Easy Test Creator - Sample Test - Life Skills Profile (Long Form)
 

Instructions

Complete the questionnaire as you assess the client's general functioning (i.e. not during crises when he or she is ill, or becoming ill, but his or her general state over the past three months).

 
Question  1

Does this person generally have any difficulty with initiating and responding to conversation?

No difficulty with conversation

Slight difficulty with conversation

Moderate difficulty with conversation

Extreme difficulty with conversation
 
Question  2

Does the person generally intrude or burst in on others' conversation (e.g. interrupts you when you are talking)?

Not intrusive at all

Slightly intrusive

Moderately intrusive

Extremely intrusive
 
Question  3

Does this person generally withdraw from social contact?

Does not withdraw at all

Withdraws slightly

Withdraws moderately

Withdraws totally or near totally
 
Question  4

Does this person generally show warmth to others?

Considerable warmth

Moderate warmth

Slight warmth

No warmth at all
 
Question  5

Is this person generally angry or prickly towards others?

Not angry at all

Slightly angry

Moderately angry

Extremely angry
 
Question  6

Does this person generally take offence readily

Not angry at all

Somewhat ready to take offence

Quite ready to take offence

Extremely ready to take offence
 
Question  7

Does this person generally make eye contact with others when in conversation?

Appropriate eye contact

Slightly reduced eye contact

Moderately reduced eye contact

Extremely reduced or no eye contact
 
Question  8

Is it generally difficult to understand this person because of the way he or she speaks (e.g. jumbled, garbled or disordered)?

Not at all difficult

Slightly difficult

Moderately difficult

Extremely difficult
 
Question  9

Does this person generally talk about odd or strange ideas?

No odd ideas

Slightly odd ideas

Moderately odd ideas

Extremely odd ideas
 
Question  10

Is this person generally well groomed (e.g. neatly dressed, hair combed)?

Well groomed

Moderately well groomed

Poorly groomed

Extremely poorly groomed
 
Question  11

Is this person's appearance (facial appearance, gestures) generally appropriate to his or her surroundings?

Unremarkable or appropriate

Slightly bizarre or inappropriate

Moderately bizarre or inappropriate

Extremely bizarre or inappropriate
 
Question  12

Does this person wash himself or herself without reminding?

Generally

Occassionally

Rarely

Never
 
Question  13

Does this person generally have an offensive smell (e.g. due to body, breath or clothes)?

Not at all

Smells slightly

Smells moderately

Smells a lot
 
Question  14

Does this person wear clean clothes generally, or ensure that they are cleaned if dirty?

Maintains cleanliness of clothes

Moderate cleanliness of clothes

Poor cleanliness of clothes

Very poor cleanliness of clothes
 
Question  15

Does this person generally neglect her or his physical health?

No neglect

Slight neglect of physical problems

Moderate neglect of physical problems

Extreme neglect of physical problems
 
Question  16

Does this person generally maintain an adequate diet?

No problem

Slight problem

Moderate problem

Extreme problem
 
Question  17

Does this person generally look after and taker her or his own prescribed medication (or attend for prescribed injections on time) without reminding?

Reliable with medication

Slightly unreliable

Moderately unreliable

Extremely unreliable
 
Question  18

Is this person willing to take psychiatric medication when prescribed by a doctor?

Always

Usually

Rarely

Never
 
Question  19

Does this person co-operate with health services (e.g. doctors and/or other health workers)?

Always

Usually

Rarely

Never
 
Question  20

Is this person generally inactive (e.g. spends most of the time sitting or standing around doing nothing)?

Appropriately active

Slightly inactive

Moderately inactive

Extremely inactive
 
Question  21

Does this person generally have definite interests (e.g. hobbies, sports, activities) in which he or she is involved regularly?

Considerable involvement

Moderate involvement

Some involvement

Not involved at all
 
Question  22

Does this person attend any social organisation (e.g. church, club or interest group but excluding psychiatric therapy groups)?

Frequently

Occasionally

Rarely

Never
 
Question  23

Can this person generally prepare (if needed) her or his own food / meals?

Quite capable of preparing meals

Slight limitations

Moderate limitations

Totally incapable of preparing food/meals
 
Question  24

Does this person generally budget (if needed) to live within his or her means?

Quite capable of budgeting

Slight limitations

Moderate limitations

Totally incapable of budgeting
 
Question  25

Does this person generally have problems (e.g. friction, avoidance) living with others in the household?

No obvious problems

Slight problems

Moderate problems

Extreme problems
 
Question  26

What sort of work is this person generally capable of (even if unemployed, retired or doing unpaid domestic duties)?

Capable of full-time work

Capable of part-time work

Capable only of sheltered work

Totally incapable of work
 
Question  27

Does this person behave recklessly (e.g. ignoring traffic when crossing the road)?

Not at all

Rarely

Occasionally

Often
 
Question  28

Does this person destroy property?

Not at all

Rarely

Occasionally

Often
 
Question  29

Does this person behave offensively (includes sexual behaviour)?

Not at all

Rarely

Occasionally

Often
 
Question  30

Does this person have habits or behaviours that most people find unsociable (e.g. spitting, leaving lighted cigarette butts around, messing up the toilet, messy eating)?

Not at all

Rarely

Occasionally

Often
 
Question  31

Does this person lose personal property

Not at all

Rarely

Occasionally

Often
 
Question  32

Does this person invade others' space (rooms, personal belongings)?

Not at all

Rarely

Occasionally

Often
 
Question  33

Does this person take things which are not his or hers?

Not at all

Rarely

Occasionally

Often
 
Question  34

Is this person violent towards others?

Not at all

Rarely

Occasionally

Often
 
Question  35

Is this person violent to him or herself?

Not at all

Rarely

Occasionally

Often
 
Question  36

Does this person get into trouble with the police?

Not at all

Rarely

Occasionally

Often
 
Question  37

Does this person abuse alcohol or other drugs?

Not at all

Rarely

Occasionally

Often
 
Question  38

Does this person behave irresponsibly?

Not at all

Rarely

Occasionally

Often
 
Question  39

Does this person generally make and / or keep up friendships?

Friendships made or kept well

Friendships made or kept up with slight difficulty

Friendships made or kept up with moderate difficulty

No friendships made or none kept up

Complete all questions, Check your answers ...

Click FINISHED button when test is complete.


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