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HH Specialist Credential

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Pediatric Environmental Home Assessment

 

Background for Indoor Pollutants Section

 

 

Go to PEHA Survey Form or PEHA Nursing Care Plan

 

Key Materials from Essentials for Healthy Home Practitioners course:

Sleep Environment

Patient’s sleep area

Own room

Shared

# in room  

Other

 

# Beds

0

1

2

More than 2

Allergen impermeable encasings on beds

On mattress and boxspring (zippered)

On mattress only (zippered)

On mattress

(not zippered)

No mattress covers

Pillows

Allergen-proof

Washable

Feather/ down

 

Bedding

Washable

Wool/not washable

Feather/ down

 

Flooring

Hardwood/ Tile/Linoleum

Small area rug

Large area rug

Wall-to-wall carpet

Dust/mold catchers

Stuffed animals /washable toys

No clutter

Non-washable toys

Plants

 

Other

Window

Washable shades/ curtains

Washable blinds

Curtains/ drapes - not washable

No window/

poor ventilation

Other irritants

Abundant cosmetics and fragrances

 

 

 

NOTES: 

 

___________________________________________________

 

Patient’s sleep area

___________________________________________________

 

# Beds

___________________________________________________

 

Allergen impermeable encasings on beds

___________________________________________________

 

Pillows

___________________________________________________

 

Bedding

___________________________________________________

 

Flooring

___________________________________________________

 

Dust/mold catchers

___________________________________________________

 

Window

___________________________________________________

 

Other irritants

 

Go to PEHA Survey Form or PEHA Nursing Care Plan

 

10320 Little Patuxent Parkway, Suite 500 • Columbia, MD 21044
Phone: 410.992.0712 • Fax: 443.539.4150