ADL Self-Care Assessment

Observed assessment template for scoring independence in bathing, dressing, grooming, toileting, and feeding, with assistance levels tracked over time.

Assessment Details

• Assessment date and time recorded
• Assessment setting documented
• Primary observer identified
• Reason for assessment documented
• Prior ADL baseline available for comparison
• Recent change in function noted

Bathing

• Initiates bathing task without cueing
• Completes washing of body parts observed
• Manages bathing supplies and water safely
• Transfers in and out of tub, shower, or bathing area safely
• Bathing assistance level documented
• Bathing safety concerns or non-conformance noted

Dressing and Grooming

• Selects appropriate clothing for the task
• Dons and doffs upper body clothing
• Dons and doffs lower body clothing
• Completes grooming tasks observed
• Uses adaptive equipment or compensatory techniques as needed
• Dressing and grooming assistance level documented

Toileting and Feeding

• Completes toileting sequence safely
• Manages clothing and hygiene after toileting
• Transfers on and off toilet safely
• Feeds self using appropriate utensils and pacing
• Swallowing, choking, or aspiration concern observed
• Toileting and feeding assistance level documented

Summary and Follow-Up

• Overall ADL independence level
• Primary barriers to independence documented
• Recommended follow-up or intervention documented
• Progress since last assessment