How to Make a Daily ADL Sheet

Activities of daily living, also known as ADL, is a questionnaire or a checklist of daily chores and activities drafted to help caregivers understand their duties when assisting a patient or a client. The questionnaire contains items related to activities such as making beds, cooking and laundry -- all chores concerning a patient's needs. The patient checks each of the items for which he requires service so the caregiver can serve him accordingly.

Decide on the item list. What items will go into an ADL questionnaire depends on the nature of services you offer. If you offer home care services, items related to cooking, laundry or grocery shopping will be part of the checklist. If you also offer personal care, items such as bathing, dressing and shaving should be included. Finally, if you offer medical and nursing services, activities such as checking for blood pressure or fever will be among the items listed for prospective clients.

Decide on the questionnaire scale. Typically, ADLs either have a two-point or a three-point scale. For example, "Do you want your caregiver to help you dress?" may be an item on the questionnaire. In a two-point scale, the client can answer by checking either "Yes" or "No." On a three-point scale, the client can select any one of these three answers: "Yes, fully dependent," "Yes, but verbal assistance only" or "No, can perform independently."

Make a list of personal care items, if applicable. Brushing the patient's teeth, shaving, bathing, indoor walking assistance, dressing and combing hair are some of the items that can be included on the ADL list.

Prepare a list of household chores, if applicable. Washing, ironing, vacuuming, bed-making and doing laundry are typically considered items representing household chores. Chores may also include running errands, grocery shopping and driving or escorting a patient to attend outdoor activities.

Make a list of kitchen chores, if applicable. Cooking, washing dishes, making coffee or tea, making a snack or other work related to patient assistance in the kitchen should be part of the checklist.