| Storage Areas |
|---|
| Yes/No |
Are pesticides, detergents, and other household chemicals kept out of child's reach? |
| Yes/No |
Are tools kept out of child's reach? |
| General Safety Precautions Inside the Home |
|---|
| Yes/No |
Are stairways kept clear and uncluttered? |
| Yes/No |
Are stairs and hallways well lit? |
| Yes/No |
Are safety gates installed at tops and bottoms of stairways? |
| Yes/No |
Are guards installed around fireplaces, radiators or hot pipes, and wood-burning stoves? |
| Yes/No |
Are sharp edges of furniture cushioned with corner guards or other material? |
| Yes/No |
Are unused electronic outlets covered with tape or safety covers? |
| Yes/No |
Are curtain cords and shade pulls kept out of child's reach? |
| Yes/No |
Are windows secured with window locks? |
| Yes/No |
Are plastic bags kept out of child's reach? |
| Yes/No |
Are fire extinguishers installed where they are most likely to be needed? |
| Yes/No |
Are smoke detectors in working order? |
| Yes/No |
Do you have an emergency plan to use in case of fire? Does your family practice this plan? |
| Yes/No |
Is the water set at a safe temperature? (A setting of 120 F or less prevents scalding from tap water in sinks and in tubs. Let the water run for three minutes before testing it.) |
| Yes/No |
If you have a gun, is it locked in a place where your child cannot get it? |
| Yes/No |
Are all purses, handbags, briefcases and so on, including those of visitors, kept out of children's reach? |
| Yes/No |
Are all poisonous plants kept out of child's reach? |
| Yes/No |
Is a list of emergency phone numbers posted near a telephone? |
| Yes/No |
Is a list of instructions posted near a telephone for use by children and/or baby-sitters? |
| Bathroom |
|---|
| Yes/No |
Are the toilet seat and lid kept down when the toilet is not in use? |
| Yes/No |
Are cabinets equipped with safety latches and kept closed? |
| Yes/No |
Are all medicines in child-resistent containers and stored in a locked medicine cabinet? |
| Yes/No |
Are shampoos and cosmetics stored out of child's reach? |
| Yes/No |
Are razors, razor blades, and other sharp objects kept out of child's reach? |
| Yes/No |
Are hair dryers and other appliances stored away from sink, tub, and toilet? |
| Yes/No |
Does the bottom of tub or shower have stickers or a rubber mat to prevent slipping? |
| Yes/No |
Is the child always watched by another while in the tub? |
| Kitchen |
|---|
| Yes/No |
Do you cook on back stove burners when possible and turn pot handles toward the back of the stove? |
| Yes/No |
Are hot dishes kept away from the edges of tables and counters? |
| Yes/No |
Are hot liquids and foods kept out of child's reach? |
| Yes/No |
Is the highchair placed away from stove and other hot appliances? |
| Yes/No |
Are matches and lighters kept out of child's reach? |
| Yes/No |
Are all appliance cords kept out of child's reach? |
| Yes/No |
Are cabinets equipped with safety latches? |
| Yes/No |
Are cabinet doors kept closed when not in use? |
| Yes/No |
Are cleaning products kept out of child's reach? |
| Yes/No |
Do you test the temperature of heated food before feeding the child? |
| Child's Room |
|---|
| Yes/No |
Is the child's bed or crib placed away from radiators and other hot surfaces? |
| Yes/No |
Are crib slats no more than 2-3/8 inches apart? |
| Yes/No |
Does the mattress fit the sides of the crib snugly? |
| Yes/No |
Is paint or finish on furniture and toys non-toxic? |
| Yes/No |
Are electric cords kept out of child's reach? |
| Yes/No |
Does the toy box have a secure lid and safe-closing hinges? |
| Yes/No |
Are the toys in good repair? |
| Yes/No |
Are toys appropriate for the child's age? |
| Outside the Home/Play Area |
|---|
| Yes/No |
Is trash kept in tightly covered containers? |
| Yes/No |
Are walkways, stairs and railings in good repair? |
| Yes/No |
Are sandboxes, and wading pools covered when not in use? |
| Yes/No |
Are swimming pools nearby enclosed with a fence that your child cannot easily climb over? |
| Yes/No |
Is playground equipment safe? Is it assembled according to the manufacturer's instructions and anchored over a level, soft surface such as sand or wood chips? |
| Parent's Bedroom |
|---|
| Yes/No |
Are space heaters kept away from curtains and flammable materials? |
| Yes/No |
Are cosmetics, perfumes, and breakable items stored out of child's reach? |
| Yes/No |
Are small objects such as jewelry, buttons, and safety pins kept out of child's reach? |
