Occupation-based Home Assessment Ghent Name: Brecinna Lick SON pate of assessment: 13 | Type of Housing: house, apartment_\/ __ mobile/motor home____ Other__ Residents in home: YV\@_,_ Us) ‘Area outside and immediately surrounding the home: ‘What occupations, if any, take place in the area immediately surrounding the home and/or inside the Bare? Taken KR dogs FoF A Walk wm she gressy ATCA Wn EAT of MOY aparkment ‘Terrain: Incline Gra Other Porch(Batig)Balcony/N.A Surface material: COWMCre ke Number of stairs: W/O Height of stairs: W/A Railing present (location, height, ease of use): 1) /\ Type and width of door toarea: SMB YUcn-levids door ,3>" ‘Type of furniture/ease of use: OVI» PAKG eA dices easily Plugs/switches (location, height, ease of usel: OV) @ Maintenance required: YOR How maintenance is completed currently: Parad Lancls capers Equipment/activities present (play, hobby, work, machinery): Cl Aner playng , Ease/efficiency of use of equipment: W/\ logs Gunlhun 4) Garaze/workshop How many cars: 2. Proximity of cars to entrance: 2.) £4, Number and height of steps from garage to entrance: 1, JyRailing present (location, height, ease of use): W/A Storage systems: VV /ry Ease/efficiency of use of tools/equipment: w/c Ways to improve occupational performance, improve moblliy, and/or improve safety in area immediately surrounding the home? ~ Porlene space closer +o enrvance = BA forholes (nw ayrassuy aren Front Entrance Number and height of steps: Railing present (location, height, ease of use): yy /oy Surfaces: Con CLE ke Types of knobsflocls: KRUPA enero Vock wW/ \evev Wandie Width of door: 2 6” Back Entrance Number and height of steps: 1/4 Railing present (location, height, ease of use}:: IJ gy Surfaces: N/a Types ofknobsslocks: Jy Width of door: Wy J a, Any concems with safety/ease/convenience of entering the home? — a Wngnrer \ignt bolo fot FrontKitchen Uist all occupations that take place in the kitchen and the primary users of this space: MEAN Preparation © dean -Vp Width of doorway into kitchen: // Height of kitchen dining table: 30 * Height of countertops: 3(," Continuous surfaces for sliding objects? WO, SM + OVEN WM xe wavy Type of stove: Oya S Types and location of controls on stove/burners: KV\OVOS Ana PLEW- lourtons On LroOWs And \oackck area of Stove, Types of controls on oven. VEMET WUMET, FEMPECATUMR | CLOCle Height of oven: ay," Effort needed to open/close oven: WAVY. na\ Are pots/pans 10 nea or do they get too hot? no, Comed Wwf Near Cesiskank RP uUbeer Type of refrigerator: AeUy ~Acoc Height Standles and refrigerator shelves: Wand e300" shelves a \ in MW 2" Dept of shelves Dishwasher controls: : smestnaye turns eno fot WeGW saucton Ease of loainglnioading: Ease of ee eoeee Boo\> dismwashey rome far From Calbmeny Plugs/switch fe ight, ease of use: jugs/switc! 3 Sr ee \ecatedl on eng. Deck. wasn of Storage oily on handles, organization, amount): Kuche no Pant Bo Knobs, some cuprvoa MN DME typically von area: \ cha rl are Ven Wg n/n Ways to improve occupational performance, improve mobility, and/or improve safety in kitchen area? — Stal anwny Cor \ess vendino J\P kw -Move clish Storage Berea Close: aK.Bathroom Su Shower Occupations that take place in the master bath-~SAREP AYes Sie , 5! % Make -VP apPucahon aroomin wisth of oorway: ayy Flooring: \WVO\R UW) Tyoesoffaucetsatsink: 2 hamdle corterdae faucet Tpesof foucetsintubjshowerssigi2 Handle Ul Knol NNon-skid surface in tub/shower: NONE, Height of step into tub/shower: |4** Height of toilet: |” Type of lever to flush: CUS -Cloum lever Location of toilet paper: Mignk Side of vile’ ugs/switches: | SeoNENacen aloove Counter YOps Light -Seviteh Heigm otminar: yoy > located” B-side of enriance Cupboards (height, type of handle, organization: Cupooacds \ecared Counter, No handke ® . ated onder DME typically used inthis area None Ways to improve occupational performance, improve mobility, and/or improve safety in bath area? “non-skid mak MW kUb/ shower T More Plug ONeAS Bedroom Occupations that take place in the bedroom area GLEE , Guessing Doorway width: Zo" Type of door/knob to access closet: \vey Wrandle Height of closet rod: &s" Type of handles, ease of use of Dresser drawers: AYAWeY PUTS , CASE) FO USE Organization of storageease offing tems? VEY, PFHAWIZed| EASY bo Yad itemsHeight and type of Lighting \am¢ on Arg stand (do ‘Ease of access to lighting by the bed: very close Yo oe d ME typically used in this area: none rea? Ways to improve occupational performance, improve mobility and/or improve safety in bedroom area — Wstadl overhead aWKRA, hee is no Switch ‘eu eMavante. i. ving room Occupations that take place inthe living room: Warde a elev sion y Yoga, Caring Doorway width: 24 " Most used furniture (type andheieht): Love SaC~ ZY" cote ee table 2%" Locations ang Ease of access to electronics televicioN and vemote in front of 5\t) a are Types and controls of window epverings veersical Dlinds w/ torn stick Types of controls to open/close windows Shading casement window storage (type, accets, organization) Open area Onder re lewsioN stand OME typically used in this area win . Ways to improve occupational performance, improve mobility, and/or improve ease of use in lving roomarea? NON, Seaning, Laundry (front/side toad, controls, storage of detergent) Aop -| f¥ One \oad At > acl Wwacher and yer, ron oreo ocared eo Stated are. auees hee Ninos WERE oa EM ELS Py Nquid ceterge Stored iH large Baskel wy hand ww vrenewt 4 welts Unclemeath k Garbage removal (bags, process, transport): ” Oaas Wed Ye be fake > A TEE aor ame ver Yair MPSHEE wohich isEquipment (vacuum, MOP, room, dustpan): oe wor Focoum orered yen closet) SN cue 8 in se stored nes FS Liew, Seer hE grove mobility, and/or imBrove ‘Sas ne osu of use related to better Srorane for Sutfer fl ~ Syrall dowecters erat We avon\alelt Other considerations ase of access to communication within and throughout the home can me Yard yo Wear eachomee a/c acceds and ease of use of Thermostat: - Easy to access uk swat, Nard +o vead prmt Access to Community Transportation: = public bus crop located cAirecHy acress We Skreet Access to grocery Store, drug stor, etc ~ BFeLeMY Stores and grarwraci€s AavarO& iw 2 wile « ets in the home and any related safety concerns: -2 syrall Ags, ali ems must lee Picked p otf He f\oer or over Sound of oll caw Presence of environmental hazards (rugs) cords, obstacles in major pathways, etc.): | ~Shepeny aren, i “ aves lorinvoow — M0 OMY oNstacie 5 |mary: List th i summary: List the top 5 modifications to the space that you feel would have the biggest impact on improving occupational performance, mobility, and/or safety in the home. Le AW the Pokloles in ovrside amassy area 2 In Stall overhead lignk in master bedreom ay frovide Synalles, easier to Access dumpsters, 4 Place non-skid mat wn Ywb/ Shower. STnstatl Brighter front porch \ight Additional recommendations: Provide more Storage Spare WwW Kircher areq rgpooey > ged sete Larne VOY PABA a A nipenai ve Signature Date and time:,