Module 3- Site Safety

  1. Promoting Safety
    1. Accident
    2. Poisoning
      1. Preventing Poisoning or Chemical Accidents
    3. Material Safety Data Sheets
    4. Preventing Burns and Scalds
    5. Emergency Preparedness Plan
      1. Evacuation
      2. Hazards
      3. Responsibilities
      4. Agency Emergency Plans
      5. Severe Weather Preparedness
      6. Thunderstorms
      7. Flooding
    6. Fire Safety
      1. Making of a Plan
      2. Practice Your Plan
      3. Fire and Severe Weather Drills
      4. DHS Surveyors' Recommendations on Fire Drills
    7. Carbon Monoxide Detectors
    8. Disaster Preparedness Rules
    9. Food Safety
      1. Temperature
      2. Hand Washing
      3. Avoid Cross-Contamination
    10. Safe Eating
      1. Awareness is the First Step of Prevention
      2. Emergency Response to Choking
    11. Slips, Trips, and Falls
      1. Preventing Slips, Trips and Falls
      2. Emergency Response to a Fall Incident
    12. Water Safety
      1. Before A Swimming/Water Sport Activity
      2. In The Water
      3. Bathing

Promoting Safety

People with intellectual disabilities have the same safety needs as the staff. A clean and orderly living space promotes staff and individual's safety, as well as accident prevention. The individual's you serve need to exercise control over their environment. Every room in a home needs to accommodate the accident prevention needs of each person who uses that room.

Staff should assist the individual with developing the right knowledge, skills, and habits necessary to prevent unsafe behavior. Teaching individual, the right skills and attitudes can prevent behaviors that result in accidents. The staff must set a good example and communicate a level of expectation on how to maintain clean and orderly environments.


An accident is an unplanned act or event resulting in injury or death to individual or damage to property. Accidents are not accidental. Most accidents take place for obvious reasons. Most accidents are caused by unsafe behavior. You can reduce accidents by changing your own behavior and the behaviors of individuals.


Accidental poisoning can be reduced by keeping all medicines, including nonprescription drugs, and other poisonous substances away from regular food and drink. Never store poisonous materials in unmarked or easily confused containers. Store cleaning supplies securely and well away from food and food preparation areas. Keep all products in original containers. And never store any cleaning products or other poisonous materials in a location that individuals who don't know how to safely use them can access. Poison Control numbers should be readily available to all staff and individuals supported. If possible, have a list of antidotes for various the poisons.

Preventing Poisoning or Chemical Accidents

If anyone at your facility has specific behavioral characteristics that put them at risk of poisoning or accidental injury, your agency should have a policy and procedures that staff should follow for keeping harmful chemicals (e.g., cleaning supplies, gasoline) and objects (e.g., knives, baseball bats, ladders) secure. However, if the individuals know how to use these items appropriately, then it would be an unnecessary restriction to keep them locked.

As you know, household cleaners can be toxic, even poisonous, if ingested, inhaled, or, in some cases, even if it meets skin. It is the organization's responsibility to make sure that your individuals served are kept safe. Therefore, it is imperative that caution be used with household cleaning products. They can cause illnesses. Most, but not all, household cleaners have labels. Many times, there are chemicals listed which you may not be familiar with. Household cleaners cannot be stored near food. Any toxic products must be kept in their original containers. Some cleaning product bottles look very similar to bottles used to hold drinks or other edibles. Be sure staff are aware of the safety needs for all chemical storage.

Poison Help Hotline 1-800-222-1222

Selection Use and Storage of Hazardous Household Products

When you go shopping for products, your selection can be your first step toward minimizing danger. Follow these guidelines:

  • Read the label. Make sure you want the product. Are the ingredients safe to use in and around your home?
  • Make sure the product will do the job you need to have done.
  • Buy the least hazardous product for the job. Let the signal words (Poison, Danger, Warning, Caution) be your guide.
  • Check the label to see if a product has several uses. Then you can avoid buying a different product for each job.
  • Avoid aerosol products. Aerosol products may contain hazardous or toxic propellants, and the fine mist that they produce may be more easily inhaled. Pressurized cans cause problems or explode when they are crushed, punctured or burned.
  • Make sure you know how to properly dispose of the container.

Remember, the word "non-toxic" is for advertising only. It does not mean the product meets any federal regulations for non-toxicity.

It may be impossible to eliminate hazardous products in your home. The following guidelines will help you when using hazardous products to keep your home and environment safe.

  • Read the directions on the label and follow them. Twice as much doesn't mean twice the results.
  • Use the product only for the tasks listed on the label.
  • Wear protective equipment recommended by the manufacturer.
  • Handle the product carefully to avoid spills and splashing. Close the lid as soon as the product is used. This will control vapors and reduce chances of spills.
  • Use products in well-ventilated areas to avoid inhaling fumes. Work outdoors if possible. When working indoors, open windows. Use a fan to circulate the air toward the outside. Take plenty of fresh-air breaks. If you feel dizzy, develop a headache or become nauseous take a break and go outside.
  • Do not eat, drink or smoke while using hazardous products. Traces of hazardous chemicals can be carried from hand to mouth. Smoking can start a fire if the product is flammable.
  • Do not mix products unless directions indicate that you can safely do so. This can cause explosive or poisonous chemical reactions. Even different brands of the same product may contain incompatible ingredients.
  • If pregnant, avoid toxic chemical exposure as much as possible. Many toxic products have not been tested for their effect on unborn infants.
  • Avoid wearing soft contact lenses when working with solvents and pesticides. They can absorb vapors and hold the chemical near your eyes.
  • Carefully and tightly seal products when you have finished. Escaping fumes can be harmful and spills can occur.
  • Most important of all: Use common sense.
  • Store it safely in your home. Follow label directions for proper storage conditions.
  • Leave the product in its original container with original label attached.
  • Never store hazardous products in food or beverage containers.
  • Make sure lids and caps are tightly sealed.
  • Store hazardous products in a safe location.
  • Store incompatibles separately
  • Keep flammables away from corrosives.
  • Store volatile products-those that warn of vapors and fumes in a well-ventilated area, out of reach of children and pets.
  • Keep containers dry to prevent corrosion.
  • Store rags used with flammable products (furniture stripper, paint remover, etc.) in a sealed marked container.
  • Keep flammable products away from heat, sparks or sources of anything that could ignite them.
  • Know where flammable materials in your home are located and know how to extinguish them.

An astounding array of hazardous products can be found in and around our homes. They are common, everyday household products as well as in pesticides. While we cannot eliminate all contact with toxic materials, we can minimize the contact.

Make informed decisions about the selection, use and storage of hazardous products. Remember hazardous products may be flammable, explosive, corrosive/caustic, toxic/ poisonous or reactive.

Learn to read the labels. Look for the signal words. POISON means highly toxic. DANGER means extremely flammable or corrosive or highly toxic. WARNING or CAUTION means less toxic.

Lastly, use common sense when using and storing hazardous products to decrease the potential health hazards and pollution.

Material Safety Data Sheets

A material safety data sheet (MSDS) is a form containing data regarding the properties of a substance. It is intended to provide workers and emergency personnel with procedures for handling or working with substances in a safe manner and includes information such as physical data (melting point, boiling point, flash point, etc.), toxicity, health effects, first aid, reactivity, storage, disposal, protective equipment and spill-handling procedures, chemical compounds, and chemical mixtures. MSDS information may include instructions for the safe use and potential hazards associated with a material or product.

The Occupational Safety and Health Administration (OSHA) requires that material safety data sheet (MSDS) "shall be maintained and kept in a readily accessible area". That means that MSDSs for the hazardous substances should be available to all staff. Any MSDS sheets that you receive with shipments or that you receive separately should be placed in your MSDS binder or file.

Before you work with products or chemicals, you should familiarize yourself with their potential for flammability, corrosiveness, and toxicity, as well as storage and handling information. Also, it is vital that you can refer to that MSDS immediately in the event of an emergency such as a spill, fire, or physical contact with the chemical. So, the next time you receive an MSDS, remember that it provides important and necessary health and safety information.

Preventing Burns and Scalds 

People with intellectual and developmental disability may not be able to safely and adequately respond to water temperatures. There are multiple factors that impact this, but someone's intellect, perception, memory, judgement, or awareness may contribute to an individuals inability to recognize a dangerous water temperature. Individual may not be physically able to communicate to staff if the water feels hot or cold, or be able to physically remove themselves from the water. People respond differently to different water temperatures. What is consider cold to one person, may not be cold to another. Some people report that 100 degree water feels hot, while others believe 100 is cold. Safe water temperature is considered to be 100 degree F.

Water safety:

Time elapse Temperature of water F Temperature of water C
1 second 155 68
5 Seconds 140 60
5 minutes 125 48
Safe Bath Water 100 37

Public Health standards state that water from the tap be no warmer than 110 degree at any time. This is to prevent scalding. Every RD is responsible for ensuring that all water temperatures are maintained below 110 degree.

How to Test Your Water Temperatures

  • Follow the thermometer manufacturer's recommended instructions for use.
  • Measure the hot water temperature prior to heavy use, or at least one hour after, so the hot water heater has time to recover and heat to its set temperature.
  • To insure accuracy, do not hold the thermometer under the running water to measure the temperature.
  • Allow the hot water to run for enough time to ensure the water is at its hottest temperature.
  • Fill a bowl or cup with hot water.
  • Immediately immerse the end of the thermometer completely into the contained water.
  • Keep the thermometer in the water until the measurement has stabilized (30 to 60 seconds), then read the temperature.

How to Prevent Scald Burns

  • Check water temperatures daily at various points to ensure that the temperature of hot water available to individuals at shower, bathing, and hand washing facilities does not exceed 110 degrees F.
  • Limit access to water temperature controls.
  • Water heater thermostats may not be very reliable. Most are marked low medium-high and do not indicate exact water temperature.
  • Install mixing valves and aqua stats on plumbing systems
  • Install anti-scald devices on faucets and showerheads. Follow manufacturer's instructions for proper maintenance and calibration of anti-scald devices. 
  •  When filling the bathtub, mix the water thoroughly and check the temperature by moving your elbow, wrist, or hand (with fingers spread) through the water before allowing someone to get in.
  • Provide constant supervision to anyone who may have trouble removing themselves from hot water or people who may not recognize the dangers associated with turning on the hot water.
  • Be certain that the water temperature in the house is at a safe level and that all the people who live there can mix hot and cold water to the correct temperature. If they are unable to do so, then ensure that the water temperature does not exceed 110 degree F. The water test should be done during periods of use and water heater recovery to ensure correct temperature is maintained.

If water temperatures greater than 110 degrees are needed for washing machines or dishwashers consider installing a second hot water heater. The second hot water heater should not be hooked into the flue from an existing gas hot water heater.

Emergency Preparedness Plan

Your agency/facility should have, or should develop, an emergency preparedness plan that will cover all categories of emergencies. It should be practiced at least twice a year. The staff and individuals at your facility need to be aware of the actions they should follow in the event of an emergency, using the emergency plan as a guide.


The plan should describe and show a diagram of the safest escape routes for staff and individuals. Choose area leaders for emergency evacuation. The escape plan should be posted and distributed to all employees.


Plans should identify hazards, and which hazards are the biggest risks. Outline actions that prevent or reduce hazards, and recommend actions to take in advance to mitigate, or prevent, a problem from becoming a major emergency.


The emergency plan should outline the responsibilities of each department during an emergency. Agencies should determine how it will communicate emergency roles and actions to its employees. Speak with your facility's management to find out how your facility provides information on its emergency plan to employees.

Agency Emergency Plans

In a major emergency, response systems such as police, fire and hospitals will be overwhelmed. Officials from all levels of government and the Red Cross tell us we should be prepared to be on our own for the first 72-hours.

Emergency Supply Kit 

A disaster of any kind may interfere with normal supplies of food, water, heat and day to-day necessities. It is important to keep a stock of emergency supplies on hand.

Emergency supplies may include the following:

  • A battery powered radio, weather radio, and flashlights, with extra batteries
  • Bottled drinking water - one gallon per day per person with at least a three-day supply for each person
  • Canned or sealed packaged foods that do not require refrigeration or cooking (at least a three-day supply)
  • Non-electric can opener, utility knife and mess kits
  • Paper towels, toilet paper, soap and detergent
  • Household laundry bleach (unscented)
  • A blanket or sleeping bag for each person
  • One change of clothing and footwear per person
  • Fire extinguisher
  • Shut-off wrench, to turn off household gas and water
  • Signal flare matches and whistle
  • Cell phone and extra battery
  • An extra set of car keys and a credit card, cash or traveler's checks
  • An emergency list of individuals information including, medications, physicians, guardian/family contacts and any other necessary information
  • First-aid kit and manual
  • Medications or special foods needed by individuals such as insulin, heart medication, dietetic food (Do not store in the kit for long period of time but add at the last minute)
  • If needed - Ensure and Depends
  • Denture needs, extra eyeglasses and contact lens supplies
  • You can store additional water by filling bathtubs and sinks with water if an emergency is declared.
Preparing Staff for Emergencies

Make sure your staff is mentally, physically, and emotionally prepared to respond. In an emergency, the first concern of staff will be the safety and welfare of family members and individuals. Encourage and support staff to have a family emergency plan so they know how their families will be taken care if they are at work at the time of the emergency. Your agency will want to ensure that all staff members have an opportunity to check with family members as soon as possible after an emergency.

The emergency preparedness plan covers the following six critical areas of emergency management:

  • Communication-plans for maintaining communication
  • Resource and assets-how to access needed supplies and support
  • Safety and security-how to maintain a safe environment
  • Staff responsibilities-adopting staff roles to meet the demands of caring for individuals
  • Utilities management-supplying uninterrupted utilities
  • Clinical and support activities-plans to address the needs of individuals during extreme conditions

Some things to consider for your Agency Emergency Plan

  • Which staff will automatically report to work in the event of a disaster?
  • Are your current volunteers appropriate for disaster related work?
  • What safety and/or legal considerations should you include in your plan?
  • Consider: do you have proper insurance for volunteers? Is any specialized training or knowledge required for working with your agency or clients, etc.?
  • How many individuals would most likely be at your site in a disaster?
  • Look at both maximum individual load and minimum availability for day, for evenings and weekends.
  • How will you find out about the condition of individual you serve who are off site?
  • What are the special needs of the individual you serve? Are these needs of the group or of individuals?
  • If your facility must be evacuated, assign a staff person the responsibility of taking a head count to ensure that all staff, volunteers and individuals have exited.
  • Who will post a notice indicating where you have gone?
  • What temporary shelter will be used? (Consider nearby schools, churches, etc. You may want to develop mutual aid)
  • If you do not have a back-up generator, in an extended power outage, where can you rent or borrow a generator? (Create a written agreement with a supplier?)
  • Where is the nearest fire station, and do they know about your agency?
  • Where is the nearest police station, and do they know about your agency?
  • Assign responsibility for care of individuals at alternate sites.
  • Review plan every six months to make sure it is still current

Severe Weather Preparedness

There are a few severe weather hazards that affect Illinois, including thunderstorms, tornadoes, lightning, floods, flash floods, damaging winds and large hail.

Tornadoes are violent storms with whirling winds up to 300 miles per hour. They may strike quickly without warning. The average forward speed of a tornado is 30 MPH but may vary from stationary to 70 MPH.

  • Most tornado damage paths in Illinois are less than 100 yards wide and a couple of miles long but can be up to a mile wide and more than 60 miles long. With whirling wind speeds up to 300 miles per hour.
  • Most Illinois tornadoes occurred between March to June with deadliest occurring in March, April and May. They usually occur between the hours of 3 PM and 10 PM. However, they have occurred every month of the year and at all hours of the day.
  • Nearly 30% of all tornadoes in Illinois occur after dark. It is CRITICAL that homes monitor severe weather conditions. A weather radio is an excellent way to do this.
  • Illinois averages 54 tornadoes per year from 1991-2020.
  • Tornado Watch - means that conditions are favorable, go to a safe place and listen for sirens.
  • Tornadoes Warning means one has been spotted seek shelter immediately.
    • Best shelters
      • In a substantial building
      • Away from windows and doors
      • In a basement
      • No Basement? Get to the lowest floor in a small, interior room, such as closet, hallway or bathroom WITHOUT windows.
If you are in: Then:
A structure (e.g. residence, small building, school, nursing home, hospital, factory, shopping center, high-rise building) Go to a pre-designated shelter area such as a safe room, basement, storm cellar, or the lowest building level. If there is no basement, go to the center of an interior room on the lowest level (closet, interior hallway) away from corners, windows, doors, and outside walls. Put as many walls as possible between you and the outside. Get under a sturdy table and use your arms to protect your head and neck. Do not open windows.
A vehicle, trailer, or mobile home Get out immediately and go to the lowest floor of a sturdy, nearby building or a storm shelter. Mobile homes, even if tied down, offer little protection from tornadoes.
The outside with no shelter

Lie flat in a nearby ditch or depression and cover your head with your hands. Be aware of the potential for flooding.

Do not get under an overpass or bridge. You are safer in a low, flat location.

Never try to outrun a tornado in urban or congested areas in a car or truck. Instead, leave the vehicle immediately for safe shelter.

Watch out for flying debris. Flying debris from tornadoes causes most fatalities and injuries.

Tornado Safety
Before a tornado:
  • Make sure everyone knows where the safe location is
  • Store an emergency kit in the safe location
  • Make an agency communications plan
  • Follow agency polices/procedures for tornado safety
During a Tornado:
  • Go to safe location away from windows on the lowest level of a sturdy building
  • If caught outside, get in a car, buckle-up, and try to drive to the closet sturdy shelter. NEVER seek shelter under a bridge, and only lie flat in a ditch as a last resort.
After a Tornado:
  • Beware of downed power lines, broken gas lines, sharp and dangerous debris
  • Avoid damaged areas
  • Stay off the roads to allow rescue workers clear passage
  • Follow instructions from local officials

Listen to local radio and TV stations and keep telephone lines clear for emergency calls. Report any funnel shaped clouds to the police.


Thunderstorms many times precede a tornado. Thunderstorms can have straight-line winds which may exceed 100 miles per hour. During a thunderstorm you should move into a building, preferably an interior room away from windows. If you are outside and unable to find a sturdy building, move to a car. Do not say in or near water.

Lightning is the second most common weather condition that KILLS (floods are first).


Be aware of flood hazards. Floods can roll boulders, tear out trees, destroy buildings and bridges, and scour out new channels. Flood waters can reach heights of 10 to 20 feet and often carry a deadly cargo of debris. Flood-producing rains can also trigger catastrophic debris slides.

Regardless of how a flood or flash flood occurs, the rule for being safe is simple: head for higher ground and stay away from flood waters. Even a shallow depth of fast-moving flood water produces more force than most people imagine. The most dangerous thing you can do is to try walking, swimming, or driving through flood waters. Two feet of water will carry away most automobiles.

For additional information on severe weather or other hazards, contact the following:

  • Your local Emergency Management Agency (EMA/ESDA)
  • Your local chapter of the American Red Cross (ARC) or
  • The nearest office of the National Weather Service (NWS)

Fire Safety

Fire is the most dangerous household accident. Injury and death result from smoke inhalation, burns, and heat. Smoke inhalation causes most of the deaths. Modern plastics do not burn quickly, but they produce large amounts of very toxic smoke. Fire and smoke are especially dangerous for people who do not make quick decision, or who move slowly. Smoke alarms can cut your risk of dying in a home fire nearly in half, but you must know what to do when they go off.

Making of a Plan

Draw a floor plan of your agency/facility, marking two ways out (including windows) of every room, and decide on the best escape routes. Pick an outside meeting place, preferably in front of your home and tell everyone to meet there after they've escaped, so you can count heads and tell firefighters if anybody's trapped inside.

Practice Your Plan

Every household should have a fire escape plan, but practice is essential; there's no time to lose in a fire emergency. Practice your escape plan as often as your individuals need to practice. The Office of State Fire Marshall has expectations on how many drills are completed every year. Every year, agencies are required to complete drills on every shift, including the overnight when people are sleeping. Every agencies should sound the alarm throughout the year to ensure individuals know how to respond in the event of an emergency.  Make your exit drills realistic. Pretend that some exits are blocked by smoke or fire and practice using alternative escape routes.

If you are caught in a fire, remember:

Heat rises carrying smoke with it, so air will be cooler and cleaner near the floor during a fire. If you run into smoke, try another escape route. If you must exit through the smoke, crawl on your hands and knees and keep your head close to the floor.

Remember RACEE If you smell smoke or discover a fire at your site, you should do the following in the order outlined:

  • Remove/Rescue the individuals and any others in the immediate danger.
  • Alert the fire department by calling 911 or local emergency number from a phone out of harm's way
  • Contain the fire by closing doors between you and the fire.
  • Extinguish the fire by using proper type of fire extinguisher, when appropriate or if it is small and easy to contain.
  • Evacuate (leave) the building immediately

Fire and Severe Weather Drills

When an alarm sounds for a drill (fire or weather alarm for a severe weather), follow the instructions provided by your agency/facility. After a drill or an evacuation drill, everyone's response to the drill is reviewed and evaluated so improvements can be made in future drills or in the case of an actual fire or severe weather event.

  • Review agency policy and procedure on disaster drills to ensure compliance with rule requirements and agency philosophy.
  • Write a drill schedule for the entire year, including the dates each type of drill should be run and on what shift it should occur.
  • Ensure staff is following the drill schedule by checking documentation the following day.
  • Follow up on any problems that may have occurred during the drill. Then check the documentation next month to see if they reoccur.
  • If your system is hard wired to an alarm company, check with them for any reception problems.
  • Run a surprise drill by not telling any staff or individuals. If there are problems during this drill, it may be an indication that staff is not properly implementing fire & disaster drills.
  • Record the length of time the drill takes to complete. There are regulations regarding the length of time it takes to evacuate in the event of a fire.


Fire and Evacuation Drill Statutory Requirements for ICF/DD
  • Fire drills shall be held at least quarterly for each shift of facility personnel.
  • Disaster drills for other than fire shall be held twice annually for each shift of facility personnel.
  • Drills shall be held under varied conditions
  • Fire drills shall include simulation of evacuation of residents to safe areas during at least one drill each year on each shift.
  • Each facility shall establish and implement policies and procedures in a written plan to provide for the health, safety, welfare and comfort of all residents when the heat index/apparent temperature, as established by the National Oceanic and Atmospheric Administration, inside the residents' living, dining activities, or sleeping areas of the facility exceeds a heat index/apparent temperature of 80 degrees F.
Fire and Evacuation Drill Statutory Requirements for CILA
  • Each living arrangement shall have a smoke detection system which complies with the Smoke Detector Act [425 ILCS 65].
  • There shall be documentation that living arrangements are inspected quarterly by the licensed CILA agency to ensure safety, basic comfort and compliance with this Part.
  • The agency shall develop, implement and maintain a disaster preparedness plan which shall be reviewed annually, revised as necessary and ensure that records and reports of fire and disaster training are maintained.
  • Evacuation drills are conducted at a frequency determined by the agency to be appropriate based on the needs and abilities of individuals served by the living arrangement but no less than on each shift annually.
  • Special provisions shall be made for those individuals who cannot evacuate the building without assistance, including those with physical disabilities and individuals who are deaf and/or blind.
  • Evacuation drills shall include actual evacuation of individuals to safe areas.
  • At least one approved fire extinguisher shall be available in the residence, inspected annually and recharged when necessary
  • First aid kits shall be available and monitored regularly by the agency.
Fire and Evacuation Drill Statutory Requirements for Community Day Service
  • Buildings used by the provider for the program shall conform with Chapters 28, 29 and 31 (specifically, Section  31-1.1 through 31-1.6 of Chapter 31) of the NFPA 101, Life Safety Code (National Fire Protection Association, 1988)
  • The provider shall develop, implement and maintain a disaster preparedness plan which shall be reviewed annually.
  • A record of actions taken to correct noted deficiencies in disaster drills or inspections is maintained.
  • Evacuation drills are conducted at a frequency determined by the provider based on the needs and abilities of the individuals served, but must be completed annually at minimum.
  • Special provisions are made for those individuals who cannot evacuate the building without assistance, including those with physical disabilities and individuals who are deaf and/or blind.

DHS Surveyors' Recommendations on Fire Drills

You are required by law and Rule(s) to practice fire drills at your facility. When conducting drills, remember:

  • During a drill, practice what is written in the evacuation procedures. If they don't result in a successful outcome, evaluate the reasons and amend the procedures.
  • Record actual time of day the drill began, the length of time it took to clear the site, and the time it took for all individuals to reach the agreed upon meeting place.
  • Be sure to document what was done to correct a problem, not just identify the problem in the follow up documentation.
  • If multiple individuals at the site need physical assistance, how and/or in what order are staff to assist.
  • When planning drills, not only should they be timed during different shifts, but also during various activities.
  • If your agency changes a procedure in writing to correct a problem, you are responsible for implementing that change.
  • You may want to incorporate rule language when writing policies and procedures.
  • Whenever possible, teach individuals to use safety devices (drop down ladders, fire extinguishers, etc.) in case staff are unable to assist them during an emergency. 
  • Weather conditions. Completely drills in all types of weather is important, but remember the individuals safety during a drill. And respond appropriately if it there is unsafe weather.
  • Have some exits purposely blocked to assure your plan will work if one planned exit is not useable during an actual emergency

Carbon Monoxide Detectors

Carbon monoxide detectors are true life savers. Carbon monoxide (CO) is:

  • A colorless, odorless, and tasteless gas or liquid.
  • It results from incomplete oxidation of carbon in combustion.
  • It burns with a violet flame.
  • It is slightly soluble in water.
  • It is soluble in alcohol and benzene.

Every home is required to have carbon monoxide detectors in the home within 15 feet of all sleeping areas for homes that use fossil fuel to cook, heat or produce hot water, or if the home is connected to a large garage.

Disaster Preparedness Rules

Rules  CILA (Rule 115) DT (Rule 119) ICFDD (Rule 350,370)
Fire Extinguishers At least one at each site which staff can locate and use. Inspected annually. At least one at each site which staff can locate and use. Inspected annually. All personnel must be properly instructed in its use. Practice during drills.
Diagram of Evacuation Route Must be posted and made familiar to all Must be posted and made familiar to all Must be posted and made familiar to all
Severe Weather Plan reviewed annually and revised as necessary. Staff knows how to react. Drills no less than annually on each shift. Plan reviewed annually and revised as necessary. Staff knows how to react. Drills no less than annually on each shift. Written plan developed. Drills held twice annually for each shift. Written evaluation of effectiveness.
Fire Drills Plan reviewed annually and revised as necessary. Staff knows how to react. Drills (incl. actual evac) no less than annually on each shift. Plan of correction for inefficiency or problems. Plan reviewed annually and revised as necessary. Staff knows how to react. Drills (incl. actual evac) no less than annually on each shift. Plan of correction for inefficiency or problems. Held at least quarterly on all shifts. Written evaluation of effectiveness.
Disaster Requiring Relocation Disaster drills include Actual evacuation of individuals to safe areas. Disaster drills include Actual evacuation of individuals to safe areas. Written plan for bedrooms below 55 degrees or over 80 degrees. Actual evacuation to safe areas at least once per year.
Training Retain records and reports including plan on correction. Staff and volunteers trained on safety, fire and disaster procedures Keep records of fire and disaster procedures. Must have CPR, Heimlich and First Aide Keep records of fire and disaster procedures. Must have CPR, Heimlich and First Aide
Emergency Numbers Readily Available Readily Available N/A
Smoke Detectors Must comply with Smoke Detector Act (425 ILCS65) Must comply with Smoke Detector Act (425 ILCS65) Must comply with Smoke Detector Act (425 ILCS65)
Mattresses and Box Springs Should be fire grade. Should be fire grade. Should be fire grade.
First Aid Kits Available and monitored regularly First Aid kit should be equivalent to American Red Cross First Aid Kit N/A
Buildings Conform with NFPA, Life Safety Code Conform with NFPA, Life Safety Code N/A
Disaster Plan Must be reviewed annually Must be reviewed annually N/A

Food Safety

Food safety is and should be a major concern. Foodborne illness causes millions of people each year to become ill as a result of eating unsafe food. The Center for Disease Control (CDC) estimates that each year roughly 1 in 6 Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die of foodborne illnesses. Foodborne illness is a disease that is carried or transmitted to a person by the food they consume. Examples of organisms that can cause a foodborne illness include E. coli, Salmonella, and Campylobacter. Sources of foodborne illness or "food poisoning" may be the food handler, the environment (such as a contaminated work surface), or the food itself.

Symptoms of Foodborne Illness include:

  • Nausea
  • Vomiting
  • Abdominal Cramps
  • Diarrhea
  • Fever

The five keys to safer food are:

  • Keep hands, preparation areas, and storage areas clean
  • Separate raw and cooked foods
  • Cook all foods thoroughly
  • Keep food at safe temperatures
  • Use safe water and raw materials


Refrigerator temperatures should be kept at a minimum of 40°F or below. Freezers should be kept at 0°F. Typically, when surveyor's complete site visits at CILAs and in Day Programs they check for the presence of a thermometer in any refrigerator or freezer that stores client food.

As a general rule, it's best to keep cold foods cold and hot foods hot. Avoid the "Danger Zone," a temperature range from 40 °F - 140°F, where bacteria are most likely to grow. Raw meat, poultry, dairy products, seafood, eggs, and produce are most susceptible to foodborne illnesses and should be handled with care and caution. Perishable foods should never be left out for longer than 2 hours. Always remember, "When in doubt, throw it out."

Utilize a food thermometer to guarantee foods are cooked to the correct temperatures. When raw foods are cooked to the proper internal temperatures, the bacteria can no longer survive. This best practice will ensure that raw, possibly contaminated foods are safe to eat.

Hand Washing

Everyone preparing food should wash their hands before handling or preparing food and after handling raw meat, touching an animal, blowing nose or sneezing, and toileting. Ensure plenty of soap and clean paper towels are nearby. Hands should be washed for a minimum of 20 seconds, or while singing the "Happy Birthday" song twice.

Avoid Cross-Contamination

  • Separate raw meat, poultry, seafood and eggs from other foods in your shopping cart and grocery bags.
  • Use a clean knife for cutting different foods (for example, use different knives for cutting meat, produce and bread).
  • During food preparation, do not taste the food with the same utensil used for stirring.
  • In the refrigerator, store raw meat separately from ready-to-eat foods.
  • When grilling, always use a clean plate for the cooked meat.
  • Don't reuse marinades used on raw foods unless you bring them to a boil first.

Safe Eating

Individuals with intellectual and developmental disabilities may have a number of factors that increase the risk of choking, including but not limited to:

  • Neurological and muscular disorders such as cerebral palsy and seizure disorders
  • Dysphagia (difficulty swallowing)
  • Side effects from medications
  • Gastroesphogeal reflux disease (GERD)
  • Difficulty swallowing
  • Few or no teeth
  • Dentures
    • Can make it difficult to sense whether food is fully chewed before it is swallowed
    • If dentures fit poorly or hurt, individuals might not want to chew their food or may not wear them and be unable to chew their food
  • Placing too much food or medication in one's mouth
  • Not chewing food well enough prior to swallowing
  • Putting a large portion of food in one's mouth
  • Eating or drinking too fast
  • Inattention to eating
    • Talking, laughing, walking, running or playing
    • Distracted by other persons or activities
  • Poor posture while eating
  • Swallowing non-edible objects (Pica)
  • Food stealing - resulting in eating quickly
  • Incorrect diet texture - liquids or food items not prepared correctly
  • Eating something with two or more diet textures, especially anything with a thin liquid and a solid component such as cereal and milk

Common Foods Identified as "High Risk" for Choking

  • Hotdogs served whole
  • Chicken on the bone
  • Grapes
  • Peanut butter
  • Peanut butter sandwiches on soft bread
  • Thick chewy bread, e.g. white bread, bagels, pizza, etc.
  • Marshmallows
  • Dry, crumbly foods such as cornbread or rice served without butter, jelly, sauce, etc.
  • Dry meats such as ground beef served without sauce, gravy
  • Whole, raw vegetables served in large bite-sized pieces
  • Whole hard fruits like apples or pears
  • Candy with large nuts
  • Hard nuts
  • Hard candy

Awareness is the First Step of Prevention

Because of the risk factors associated with choking, it is critical to provide adequate supervision of persons served, and be trained and familiar with individuals' needs:

  • Prescribed diets
  • Meal time or Pica precautions
  • History of previous choking incidents or difficulty swallowing
  • Properly assisted eating techniques
  • Positioning during and after meal time
  • Required supervision during meals

Important Safety Tip: It is common for people to respond to choking by either leaving the table or moving around very quickly. Be alert for those who leave without warning or who get up, move quickly and appear to be agitated.

Emergency Response to Choking

  • Immediately call 911. If another person is present, instruct them to call 911.
  • Follow your agency's training for responding to a choking victim.
  • Immediately provide repeated abdominal thrusts, known to some as the Heimlich maneuver, until the object causing the choking is dislodged and the individual can cough forcefully, speak or breathe, or until the individual becomes unconscious.
  • If the individual is unconscious, remove any visible obstructions from the mouth and begin administering CPR. Check periodically to see if the obstruction becomes dislodged.

Slips, Trips, and Falls

Falls are the leading cause of injury and accidental death in older adults. In some persons with developmental disabilities, the degenerative changes seen in aging can occur as early as age 35. Falls can result in hip fractures, broken bones, and head injuries. Even falls without a major injury can cause an individual to become fearful or depressed, making it difficult for them to stay active.

Preventing Slips, Trips and Falls

The best way to prevent falls is to make changes in several areas, including taking a look at where the individual may be at risk. Sometimes making changes in the home, physical therapy/exercise, medications or daily activities can help mitigate the risk of falls. Individuals should have pants that fit appropriately and don't fall down or are too long to cause a tripping hazard. Another important protection for individuals is ensuring proper and appropriate foot wear. Shoes should be worn anytime someone is ambulating, even in the house. Shoes should be proper fitting, have laces tied, and have a rubber sole that is designed to prevent slipping.

Some considerations include:

  • Have good lighting. Use bright light bulbs, and add lights that can be turned on by a switch near the doorway and close to the bed. Another option is to install voice or sound-activated lamps. Keep a flashlight at bedside. Use night lights.
  • Keep stairways safe. Be sure that stairwells are well lit and have handrails on both sides. Fluorescent tape may be placed on the edges of the top and bottom steps.
  • Keep bathrooms safe. Install grab bars beside tubs, showers and toilets. Use a rubber bath mat in the shower or tub. Consider using a shower chair in the shower.
  • Avoid rugs but if you must use them, keep rugs in place. Check that all carpets and rugs have skid-proof backing or are tacked to the floor, including carpeting on stairs. Place non-skid mats or carpet on all surfaces that may get wet.
  • Avoid clutter. Keep rooms free of clutter, especially on floors. Keep cords and wires out of walkways. Arrange your furniture and other objects so they are not in walkways.

Emergency Response to a Fall Incident

Even with the best precautions, falls may still occur. The response to an individual's fall depends on the circumstances of the fall, the person's ongoing health status, and what injury the person appears to have sustained. If you observe someone who has experienced a fall, quickly assess the situation by listening, observing and asking questions. Follow necessary and appropriate protocols such as first aid or calling 911.

Water Safety

People can drown in lakes, oceans, swimming pools, whirlpools, bathtubs or showers. Wherever there is water, there is risk.

Near drowning can cause serious impairments and/or brain damage. Be alert to these contributing factors:

  • Inadequate supervision
  • Seizure disorder
  • Medical emergencies while in the water (heart attack/stroke)
  • Use of medication
  • Water conditions, including temperature and clarity; hidden objects

Before A Swimming/Water Sport Activity

  • Assess each person's swimming abilities and the level of supervision needed. Know each person's health care needs, behaviors and other conditions which may impact their safety in the water. Make specific staff/individual supervision assignments; one to one supervision should be provided to people with seizure disorders and people who are not ambulatory.
  • Use U.S. Coast Guard -approved person floatation devices (PFD) for people who cannot swim, those who have seizure disorders and those who are not ambulatory. PFDs must be properly sized and maintained to be effective; however, they are not a substitute for supervision.
  • Establish a system for ensuring that the whereabouts of all individuals is known. Visual contact must be maintained with all individuals in the water at all times. Alert lifeguards to the special needs of individuals; ask lifeguards if the swimming area poses any special risks.
  • Before individuals enter the water, assess clarity and temperature of the water, weather conditions, and potential for overcrowding of the area. Provide supervision appropriate to the conditions found.

In The Water

  • Do not rely on lifeguards to provide supervision. Staff, who are responsible for individuals, must be directly supervising the individuals and must be in the water with them.
  • Call for help at the first sign of trouble.
  • Maintain visual contact at all times with individuals for whom they are responsible. Supervision of individuals must not be interrupted by assigned staff to perform other duties, such as escorting individuals to the bathroom.
  • All rules of the swimming area should be observed.


  • Assess each person's needs for bathing supervision and assistance.
  • Be aware of each person's health care needs which could impact their need for supervision when bathing. If supervision is required, never leave the person alone.
  • Staff should ensure that all bathing supplies are available in the bathroom before assisting an individual with bathing.
  • Know how to correctly operate all special tubs and bathing equipment.
  • Showering is generally safer than bathing for people with seizure disorder.
  • Water temperature in the house is at a safe level and should not exceed 110 degrees.