|
Checklist 1 |
Put a check mark when risk/hazard is found |
|
Some areas in the home have visible fire hazards |
|
|
Hoarding of excrement and/or urine |
|
|
Bathroom has no running water |
|
|
Bathroom is unusable and unsanitary |
|
|
Emergency personnel will be unable to enter the house quickly due to hoard |
|
|
Windows cannot be opened from the inside |
|
|
Doors cannot be opened or can barely be opened |
|
|
Stairs are unsafe to use |
|
|
Living room floor has clutter |
|
|
Bedroom floor has clutter |
|
|
Dining room floor has clutter |
|
|
Materials are piled high from floor to ceiling |
|
|
There are piles of heavy materials |
|
|
There are unstable piles of materials that can shatter or break (e.g. glass) |
|
|
There are sharp items mixed with the floor clutter or piles |
|
|
Electrical wiring is unsafe |
|
|
There are no smoke alarms |
|
|
Smoke alarms are present but are defective |
|
|
An area or several areas inside the home have pooled water |
|
|
Structural damage is present |
|
|
Stairways are physically damaged and are not usable |
|
|
Rotting food is present |
|
|
Insect infestation found |
|
|
Rodent infestation found |
|
|
Dead animals are found mixed with the clutter |
|
|
There is presence of animal waste inside the house |
|
|
There is presence of fluids such as blood and vomit |
|
|
Some parts of the home are structurally compromised due to molds and other fungus |
|
|
Running water is not present in other parts of the home |
|
|
Electricity has been shut off |
|
|
Garbage collection has been discontinued |
Click here to download and print Hoarding Assessment Checklist #1
|
Checklist 2 |
Rate the ability of the person to conduct a specific activity Scale: 1 – 5 |
|
He/she is able to cook in the kitchen and prepare his/her own food properly. |
|
|
He/she is able to make full use of the refrigerator. |
|
|
He/she is able to safely use the stove or oven. |
|
|
He/she is able to use the kitchen sink and counters. |
|
|
The dining room table is not cluttered or is at least usable. The person is able to eat on the table. |
|
|
He/she can navigate the house safely and is able to access all the areas of the home. |
|
|
He/she is able to use the bathroom and the toilet. |
|
|
He/she is able to use the sink in the bathroom. |
|
|
When someone knocks on the door, he/she is able to respond quickly and he/she can reach the door quickly, as well. |
|
|
He/she sleeps in the bedroom and on the bed. |
|
|
He/she is able to do laundry (there is running water, washing machine is working, laundry area is accessible, etc.) |
|
|
He/she is capable of finding important documents with ease. |
|
|
He/she is able to care for animals adequately. |