g. walking, feeding): High Medium Low COSHH Cleaning materials storageRisk Details (Cleaning materials storage):Risk and Control Measures (Cleaning materials storage):Severity of risk (Cleaning materials storage): High Medium Low Medication storageRisk Details (Medication storage):Risk and Control Measures (Medication storage):Severity of risk (Medication storage): High Medium Low Infection Control - PPE available?Risk Details (Infection Control - PPE available?):Risk and Control Measures (Infection Control - PPE available?):Severity of risk (Infection Control - PPE available?): High Medium Low Suitable refuse containersRisk Details (Suitable refuse containers):Risk and Control Measures (Suitable refuse containers):Severity of risk (Suitable refuse containers): High Medium Low Equipment Used Mobility Aids in use in the home:Manufacturer/ Model/responsibility for maintenance:Who is responsible for servicing and date of last service?Serial Number:Mobility Aids in use in the home:Manufacturer/ Model/responsibility for maintenance:Who is responsible for servicing and date of last service?Serial Number:Mobility Aids in use in the home:Manufacturer/ Model/responsibility for maintenance:Who is responsible for servicing and date of last service?Serial Number: Risk Assessment Summary Having considered the information and recommendations of the overall risk assessment, I am of the opinion that, at the time this assessment was carried out, the situation is that:Risk Assessment SummaryNo risk has been identifiedThe overall a medium risk was assessed but there are adequate precautions are in place to mitigate the riskThe Risk is significant and actions have been recommended as detailed in the summaryUnacceptable levels of risk have been assessed and some areas of care cannot be undertaken until significant changes have been made as detailed in the summary below.Risk Assessment Summary All tasks assessed within this process must be carried out in accordance with Family Support Wales policy and guidance. No unnecessary risks will be taken that may jeopardise the Service User / Support Workers wellbeing. Community Support Workers to notify Family Support Wales of any changes that may have occurred since the last risk assessment. If required, a new assessment may be undertaken. Assessors name:*Assessors position:*Date (signed by assessor)* Date Format: DD slash MM slash YYYY I have read and understood the risk assessment and I will inform Family Support Wales office immediately if there are any changes within the home which may affect this assessment.* I certify Support Workers Name:Date (signed by Support Worker) Date Format: DD slash MM slash YYYY Support Workers Name:Date (signed by Support Worker) Date Format: DD slash MM slash YYYY EmailThis field is for validation purposes and should be left unchanged.
