In short
An ADL checklist records whether your parent can do each basic self-care task, such as bathing, dressing and eating, plus household tasks like meals, money and medicines, alone or with help. Use the checklist below, then print the list of tasks that need help to share with the doctor, a care manager or a home care agency.
Printable checklist
ADL and IADL checklist
Go through each task as things are this week. Pick what your parent can do without help. Then print the list for the doctor, a care manager or an agency. Nothing you choose leaves this page.
An original checklist of the everyday tasks care teams commonly review. It is not the Katz Index, the Lawton scale or any other validated instrument, and it is not a diagnosis.
How to use the result
- Repeat it every few months, and after any fall or hospital stay
- Bring it to the doctor or to an assessment
- Be specific: note what kind of help, how often, and at what time of day
Questions families ask
What is an ADL checklist?
A list of daily tasks used to record which ones a person can do alone.
Is this the Katz Index?
No. It is an original checklist for families. The Katz Index is a clinical tool.
Can I print the results?
Yes. Use the print button after answering.
Do my answers get saved?
No. Nothing leaves your browser.