Create your own independent living checklist on SeniorHousingNet.com

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Yes	No	N/A
			I want to remain independent as long as I am able.
			I have concerns about my health.
			Emergency medical help is important to me.
			Housekeeping assistance would be helpful to me.
			I would like assistance with home maintenance and repairs.
			I would like assistance with some outdoor maintenance.
			I would enjoy the opportunity to meet new people in a social setting.
			I would like planned social and recreational activities.
			I would like transportation service available.
			I would like meals prepared for me.
			I am willing to move from where I live now.
			I would feel safer if I moved somewhere else.

	I want to remain independent as long as I am able.
	Barber/beauty shop
	Laundry facilities and services
	Kitchen appliances (kitchen or kitchenette in unit) __________________________________
	Bathrooms (full private bathrooms in units, step-in showers)
	Bathrooms (full private bathrooms in units, step-in showers)
	Handicapped access
	Guest accommodations
	Parking (garage, carport or in the open)
	Scheduled transportation
	Storage
	Meals (number per day and ability to meet special dietary needs); tray service (if ordered by a doctor) __________________________________
	Utilities
	Telephone services
	Safety Features (emergency pull cords or call systems in apartments, fire sprinklers & smoke alarms, ample lighting)
	Security System
	Exercise programs, including recreational activities
	Staff (available 24 hours a day, helpful, appropriate ratio, strong management reputation
	Housekeeping (linen availability)
	Dining Facility (proximity to apartment, cleanliness)
	Facility (overall appearance, maintenance)

	What was your feeling when you toured the community? ________________________________________
	Was there activity in the main lounge?
	Was mealtime in the dining room pleasant?
	Were any residents using the activities room?
	Were any residents using the exercise facilities?
	Was there activity in the library or other common areas?
	Are carpets and furniture clean?
	Are amenities operating?
	Was staff friendly and respectful?
	Did staff know residents by name?
	Have the common areas and apartments been designed to allow you to live as easily and independently as you would like?
	Other observations you feel are important? _______________________________
	What percentage of the apartments have been rented and are occupied? __________________________________
	Is the management staff experienced? Effective? Friendly and personable? __________________________________
	Does the community have a good reputation in the local community?
	Your thoughts and feelings about your visit: ______________________________

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