The following is a sample of the questions and statements that will be in the LivAbility^sm Questionnaire.

To receive the sample LivAbility^sm Report, click on SUBMIT at the bottom of this page. It contains safety and security products and ideas that would be good for everyone to consider. A more extensive list of safety and security suggestions will be in the full LivAbility^sm Report.

YOUR HOME

LIVING ARRANGEMENTS

I live in a single family dwelling/townhouse with an outside entrance

I live in an apartment/condo with an inside entrance

EXTERIOR FEATURES

ENTRY TO YOUR HOME

There are steps when approaching or entering my home

INTERIOR FEATURES

WINDOWS

I use a crank device to open and close my windows

My windows are difficult to open and close

STAIRWAYS

A flight of stairs leads from one level to another in my home

My stairs are well lighted

LIGHTING

My lamps give adequate light without glare

My lamps are stable

TELEPHONE(S)

I can easily hear or notice the sound or signal on my telephone

I can easily see the letters and numbers on the telephone

I can clearly hear the person calling

KITCHEN

APPLIANCES

I use a microwave oven

I use an electric stove

I use a gas stove

BATHROOM

TUB/SHOWER

I take a tub bath

I take showers in a bathtub

I take showers in a shower stall without a bathtub

DOOR

My bathroom door opens into the bathroom

My bathroom door has a lock on it

BEDROOM

LOCATION

The bedroom is located upstairs or downstairs from the floor where I spend most of my daytime hours

My bathroom is located near my bedroom

FURNISHINGS

I have difficulty getting in and out of bed

I have a night light between my bed and the bathroom

YOUR PHYSICAL CHARACTERISTICS, HEALTH AND FITNESS

MEDICATIONS

I take medications at various times during the day

EYESIGHT

I have difficulty seeing fine print or items up close

I have difficulty seeing when there isn't much light

I have difficulty seeing depth and edges of objects

REACHING

I have difficulty reaching items over my head

I have difficulty reaching items on or near the floor

DEXTERITY

I have difficulty grasping objects

I have difficulty opening some jars and containers

MOBILITY

I walk but have difficulty lifting my feet over obstacles

I walk but have difficulty going up or down stairs

I use a walker all or most of the time

Safety and Security Items

The Sample Report will print Safety and Security Items

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Report of Customized Suggestions
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COMMENTS: Please share your comments about this Questionnaire and the Report. Share your report with your friends and better yet encourage them to get their own Report.