Activities of Daily Living (ADL) Checklist Form
Use this checklist to track completion of essential daily living activities. Select each task as completed.
Which daily living activities have been completed?
*
Bathing or showering
Dressing (putting on and taking off clothes)
Grooming (brushing hair, teeth, shaving)
Toileting (using the toilet, personal hygiene)
Transferring (getting in and out of bed or chair)
Walking or moving around
Feeding (eating and drinking)
Continence (managing bladder and bowel)
Other (please specify below)
Additional notes or observations
Submit Checklist
Should be Empty: