Submitted by Robert Pressley, England

CLIENTS ACTIVITY SURVEY

Name of Client ________________________________________________

Assessment of clients physical abilities:-

A Have you a physical disability affecting:-

• Hands
• Feet
• Movement, Walking
• Other

B Have you a visual impairment

• At close to with ' Fine work'
• Long Distance
• Registered Blind

C Have you a hearing impairment

• Hearing Aid
• Hearing loss in one ear

D Have you any problem with communication

• By speech
• Physical disability
• Language barrier

2 What social activities do you carry out at home:-

• Family involvement
• cooking / baking
• knitting
• Needlework
• Watching Television
• Listening to the radio
• Crafts eg woodwork, DIY, Flower Arranging
• Books
• Shops
• Pub
• Church
• Clubs