Risk Assessment Form

Section 1: Client Details

Section 2: Risk Assessment Table

Mobility Hazards

Select LikelihoodHighMediumLow Select ImpactHighMediumLow

Fire Safety

Select LikelihoodHighMediumLow Select ImpactHighMediumLow

Medication Errors

Select LikelihoodHighMediumLow Select ImpactHighMediumLow

Environmental Risks

Select LikelihoodHighMediumLow Select ImpactHighMediumLow

Section 3: Additional Observations

Section 4: Recommendations

Section 5: Consent and Acknowledgment

I acknowledge that this risk assessment has been discussed with me, and I consent to the implementation of the mitigation measures outlined above.

Section 6: Signatures