Home Renovation Safety Assessment Form
Use this form to assess renovation-site safety conditions, identify hazards, and capture the information needed to plan work safely.
Project Overview
Property type
*
House
Apartment/Condo
Townhouse
Other
Renovation area(s)
*
Kitchen
Bathroom
Basement
Attic
Living Room
Bedroom
Exterior
Other
Renovation scope description
*
Expected start date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Safety Conditions Assessment
Current electrical safety
*
Unsafe
1
2
3
4
5
6
7
8
9
Safe
10
1 is Unsafe, 10 is Safe
Structural stability
*
Unstable
1
2
3
4
5
6
7
8
9
Stable
10
1 is Unstable, 10 is Stable
Dust / air quality
*
Poor
1
2
3
4
5
6
7
8
9
Good
10
1 is Poor, 10 is Good
Ventilation
*
Poor
1
2
3
4
5
6
7
8
9
Good
10
1 is Poor, 10 is Good
Fire safety readiness
*
Not ready
1
2
3
4
5
6
7
8
9
Ready
10
1 is Not ready, 10 is Ready
Known hazards present
Exposed wiring
Uneven flooring
Asbestos concern
Mold concern
Water damage
Gas line work
None known
Access, Equipment, and Follow-up
Contractor/Company or Responsible Person Name
*
Site Access Notes
Required Safety Equipment on Site
Hard Hats
Gloves
Goggles
Masks/Respirators
Hearing Protection
Barrier Tape
Fire Extinguisher
First Aid Kit
Urgent Safety Concerns or Observations
Preferred Follow-up Method
*
Email
Phone
Onsite Revisit
No Follow-up Needed
Submit
Should be Empty: