Mental Health Environment of Care Checklist
Use this checklist to assess and document the safety of environments for mental health care.
Evaluator Name
*
First Name
Last Name
Evaluator Email
*
example@example.com
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility Name
*
Location/Unit Assessed
*
Type of Area
*
Please Select
Patient Room
Bathroom
Hallway/Common Area
Nursing Station
Other
Environmental Risk Assessment
*
Rows
Safe
Needs Attention
N/A
Doors and handles free of ligature points
1
2
3
Windows secure and shatter-resistant
4
5
6
Bathroom fixtures are anti-ligature
7
8
9
Furniture is tamper-resistant and secured
10
11
12
No access to sharp objects
13
14
15
Electrical outlets covered or tamper-resistant
16
17
18
Good visibility for staff monitoring
19
20
21
No unsecured cords or wires
22
23
24
Emergency call system functional
25
26
27
Are any immediate hazards present?
*
Yes
No
If hazards are present, please describe and specify location(s).
Overall Safety Rating for this Area
*
1
2
3
4
5
Additional Comments or Recommendations
Submit Checklist
Should be Empty: