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Rebuilding Together Greater Milwaukee Occupational Therapy Home Safety AssessmentThis document is for RTGM use only and is not to be reproduced or altered without the permission of Linda Balfanz,

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Family members or caregivers who are seeking assistance in evaluating the living conditions and needs of a senior loved one.

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What is form senior home assessment?

Form Senior Home Assessment is a document used to evaluate the condition, safety, and suitability of a senior citizen's living environment to ensure it meets their needs.

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Typically, healthcare providers, social workers, or family members responsible for the care of a senior citizen are required to file the form.

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The purpose of the form is to assess whether a senior's home environment supports their health and safety needs and to identify any necessary modifications or services.

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Information required includes the senior's personal details, health status, living conditions, safety hazards, and any assistance they may need.

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