Home Care Safety Assessment Tool (Page 1 of 4) Page 1 |2 | 3 |4 Client Name:_______________________________________ Case Number:______________________________________ Address:___________________________________________ City/State/Zip:______________________________________ Phone:_____________________________________________   Draw or Map Community area as relevant           Community Environment: Conduct a "Windshield Survey" by assessing and describing the risks and assets of the clients community Neighborhood:       Overall safety: Excellent Good Fair   Define or Specify Risks: ________________________________________________________________________     Abandoned Buildings: Yes/No Proximity:_______________________________     Unguarded Railway Crossings Yes/No   Additional comments:__________________________________________________________