• Hospital or Nursing Facility
• Home
• Environmental Assessment

Hospital or Nursing Facility

• Observe the patient's facial expression and posture in bed.
• Note the placement and position of bed.
• Check the bed and bed rails for proper functioning and position.
• Assess any equipment attached to the patient and/or bed such as nasogastric tubing, urinary catheter, IV, or monitor for proper functioning.
• Make sure that the call cord, the telephone, paper wipes, and water (if allowed) are within easy reach of the patient.
• Note whether privacy and space for the patient's personal possessions are adequate.
• Note any unusual odors emanating from the patient or in the room.
• Note whether the floor is free from litter and moisture.
• Make sure no unnecessary equipment and/or supplies are in the room.
• Make sure lighting is adequate.

• Neighborhood location: Urban, suburban, rural
• Sidewalks, paved streets, presence of churches, schools, playgrounds, industries and/or businesses
• Traffic patterns in neighborhood
• Size and type of home: Apartment, house, trailer
• Description of home
• Whether patient owns or rents the home
• Length of time in current home
• Distance to shopping
• Type of water supply
• Type of sewage disposal
• Type and efficiency of heating and cooling systems
• Method of transportation: Car, bus, walking
• Presence of a telephone or emergency signaling system
• Neighbors: Proximity: whether patient perceives as supportive or threatening
• Adequacy of lighting outside and inside, including nightlights
• Distance to street lights, fire hydrant, fire station
• Visibility of path from car to house by neighbors
• General cleanliness and whether home is infested with insects or rodents
• Safety of the inside and outside stairs, number of steps
• Security of the outside doors
• Activities of neighborhood residents: Children at play outdoors, transient persons, older residents visibility, activity after dark
• Patient's perception of safety for self in environment; patient's awareness of crimes in area, perception of own vulnerability; degree to which precautions or fear affects daily activities
• Availability of safe source of heat and, if appropriate, air-conditioning
• Presence, placement, and functioning of smoke alarms
• Presence and placement of fire extinguishers
• Safety of the bathroom floor, tub, commode; functioning of the fixtures; raised toilet seat, grab bars near toilet and/or in tub, shower seat
• Temperature of the hot water 120°F or less (49°C or less).
• Condition of the floors and stairs: Cleanliness, evenness, freedom from clutter, presence of throw rugs, adequacy of lighting at night
• Width of hallways and doorways for maneuverability of walker or wheelchair
• Proximity of bathroom to bedroom
• Hospital bed located for convenience of family caregivers and for opportunity of interaction with family
• Safety and state of repair of the furniture
• Safe use of appliances and electrical cords
• Functioning refrigerator, stove
• Presence of books, radio, television, newspaper, magazines
• Computer and internet access
• Proper storage of household cleaners
• Proper storage of food and medicines
• Availability of laundry facilities
• Availability and functioning of lawn equipment

Environmental Assessment

• Potential Exposures
• Note whether illness occurred after contact with a chemical, pesticide, or other substance.
• Have there been symptoms that improve when away from home, work, or school?
• At present work (or school):
• Note exposure to solvents, dusts, fumes, radiation, loud noise, pesticides, or other chemicals
• Presence of Material Data Safety Sheets on chemicals at work
• Personal protective equipment available and required
• Work clothes remain at work site
• Coworkers with similar health problems
• Past work—investigate past work (or school) experiences, length of job, military service, farm, or seasonal work
• Residence—note when residence built, type of heating, recently remodeled chemicals stored on property, source of drinking water
• Neighborhood—environmental concerns related to air, water, or soil; industries, farms or presence of a hazardous waste site or landfill nearby
• Activities—activities and hobbies that engage in burning, soldering, or melting any products; participate in gardening, fishing, or hunting; use game or home-grown food; use of pesticides; use of alternative healing or cultural practices
• Referrals and Resources
• Agency for Toxic Substances and Disease Registry, www.atsdr.cdc.gov
• Association for Occupational and Environmental Clinics, www.aoec.org
• Environmental Protection Agency, www.epa.gov
• Material Safety Data Sheets, www.hazard.com/msds
• Occupational Safety and Health Administration, www.osha.gov
• Local Health Department, Environmental Agency, Poison Control Center