Structure type: (2 story, ranch, bi-level, split level, I½ story, apt, duplex, town house) Location of house (rural, semi rural, suburban, urban)

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Universal Design Home Assessment Instructions: Please fill out as much information as possible on this page using observation techniques. Some questions may require information from the client. Date of home visit: UD Consultants: General Description of the house and location: Structure type: (2 story, ranch, bi-level, split level, I½ story, apt, duplex, town house) Building Material (brick, frame, stucco, stone, other) Approximate Age of House How well is the house maintained? Circle the appropriate response Interior: Poor Fair Average Good Excellent Exterior: Poor Fair Average Good Excellent Location of house (rural, semi rural, suburban, urban) Size of lot (acres) Grade of property: (flat, sloping, hilly) Location of house (level with street, above street level, below street level How many people live here? people List people and approx ages Height of primary residents How long have you lived in this neighborhood? years How long have you lived in your current home? years Do you own or rent your home? Own Rent Other What modifications have you made to this house to improve accessibility, When? Reprint of this document with permission of authors only (Zavotka, Susan; Huss, Megan; Teaford, Margaret; Price, Christine. The Ohio State University. Contact zavotka.1@osu.edu.

UNIVERSAL DESIGN HOME ASSESSMENT INSTRUMENT A. FRONT ENTRANCE 1. Sidewalk/Ramp a. Grade: For every 1 rise, ramp needs 12 in length b. Preferably no steps from driveway to porch c. Handrails: High enough for resident to hold on to while sitting and standing d. Walkway: Passageway is clear; easy to walk on e. Ramp and/or handrails are sturdy and secure 2. Weather Protection a. Covered area to protect against harsh weather b. A chair or a small table located next to door 3. Entry/Door a. No step from porch to entry area b. Threshold is no more than ½ above floor c. Width of door is at least 32 d. Peephole is eyelevel for primary resident e. Lock is easy to use/ touch pad could be used f. Handle is lever or D- shaped 4. Level of Lighting a. A clear bright light adjacent to door/doorbell

B. GARAGE ENTRANCE 1. Garage Features a. Garage is attached to house b. Driveway is flat c. Walkway: Passageway is clear; easy to walk on d. Ramp and/or handrails are sturdy and secure 2. Weather Protection a. Covered area to protect against harsh weather b. A chair or a small table located next to door 3. Entry/Door a. No step from garage floor to house b. Handrails are provided on both sides of steps c. Threshold is no more than ½ above floor d. Width of door is at least 32 e. Peephole is eyelevel for primary resident f. Lock is easy to use/ touch pad could be used g. Handle is lever or D- shaped 4. Level of Lighting a. A clear bright light adjacent to door/doorbell

C. ALTERNATIVE ENTRANCE 1. Sidewalk/Ramp a. Grade: For every 1 rise, ramp needs 12 in length b. Preferably no steps from yard to entrance c. Handrails: Both sides of steps d. Walkway: Passageway is clear; easy to walk on e. Ramp and/or handrails are sturdy and secure 2. Weather Protection a. Covered area to protect against harsh weather b. A chair or a small table located next to door 3. Entry/Door a. No step from porch/deck to house b. Threshold is no more than ½ above floor c. Width of door is at least 32 d. Peephole is eyelevel for primary resident e. Lock is easy to use/ touch pad could be used f. Handle is lever or D- shaped 4. Level of Lighting a. A clear bright light adjacent to door/doorbell

D. HALLS AND STAIRS 1. Stairs a. Railings are sturdy and exist on both sides of steps b. Railings extended beyond top and bottom of stairs c. Tread height: 6 ¾ Tread width: 9 ½ d. Safe material on stairs (flooring is not slippery or uneven) 2. Nightlight a. Located in hallway to prevent fall 3. Lighting a. Switches are within easy reach: 36"-48" from floor b. Rocker panel switch c. Level of lighting is about 40 footcandles 4. Hall Width a. At least 42" wide 5. Flooring a. Floor material is either nonglare, non-slip hard surface or low pile carpet. b. No scatter rugs or if necessary, non-slip backing

E. LIVING ROOM/FAMILY ROOM 1. First floor location a. Living area is located on first floor 2. Furniture Arrangement a. Allows for unobstructed movement in the space 3. Window sills a. No higher than 30 from floor for seated visibility 4. Emergency Response a. Phone jack and phone is located near a chair if person is not ambulatory 5. Nightlight a. Located in hallway to prevent falls 6. Lighting a. Switches and outlets are within easy reach: 18"-48" from floor b. Rocker panel switches c. General level of lighting is about 40 footcandles d. Task lighting is provided by a seating area 7. Flooring a. floor material is either nonglare, non-slip hard surface or low pile soft surface. b. No scatter rugs or if necessary, non-slip backing

F. KITCHEN 1. First floor location a. Living area is located on first floor 2. Counter and work surfaces a. Located next to appliances and sink b. Work surfaces vary from 36" to 30" from floor c. At least one seated work area is available 3. Cabinets/Storage a. Door handles are D shaped b. Roll-out shelves and/or baskets provide accessibility c. At least some shelves are located at shoulder height 4. Appliances a. Refrigerator: Side-by-side or freezer on the bottom b. Range/oven: Electric, oven at shoulder height or below c. Microwave: Shoulder height or below d. Dishwasher: Raised for easier access e. Controls: Easy to reach, read, and manipulate

F. KITCHEN continued.. 5. Lighting a. Switches and outlets are within easy reach: 18"-48" from floor b. Rocker panel switches c. General level of lighting is about 75 footcandles d. Task lighting is provided by work surfaces 6. Flooring a. Floor material is either nonglare, non-slip hard surface or low pile carpet. b. No scatter rugs or if necessary, non-slip backing 7. Doorways a. Doorway is at least 32 wide b. Lever door handle

G. BATHROOM FIRST FLOOR 1. First floor location a. Full bath with shower is located on first floor 2. Location a. Located in an area that is easy for resident to get to 3. Walk-in Shower a. Contains a hand-held adjustable shower head b. Grab bars that can support the primary users c. Easy to reach water control and faucets d. Lever faucet handles e. Fold-down shower seat f. Shower floor should be a non-slip surface 4. Bathtub a. non-slip bottom surface b. grab bars 5. Sink a. Lever faucet handles b. Surface height is 30" with 29" clearance for wheelchair 6. Storage/accessibility a. Shelves and baskets provide easy accessibility to items b. Medicine cabinet shelves within easy reach c. Linen closet- shelves within easy reach d. Cabinet handles are D- shaped

G. BATHROOM FIRST FLOOR continued. 7. Lighting a. Switches and outlets are within 18"-48" from floor b. Rocker panel switches c. General level of lighting is about 70 footcandles d. Task lighting is provided by sink e. Nightlight in bathroom 8. Flooring a. Either non-glare, non-slip hard surface or low pile soft surface. b. If bath mat is used, it should have a non-slip backing 9. Doorways a. Doorway is at least 32 wide b. Lever door handle 10. Floor space a. A 5 x5 floor space for wheel chair accessibility 11. Toilet a. Toilet at a reachable height (according to resident) b. Reinforced walls by toilet for grab bar installation if needed 12. Emergency Response System a. telephone or some form of emergency response present

H. BATHROOM SECONDARY 1. Location a. Located in an area that is easy for resident to get to 2. Walk-in Shower a. Contains a hand-held adjustable shower head b. Grab bars that can support the primary users c. Easy to reach water control and faucets d. Lever faucets instead of knobs e. Shower floor should be a non-slip surface 3. Bathtub a. non-slip bottom surface b. grab bars 4. Sink a. Lever faucet handles b. Surface height is 30" with 29" clearance for wheelchair 5. Storage/accessibility a. Shelves and baskets provide easy accessibility to items b. Medicine cabinet shelves within easy reach c. Linen closet- shelves within easy reach d. Cabinet handles are D- shaped

H. BATHROOM SECONDARY continued. 6. Lighting a. Switches and outlets are within 18"-48" from floor b. Rocker panel switches c. General level of lighting is about 20 footcandles d. Task lighting is provided by sink e. Nightlight in bathroom 7. Flooring a. Either non glare non-slip hard surface or low pile soft surface. b. If bath mat is used, it should have a non-slip backing 8. Doorways a. Doorway is at least 32 wide b. Lever door handle 9. Floor space a. A 5 x5 floor space for wheel chair accessibility 10. Toilet a. Toilet at a reachable height (according to resident) b. Reinforced walls by toilet for grab bar installation if needed 11. Emergency Response System a. telephone or some form of emergency response present

I. BEDROOM FIRST FLOOR 1. First floor location a. Bedroom/room that could become a bedroom is available on the first floor 2. Furniture Arrangement a. Allows for unobstructed movement in the space (5' x 5' floor space) 3. Window sills a. No higher than 30 from floor for seated visibility 4. Emergency Response a. Phone jack and phone is located near the bed 5. Nightlight a. Located in hallway near bedroom 6. Lighting a. Switches and outlets are 18"-48" from floor b. Rocker panel switches c. General level of lighting is about 70 footcandles d. Task lighting is provided by the bed 7. Flooring a. floor material is either nonglare, non-slip hard surface or low pile carpet. 8. Storage a. Multi-level, adjustable shelves and rods, most at shoulder level or below 9. Doorways a. Doorway is at least 32 wide b. Lever door handle

J. BEDROOM SECONDARY 1. Furniture Arrangement a. Allows for unobstructed movement in the space (5' x 5' floor space) 2. Window sills a. No higher than 30 from floor for seated visibility 3. Emergency Response a. Phone jack and phone is located near the bed 4. Nightlight a. Located in hallway near bedroom 5. Lighting a. Switches and outlets are 18"-48" from floor b. Rocker panel switches c. General level of lighting is about 20 footcandles d. Task lighting is provided by the bed 6. Flooring a. floor material is either nonglare, non-slip hard surface or low pile carpet. 7. Storage a. Multi-level, adjustable shelves and rods, most at shoulder level or below 8. Doorways a. Doorway is at least 32 wide b. Lever door handle

K. LAUNDRY 1. Location a. First floor location 2. Washer/Dryer a. Front loading washer & dryer b. Front or side controls easy to grasp and turn 3. Table/counter space a. A place to sit for folding or sorting clothes 4. Lighting a. Switches and outlets are 18"-48" from floor b. Rocker panel switches c. General level of lighting is about 70 footcandles d. Task lighting is provided by washer and dryer 5. Flooring a. floor material is either nonglare, non-slip hard surface or low pile carpet. 6. Storage a. Multi-level, adjustable shelves and rods 7. Doorways a. Doorway is at least 32 wide b. Lever door handle

L. GENERAL 1. Thermostat a. Located 57 from floor 2. Smoke /Carbon monoxide detectors a. One smoke detector per floor (in bedroom or hallway) b. Carbon monoxide detector 3. Basement Stairs a. Railings are sturdy and exist on both sides of steps b. Railings extended beyond top and bottom of stairs c. Tread height: 6 ¾ Tread width: 91/2" d. Safe material on stairs (flooring is not slippery) 4. Convenient outdoor water spigot