Your Personal Home Safety & Independence Planning System. Fill it in right here, it autosaves on your device, and you can print, save as PDF, or export a backup file anytime.
Rate each area 1–5 (1 = safe, 5 = hazard). Anything 3+ is a priority: photograph it and add it to your 30-Day Plan in Section 6.
Part A · Fall Risk Hotspots
Part B · Daily Task Friction
For each task: difficulty 1–5, which body part it stresses, and how long it takes.
Part C · Emergency Preparedness
Section 2
Bathroom Audit & Upgrade Ladder
20 min · after changes / annually
Current State
Upgrade Ladder: pick a level per zone
Renters: everything in the $0–$50 columns is 100% reversible. No damage. Take it with you.
Section 3
Kitchen & Living: Golden Zone Mapper
30 min · after reorg / annually
Golden Zone rule: weekly-use items live between shoulders and hips. Reaching up / bending down all day is cumulative injury: 73,000 shoulder impingement opportunities a decade, or zero.
Golden Zone Inventory
Chair & Seating Audit
Pass test: stand up without using hands · knees at 90° · feet flat · no rocking.
Living Room Hazard Map
Section 4
Stairs, Entryways & Night Navigation
20 min · quarterly
Stair Audit (each run)
Entryway Audit
Night Navigation System
Red light rule: bedroom & bath hallways get red/amber only. Preserves melatonin and night vision.
Section 5
Pain Pattern Tracker
2 min/day · 14 days minimum, then weekly
Why 14 days? Patterns hide until you write them down. The trigger you can name is the trigger you can fix.
14-Day Baseline Log
Pattern Analysis (after 14 days)
Section 6
The 30/60/90-Day Upgrade Plan
execution starts day 5
30-Day Sprint · High risk / low cost / high impact
60-Day Build · Medium investment / structural
90-Day Future-Proof · Major / planning
Section 7
Family Conversation Toolkit
the highest-leverage conversation you'll have
Conversation Planner
Who When Where Format
Talking-Point Script
"I've been working on a home safety plan. I've assessed the house, found some things to fix, and made a 90-day roadmap. I'd love to walk you through it, partly so you know what I'm doing, partly because your help on a few things would be great. No pressure, just want you in the loop."
Specific Asks
Boundaries to State Clearly
Follow-Up Email Draft
Section 8
Quarterly Reassessment Protocol
Jan / Apr / Jul / Oct
Quarterly Review Checklist
Annual Deep Dive (your birthday month)
Section 10
My Plan & My Team
the part that makes it yours
My "Why": read this when motivation dips
My Non-Negotiables
My Team
Pharmacy & Medical
Pharmacy Insurance Allergies Blood type
Filled 5 sections? You're ahead of 99% of households.
The 5-day email course walks you through this workbook one day at a time: assessment, bathroom, kitchen, stairs, then a 30/60/90 plan that actually sticks.