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
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)
Considerable involvement
Moderate involvement
Some involvement
Not involved at all Question 22
Does this person attend any social organisation
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
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
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