What is the Activities of Daily Living questionnaire?

• Do you live alone or with other people?
• How does your disability limit your ability to work?
• What do you do on a typical day, starting from the time you wake up until the time you go to             bed?
• Do you take care of other people—such as children, a spouse, parents, other relatives, or pets?          What do you do for them? Do you have any help from anyone else?
• What were you able to do before you became disabled that you cannot do now?
• Does your disability affect your sleep?
• Does your disability affect your ability to get dressed, bathe yourself, shave, use the toilet, or          otherwise take care of yourself?
• Do you need help or reminders to take medication?
• Do you prepare your own meals?
• Are you able to do household chores? Are there any household chores that you need help                   with?
• How often do you go outside?
• Do you drive?
• Can you go out alone?
• Can you shop? Can you do it independently?
• Are you able to pay your own bills and manage your own money?
• Do you have hobbies, interests, and activities that you enjoy on a regular basis?
• Do you spend time with others? In what situations? Do you have trouble getting along with               people?
• What abilities does your disability impact? Examples include lifting, walking, concentrating,               using hands, talking, sitting, and other important abilities.
• How far can you walk before you need to rest?
• How long can you pay attention?
• Do you finish what you start?
• Can you follow verbal or written instructions?
• Do you get along with authority figures?
• Have you ever been fired because you had trouble getting along with others?
• How well do you handle stress and changes in routine?
• Do you use any assistive devices (such as hearing aids or crutches, for example)?
• Do you take any medications? What are the side effects of those medications?

If you answer yes, or in such a way as to indicate that you are disabled, then you will be asked to further explain your limitations or condition in a short answer format. Additionally, there is space at the bottom of the questionnaire for you to add in information that was not included in the routine questions.

The good news is that you are the person in the best position to answer questions about what you do on a typical day. When you complete the form it is important to:

• Be honest. You do not want to exaggerate or understate your limitations and abilities.
• Give as many details as you can so that the person reading the questionnaire gets an accurate         idea of what your life is like on a daily basis.