Main safety concern General home fire and burn safety review Recent smoke, cooking, burn, or alarm concern New caregiver, family helper, or home-care routine Mobility, hearing, vision, or memory changes
Smoke alarm status Not sure alarms are installed and working Some alarms work, but coverage is incomplete Needs louder, strobe, or bed-shaker alarm review Installed and tested recently
Escape plan status No written or practiced escape plan Some exits known, but not practiced Needs walker, wheelchair, stairs, or transfer help Plan is written and practiced
Cooking safety status Often cooks alone Forgetting, fatigue, or distraction is a concern Caregiver or family helps with meals Rarely cooks or uses prepared meals
Burn or scald concern No known burn or scald concern Hot water, bathing, or sink scald risk Kitchen burns, spills, or loose clothing risk Recent burn or near miss
Oxygen or smoking risk No oxygen or smoking concern known Medical oxygen is used in the home Smoking, candles, incense, or open flames are present Not sure what risk applies
Heating and electrical setup Not reviewed recently Space heater, fireplace, or portable heat used Extension cords, power strips, or overloaded outlets Recently reviewed and clear
Caregiver check-in support Check-ins are limited or irregular Family, friend, or neighbor can help Paid caregiver or agency involved Senior housing or facility staff involved
Local help status Local fire department or Red Cross not contacted May need help testing or installing alarms Local safety contacts are written down
Use broad planning answers only.
Do not enter names, addresses, diagnoses, birth dates, account numbers, passwords, medical records, or private household details. Keep exact alarm locations, keys, contacts, and medical details in a secure printed plan.
This planner is educational and organizational only. It is not medical, emergency-response, electrical, housing, legal, insurance, or fire-code advice. For smoke, fire, gas smell, carbon-monoxide alarm, oxygen fire risk, serious burn, unsafe heat source, or immediate danger, leave safely if needed and contact emergency services or local authorities right away.
Official references:
U.S. Fire Administration older adult fire safety ,
U.S. Fire Administration smoke alarms ,
U.S. Fire Administration burn first aid ,
NFPA older adult safety tips .
