Describe the client, setting, and daily-living domains. Makeform creates an editable questionnaire with clear support ratings, observations, strengths, and client priorities.
Route completed questionnaires to Google Sheets, Slack, and Zapier.
Sample prompts for the builder
Choose a prompt, adapt it, or send it to the builder. Each structure is an example, not a completed assessment.
Audience
Social workers reviewing daily skills with an adult client
Format
Domain questionnaire with a defined support scale
Prompt size
314 chars
Example questionnaire structure
Domain questionnaire with a defined support scale
Personal care and daily routine
Meals and household tasks
Money, travel, and schedules
Client priorities and strengths
Next review date
Suggested routing tags
Baseline review
Support plan
Follow-up due
Define each rating in observable terms: independent, prompted, physically assisted, or not assessed.
Step 1
Define
choose domains, setting, and rating meanings
Step 2
Review
combine self-report with observed examples
Step 3
Prioritize
identify strengths and client-led goals
Step 4
Revisit
repeat the same scale on the next review date
A usable skills picture
Keep the review focused on real activities, support conditions, and client priorities instead of one vague score.
Reuse defined activities and support levels while keeping not observed separate from unable.
Place client confidence and preferences beside practitioner observations for discussion.
Ask about barriers, effective support, and next steps only when relevant.
Adapt to the review
Start with a relevant situation, then edit its language, activities, scale, and logic.
Map routines, current support, strengths, and activities needing observation.
Explore confidence with home, travel, money, communication, and help-seeking.
Record evidence source, cues, environmental factors, equipment, and notes.
Repeat ratings, record changes, and update goals in one form.
Questionnaire workflow
Describe the context, review the questions, and use responses for collaborative next steps.
Name the review stage, domains, respondent, and evidence source.
Distinguish independence, reminders, supervision, physical help, untried, and unassessed tasks.
Show barrier, strategy, and goal questions when a response makes them relevant.
Route the response, agree on actions, and schedule a review using the same scale.
Choose the right format
Choose comparable ratings, a quick task record, open context, or a combination.
Field guide
Choose relevant domains, phrase tasks concretely, allow not assessed, and capture strengths and context.
Personal routines
Ask only about relevant routines. Separate what the person does from prompting, setup, equipment, or assistance.
Home and meals
Replace broad judgments with specific tasks: simple meals, appliances, food storage, cleaning, laundry, and home upkeep.
Money and organization
Cover expenses, price comparison, budgeting, appointments, and reminders. Avoid account numbers or unrelated sensitive details.
Community access
Cover routes, preferred transport, changes, service contact, help-seeking, and communication. Separate familiar from unfamiliar journeys.
Everyday safety
Use relevant scenarios such as a broken appliance, getting lost, an alarm, or an unfamiliar visitor. Focus on planning, not pass-or-fail labels.
Strengths and goals
Ask what the person values, does successfully, finds difficult, and wants to practice next.
Related tools
Connect the questionnaire to intake, routine, assessment, and upload forms.
Create a broader skills inventory with ratings and notes.
Open toolCollect referral context and initial support information.
Open toolCreate a separate general health questionnaire.
Open toolFAQ
Answers for social workers, occupational therapists, transition teams, and community staff.
It reviews daily activities such as personal routines, meals, home tasks, money, transport, communication, and safety. It can combine client views, observations, support used, strengths, and priorities. It supports planning but is not a diagnosis or universal test of readiness to live alone.
Choose domains matching the person's goals and environment: routines, meals, home management, money, appointments, transport, communication, help-seeking, or safety. Prefer a short relevant form over unnecessary questions.
Use observable choices: independent, reminder, supervision or setup, hands-on help, not attempted, and not assessed. Keep unassessed separate from unable. Add examples of prompting, supervision, and assistance so reviewers interpret ratings consistently.
Yes. Ask the client about confidence, preferences, and goals, then record practitioner observations and support used. Separate versions may suit different timing or accessibility needs.
Yes. When an activity needs support, ask about useful cues, help, equipment, or environmental changes. When the client identifies a priority, ask for a next step and supporter. Conditional paths keep other sections short.
Use plain language, one activity per question, readable labels, and neutral choices. Explain the purpose and audience. Offer preferred communication formats and supported completion when appropriate. Collect only needed information and invite strengths and priorities in the client's words.
Reuse wording and rating definitions, but do not treat a score as the whole story. Record changes in setting, support, or equipment. Review goals with the client, then agree on next steps and a date.
Yes. Makeform is unlimited free for creating, editing, publishing, and collecting responses. The paid tier removes the Makeform badge. Before publishing, check that the domains, language, rating definitions, consent information, and routing match your process.
Build a clearer daily-living review.
