Select your highest applicable descriptor for each statutory activity. The calculator sums your points for Daily Living (Activities 1–10) and Mobility (Activities 11–12).
Daily Living Component (Activities 1 to 10)
Activity 1: Preparing Food
a. Can prepare and cook a simple meal unaided (0 pts)
b. Needs to use an aid or appliance (2 pts)
c. Cannot cook a simple meal using a conventional cooker but can use microwave (2 pts)
d. Needs prompting to prepare or cook a simple meal (4 pts)
e. Needs supervision or assistance to prepare or cook a simple meal (4 pts)
f. Cannot prepare and cook food at all (8 pts)
Activity 2: Taking Nutrition
a. Can take nutrition unaided (0 pts)
b. Needs an aid or appliance or prompting (2 pts)
c. Needs supervision or assistance (4 pts)
d. Cannot take nutrition without substantial assistance (6 pts)
e. Cannot convey food and drink to mouth at all (10 pts)
Activity 3: Managing Therapy or Monitoring a Health Condition
a. Can manage therapy or monitor health condition unaided (0 pts)
b. Needs aid, appliance, or supervision for up to 3.5 hrs/week (1 pt)
c. Needs supervision/assistance for 3.5 to 7 hrs/week (2 pts)
d. Needs supervision/assistance for 7 to 14 hrs/week (4 pts)
e. Needs supervision/assistance for 14+ hrs/week (6 pts)
Activity 4: Washing and Bathing
a. Can wash and bathe unaided (0 pts)
b. Needs an aid or appliance to wash or bathe (2 pts)
c. Needs prompting or supervision to wash or bathe (2 pts)
d. Needs assistance to wash body parts between waist and knees (3 pts)
e. Needs assistance to wash entire body (4 pts)
f. Cannot wash and bathe at all (8 pts)
Activity 5: Managing Toilet Needs or Incontinence
a. Can manage toilet needs unaided (0 pts)
b. Needs an aid or appliance to manage toilet needs (2 pts)
c. Needs prompting or supervision to manage toilet needs (2 pts)
d. Needs assistance to manage toilet needs (4 pts)
e. Cannot clean themselves or manage incontinence (6 pts)
f. Cannot manage toilet needs at all (8 pts)
Activity 6: Dressing and Undressing
a. Can dress and undress unaided (0 pts)
b. Needs an aid or appliance to dress or undress (2 pts)
c. Needs prompting to dress or undress (2 pts)
d. Needs assistance to dress/undress lower body (2 pts)
e. Needs assistance to dress/undress upper body (4 pts)
f. Cannot dress or undress at all (8 pts)
Activity 7: Communicating Verbally
a. Can express and understand verbal information unaided (0 pts)
b. Needs an aid or appliance to speak or hear (2 pts)
c. Needs communication support to express or understand complex info (4 pts)
d. Needs communication support to express or understand basic info (8 pts)
e. Cannot express or understand verbal information at all (12 pts)
Activity 8: Reading and Understanding Signs, Symbols and Words
a. Can read and understand unaided (0 pts)
b. Needs an aid or appliance to read (2 pts)
c. Needs prompting to read or understand complex written info (2 pts)
d. Needs prompting to read or understand basic written info (4 pts)
e. Cannot read or understand signs, symbols or words at all (8 pts)
Activity 9: Engaging with Other People Face to Face
a. Can engage with others unaided (0 pts)
b. Needs prompting to engage with other people (2 pts)
c. Needs social support to engage with other people (4 pts)
d. Cannot engage with other people due to severe psychological distress (8 pts)
Activity 10: Making Budgeting Decisions
a. Can make simple and complex budgeting decisions unaided (0 pts)
b. Needs prompting or assistance to make complex budgeting decisions (2 pts)
c. Needs prompting or assistance to make simple budgeting decisions (4 pts)
d. Cannot make any budgeting decisions at all (6 pts)
Mobility Component (Activities 11 and 12)
Activity 11: Planning and Following Journeys
a. Can plan and follow route unaided (0 pts)
b. Needs prompting to undertake any journey to avoid overwhelming psychological distress (4 pts)
c. Cannot plan route of journey unaided (8 pts)
d. Cannot follow route of unfamiliar journey without assistance (10 pts)
e. Cannot undertake any journey due to overwhelming distress (10 pts)
f. Cannot follow route of familiar journey without assistance (12 pts)
Activity 12: Moving Around (Physical Walking Ability)
a. Can stand and move more than 200 metres unaided (0 pts)
b. Can stand and move 50m to 200m unaided (4 pts)
c. Can stand and move 20m to 50m with aids (8 pts)
d. Can stand and move 20m to 50m unaided (8 pts)
e. Can stand and move 1m to 20m (10 pts)
f. Cannot stand or move more than 1 metre (12 pts)