Trip and Fall Risk Assessment Checklist
Evaluate and document potential trip and fall hazards in the environment.
Assessment Location
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor's Name
*
First Name
Last Name
Area/Department Being Assessed
*
Checklist: Trip and Fall Hazards
*
Rows
Present
Not Present
N/A
Loose flooring or rugs
1
2
3
Uneven surfaces
4
5
6
Obstructed walkways
7
8
9
Poor lighting
10
11
12
Unsecured cables or cords
13
14
15
Wet or slippery floors
16
17
18
Damaged stairs or handrails
19
20
21
Overall Risk Level for Area
*
Low
Moderate
High
Are warning signs or barriers in place where hazards exist?
*
Yes
No
Not Applicable
Rate the effectiveness of current controls (e.g., signage, barriers, cleaning schedules)
*
1
2
3
4
5
Immediate Actions Taken (if any)
Recommendations for Reducing Trip and Fall Risks
*
Additional Comments or Observations
Submit Assessment
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