Safety & Home Readiness Assessment
Complete this assessment before requesting care services, then share the details with your caregiver — sections 11 and 12 (emergency contacts and care instructions such as allergies, medication reminders, dietary restrictions, and emergency procedures) should be written down and given to the caregiver directly. Your selections here stay on this device and are not submitted to CareHarbor360.
0 items checked · Certification section incomplete
Section 1 — General home information
Is the caregiving location:
Section 2 — Household members
Who normally lives in the home?
Section 3 — Pets
Are pets present?
Section 4 — Smoking
Is smoking permitted inside the home?
Section 5 — Security cameras
Are security cameras installed?
Section 6 — Weapons
Are firearms or other regulated weapons stored at the caregiving location?
Section 7 — Household hazards
Check all that apply.
Section 8 — Infectious illness
Is anyone currently experiencing a contagious illness that may affect the caregiving engagement? If yes, provide relevant information to the caregiver before services begin.
Section 9 — Mobility considerations
Care recipient:
Section 10 — Medical considerations
Select any that apply.
Section 13 — Household expectations
Indicate any expectations that apply.
Section 14 — Client certification
I certify that:
Finish the certification
Tick all five statements in Section 14 to certify your assessment.
Part of the Trust and Safety Policy. Questions: support@careharbor360.com