NDIA Accountability Project

manage all of my day-to-day personal care activities

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WITHOUT ASSISTANCE I AM ABLE TO,

Please circle best response:

  • manage all of my day-to-day personal care activities Always Usually Sometimes Never eg. shower, dress, groom, toilet, maintain personal hygiene

  • manage all of my own mental health care needs Always Usually Sometimes Never eg. remember medications, attend appointments, complete scripts

  • manage all of my own Physical Health care needs Always Usually SometimesNever eg., manage health conditions, dental care, attend appointments

  • remain safe throughout the day Always Usually Sometimes Never eg avoid hazardous situations in home/community, avoiding criminal behaviour, falls risk, safe ‘drinking/drug taking’, turn appliances off

  • set Personal Goals and maintain Direction in life Always Usually Sometimes Never eg. plan daily activities, set future goals, save for a holiday, pursue a career, a sense of purpose

  • complete all of my Household Responsibilities Always Usually Sometimes Never eg. clean, garden, cook, maintain home, go shopping, maintain vehicle

  • maintain employment, education and/or training roles Always Usually Sometimes Never

  • maintain my interests and hobbies Always Usually Sometimes Never

  • successfully manage my own finances Always Usually Sometimes Never eg. pay bills, save money, pay rent, budget, set up bank accounts

  • organise my own daily routines & activities Always Usually Sometimes Never eg. get places on time, make daily decisions, remember tasks, get out of bed on time

  • manage my caring roles/responsibilities Always Usually SometimesNever eg. parent children, look after pets, support/care for parents

  • maintain a productive Relationship with my Family members Always Usually Sometimes Never eg. family contact & support, relationship with your partner, relationship with your children

  • maintain productive social Relationships with Friends/acquaintances Always Usually Sometimes Never eg. maintain contact with friends, attend social events, meet new people

                                                                                         Always  Usually  Sometimes Never•   effectively participate in the community

    eg. participate in community/social groups, follow directions and rules, engage with public

  • understand and communicate using speech and language Always Usually Sometimes Never Always Usually Sometimes Never

  • understand and communicate using non-verbal means

For questions about use of this form refer to the usage guidelines or contact Jason.mortimore@act.gov.au Page 1 of 2

  • adjust to ‘Life Changes’ and ‘Life Stressors’

Always Usually Sometimes Never eg. move home, a new job, new Doctor, lose a friend, new housemate, wake late, manage crowds

  • develop new skills for living independently

Always Usually Sometimes Never eg. cooking skills, internet use, catching bus to new place, a new job, new living arrangements

  • effectively access the community

Always Usually Sometimes Never eg. drive a vehicle, catch public transport, ride and/or walk places

  • effectively manage physical tasks

Always Usually SometimesNever eg. walk, sit for periods, lift objects, stand, balance,

NDIS Applicant’s Name: (*a self report questionnaire regarding the applicant’s perceived function)

For questions about use of this form refer to the usage guidelines or contact Jason.mortimore@act.gov.au Page 2 of 2