This ADL Assessment Checklist – Activities of Daily Living template is designed for occupational therapists, caregivers, home health professionals, and allied health clinicians. It features a structured checklist of essential daily living tasks—including basic activities (BADLs) such as bathing, dressing, grooming, feeding, toileting, and mobility, as well as instrumental activities (IADLs) like meal preparation, medication management, housekeeping, and more.
What sets this template apart:
Fully editable WORD Doc
Clear layout with independence rating columns and space for notes—making it excellent for functional evaluation and care planning.
Perfect for professionals conducting clinical assessments, organizing care plans, documenting rehabilitation progress, or guiding families in home care scenarios.
Benefits include:
Consistent and standardized evaluation across clients or patients.
Improved communication between therapists, caregivers, families.
Time-efficient documentation—no more creating forms from scratch.
✦ FEATURES ✦
➔Printable - just print and start writing
➔Computer/Laptop/Tablet/Phone
➔Editable WORD Document - ❗️You will need to use this form in Microsoft WORD.
➔Size - US Letter 8.5x11 & A4 8.27x11.69
REMINDER: This digital download is for personal use. If you would like to redistribute (make multiple copies) and share online, distribute as handouts for clients, groups and workshops etc., you can purchase the Redistribution License by CLICKING HERE. Purchase only ONE time and it’s good for ALL past and future purchases at CC Digital Studios Website, Etsy and TPT.
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