Safety Assessment. Home safety. Sufficient locks on all doors and windows? Harmful substances are kept in locked areas?

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Home safety Safety Assessment Sufficient locks on all doors and windows? Harmful substances are kept in locked areas? Medication and cleaning agents kept in locked areas? Child protective equipment on dangerous items? (e.g., stove) Alarm on doors or windows in the event they are opened? Video monitoring in common areas? Smoke detectors /carbon monoxide detectors active and located appropriately Fire extinguishers are available? Matches, lighters, fire equipment locked? Fireplace guard in place? Firearms are in secure locked location and deactivated? Large pieces of furniture are secure? Sharp or potentially dangerous items kept out of reach? Child bedrooms labeled for emergency personnel? Window guards installed? Safety gates installed near stairs? Allergy items locked up if appropriate?

Fire drills practiced? Elopement drills practiced? Elopement plan in place? Family has a safety plan with all emergency information handy? Outside Home Safety Fence around yard? Pond or lake area secured for safety? Pool alarm? Pool safety locks? Neighbor s pool secure? Video monitoring? Dangerous items locked away (ladder, machinery)? Garage locked and secure? Community Safety Child wears medical ID bracelet? If appropriate child wears GPS tracking system? Community emergency personnel informed of child? Photo provided to community personnel (police, fire department, EMS)? Neighbors informed of potential elopement risk? Neighbors provided with photo and contact information? Potential elopement locations identified and potential route noted? Child / Individual has some form of identification?

Plan for elopement or wandering identified by family members? Travel Safety Scouted location for potential safety issues (e.g., pool, preferred activities)? Notified hotel of needs and concerns? Informed the front desk and provide a picture with your contact information? Know all the potential exit locations? Use portable door alarms? Child has identification jewelry locator device, cellular phone, and/or identification cards? Requested a room without a pool/ocean view and balcony? Use a portable pool alarm? Behavior that poses personal safety concern Climbs? Elopes (e.g., leaves house unattended)? Wanders away from parents in community locations? Flops to ground and does not get up? Engages in pica (mouthing or ingesting nonedible items)? Engages in self-injury? Engages in aggression? Engages in bruxism? Engages in mischievous behavior (e.g., taking apart items)? Plays with substances? Scripts dangerous behaviors viewed on videos (e.g., throwing objects)?

Engages in property destruction? Approaches strangers? Displays inappropriate affection? Disrobes? Engages in food stealing? Safety Skills To Target: Holds hand of an adult Walks alongside adult / stays with an adult Follows instruction, Come here Responds to name by turning and looking Follows instruction, Stop Follows instruction Get down Asks for permission to leave a location Requests locations / people / activities / items Cooperates with medical ID jewelry Waits in designated area Answers relevant social questions with adequate articulation Exchanges communication card in response to social question or Are you lost Responds to text instruction to text location Uses augmentative device as back up or primary mode of communication Keeps seatbelt on Exits location when fire alarm signals

Swims Requests to swim Discriminates where swimming is permitted and where it is not Understands safety signs (e.g., Poison, do not enter) Waits at curb to cross street with an adult Looks both ways before crossing street and does not cross when cars are approaching Locks bathroom door / stall Labels places Labels location (i.e., answers question Where are you? ). Follows instruction on cell phone Labels location on the cell phone Follows instruction on cell phone to locate an adult and exchange emergency information when lost Texts location Takes photo or video of location and sends photo Calls an adult if separated or lost Identifies familiar person versus stranger Declines inappropriate instructions Says, No when offered food or activity from strangers Gets parent when doorbell rings Avoids dangerous substances and tells an adult Labels body parts Labels location of injury on self

Recalls experiences Discriminates good touch from bad touch Responds to lures from strangers by saying, no, running away, telling an adult Requests privacy Responds appropriately to emergencies (e.g., leaves location, calls 911)