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  • The Need
    • Accessible Criteria
    • Helpful Links
  • Solutions
    • What Is Accessible Design?
    • Assistive Technology
  • Resources
    • About Accessible Alabama
    • Access For All University
    • Research Briefs
    • Accessible Browser Settings
    • Photo Gallery
    • Resource Links
  • Housing Help
    • Housing Help
    • Birmingham
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Assessment

Home / Community Readiness Assessment / Assessment

Step 1 of 7 - Basic Information

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  • Basic Information

  • Let us get to know you

    Please complete the following questions so that we are able to learn a few basic things about you and your current living situation.
  • Consider the activity with which you typically require the most assistance.
  • Activities of Daily Living In And Outside The Home

    Would you be able to complete the following daily living activities independently if your home were made accessible? Rate your need for assistance. Check the box below activities in which you are utilizing assistive technology.
  • No AssistanceSome AssistanceComplete Assistance
    Using the restroom
    Bathing
    Shaving
    Brushing teeth
    Grooming
  • No AssistanceSome AssistanceComplete Assistance
    Cooking
    Loading dishwasher
    Washing dishes
    Meal preparation
    Reaching cabinets
    Feeding oneself
  • No AssistanceSome AssistanceComplete Assistance
    Load/unload machines
    Fold/put up laundry
  • No AssistanceSome AssistanceComplete Assistance
    Making bed
    Dressing
    Access to closet
  • No AssistanceSome AssistanceComplete Assistance
    Cleaning
    Open/shut doors
    Electric outlets
    Light switches
    Thermostat
    Mobility from room to room
    Security and safety
  • No AssistanceSome AssistanceComplete Assistance
    Mow lawn
    Flowers/grass
    Clean deck
    Ramps
  • No AssistanceSome AssistanceComplete Assistance
    Getting groceries
    Running errands
    Refilling prescriptions
  • No AssistanceSome AssistanceComplete Assistance
    Able to walk
    Able to drive
    Accessing the mailbox
    Retrieving the newspaper
  • No AssistanceSome AssistanceComplete Assistance
    Writing checks
    Paying bills
    Budgeting
  • Mental Health and Well-Being

    Rate yourself as truthfully as possible, in the following areas.
  • Very poorPoorFairGoodExcellent
  • NoA littleSomeA lotVery much
  • NeverA few times a yearA few times a monthA few times a weekDaily
  • NeverA few times a yearA few times a monthA few times a weekDaily
  • NeverA few times a yearA few times a monthA few times a weekDaily
  • Almost noneA littleA few hoursMost of the dayAlmost all
  • No accessPoor accessFair accessGood accessExcellent access
  • Rarely or neverOccasionallySomewhat oftenVery oftenAlways
  • Rarely or neverOccasionallySometimesAlmost alwaysAlways
  • Rarely or neverOccasionallySometimesAlmost alwaysAlways
  • Very unsafeSomewhat unsafeAbout averageFairly safeVery safe
  • Very insecureSomewhat insecureAbout averageFairly secureVery secure
  • Check all that apply.
  • Performance of Adult Roles

    Rate yourself as truthfully as possible, in the following areas.
  • Check all that apply.
  • Personal Fulfillment

  • Very unsatisfiedSomewhat unsatisfiedNeutralSatisifiedVery satisfied
  • Very unfulfilledSomewhat unfulfilledNeutralFulfilledVery fulfilled
    Physical/Mental Health
    Family
    Friends
    Work
    Leisure
    Marriage/Intimacy
    Financial Security
    Living Situation
    Community Preparation
  • Check all that apply.
  • NoNot muchSomewhatMostlyYes
  • Active Preparation and Planning

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