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
• Assessor name and role
• Assessment setting
• Assessment type

Bathing

• Bathing independence level
• Bathing task performance observed
• Bathing assistance required

Dressing and Grooming

• Dressing independence level
• Grooming independence level
• Dressing and grooming barriers observed

Toileting and Feeding

• Toileting independence level
• Feeding independence level
• Toileting and feeding assistance required

Summary and Follow-Up

• Overall ADL independence summary
• Change since last assessment
• Recommended follow-up interval
• Assessor signature