Care Questionnaire

Candidate ID*

Candidate Unique Key*

Full Name*

The following tasks would be asked of you in a variety of roles in Care Home setting. Some of those tasks are very personal and require a great deal of compassion. If there is anything you do not feel comfortable with it is imperative, you speak it through with your consultant. When your asked to do these tasks, it may be in front of vulnerable clients and your refusal may cause embarrassment. To ensure we do not cause undue stress please be honest and forthright.

Are you comfortable in performing the following tasks for vulnerable clients?

Assist a vulnerable client to get in and out of bed?*

Yes
No

Assist a vulnerable client to eat?*

Yes
No

Assist a vulnerable client to undress?*

Yes
No

Assist a vulnerable client to wash, bath and shower?*

Yes
No

To assist with toileting, continence management and personal hygiene?*

Yes
No

To assist Clients with their medication at the agreed level of support and as detailed in their Medication Care Needs Assessment?*

Yes
No

To prepare food and drink for the Client, being aware of the Client’s choice, likes/dislikes, nutritional needs and cultural requirements?*

Yes
No

To provide light general household domestic duties, including housework and laundry, as detailed in the care plan or instructed by Management?*

Yes
No

To take responsibility for the safe handling of property and equipment belonging to the Client?*

Yes
No

To provide companionship to the Client, actively talking and listening to them about their interests?*

Yes
No

Signature*

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Care Questionnaire

Are you comfortable in performing the following tasks for vulnerable clients?

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