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East Sussex Pilot SAQ; TASC Questionnaire (pdf - 512Kb)

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2. Planning and organising your daily life<br />

Please indicate any assistance that you need in planning and organising your daily life.<br />

This might include managing your finances, arranging support, making arrangement for<br />

repairs to your home or property, appointments, travel or holiday.<br />

What I need My View CC View Agreed View Score<br />

A = I complete these activities<br />

without any need for support or<br />

assistance<br />

B = I need occasional support or<br />

assistance about once a month.<br />

C = I need support and assistance<br />

about once a week.<br />

D = I need support and assistance 2<br />

or 3 times a week.<br />

E = I need support or assistance on<br />

a daily basis.<br />

Do you manage your own finances If no then please tell us who does.<br />

Yes No<br />

How would you like your situation to change for the better What would make the<br />

most difference to you<br />

<strong>East</strong> <strong>Sussex</strong> County Council<br />

Adult Social Care Department<br />

Page 6 of 15<br />

Self Assessment <strong>Questionnaire</strong><br />

K Mackay In-Control <strong>Pilot</strong> (Health) – V2

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