How to use it
- Fill in a page each day, as it happens or at the end of the day. Rows follow the order of the care questions on the form, so you can copy across.
- Write down every time, not just the total. The form asks how often each day and, at night, how many minutes each time.
- Write what you needed, whether or not anyone gave it. The form says to tell DWP about the difficulty you have or the help you need, whether you get the help or not.
- Mark each page good, in between or bad, so you can say how many of each there are in an ordinary week. Do not leave out the bad days.
- If you are helping a parent, write about them and ask them to check it. If a task is painful, makes them breathless or unsteady, or is unsafe, say so in the last column.
- Keep it with the form. Take it when you get help from an adviser.
The 7-day diary
Print this page, or save it as a PDF. Each day is on its own sheet.
Day 1
Date
Good day In between Bad day
Daytime, from getting up until the household closes down for the night (the form counts the evening as day)
| What (form question) | Times today | Who helped, and what they did | How long, and pain, breathlessness or danger |
|---|---|---|---|
| Getting out of bed, getting into bed (Q29) | |||
| Toilet, commode, incontinence, cleaning myself (Q30) | |||
| Washing, bathing, showering, appearance (Q31) | |||
| Dressing and undressing (Q32) | |||
| Moving around indoors, stairs, getting out of a chair (Q33) | |||
| Falls or stumbles (Q34) | |||
| Cutting up food, eating and drinking (Q35) | |||
| Medicines and treatment (Q36) | |||
| Communicating: phone, letters, being understood (Q37) | |||
| Hobbies, social or religious activities (Q39) | |||
| Someone needed to keep an eye on me in the day (Q40) |
Night, from when the household closes down until I get up the next morning
| What (form question) | Times tonight | Who helped or was awake | Minutes each time |
|---|---|---|---|
| Help in the night: turning over, settling, the toilet, medicines, changing sheets (Q42) | |||
| Someone awake to watch over me (Q44) |
Anything else about today, and what I did without help because nobody was there
Day 2
Date
Good day In between Bad day
Daytime, from getting up until the household closes down for the night (the form counts the evening as day)
| What (form question) | Times today | Who helped, and what they did | How long, and pain, breathlessness or danger |
|---|---|---|---|
| Getting out of bed, getting into bed (Q29) | |||
| Toilet, commode, incontinence, cleaning myself (Q30) | |||
| Washing, bathing, showering, appearance (Q31) | |||
| Dressing and undressing (Q32) | |||
| Moving around indoors, stairs, getting out of a chair (Q33) | |||
| Falls or stumbles (Q34) | |||
| Cutting up food, eating and drinking (Q35) | |||
| Medicines and treatment (Q36) | |||
| Communicating: phone, letters, being understood (Q37) | |||
| Hobbies, social or religious activities (Q39) | |||
| Someone needed to keep an eye on me in the day (Q40) |
Night, from when the household closes down until I get up the next morning
| What (form question) | Times tonight | Who helped or was awake | Minutes each time |
|---|---|---|---|
| Help in the night: turning over, settling, the toilet, medicines, changing sheets (Q42) | |||
| Someone awake to watch over me (Q44) |
Anything else about today, and what I did without help because nobody was there
Day 3
Date
Good day In between Bad day
Daytime, from getting up until the household closes down for the night (the form counts the evening as day)
| What (form question) | Times today | Who helped, and what they did | How long, and pain, breathlessness or danger |
|---|---|---|---|
| Getting out of bed, getting into bed (Q29) | |||
| Toilet, commode, incontinence, cleaning myself (Q30) | |||
| Washing, bathing, showering, appearance (Q31) | |||
| Dressing and undressing (Q32) | |||
| Moving around indoors, stairs, getting out of a chair (Q33) | |||
| Falls or stumbles (Q34) | |||
| Cutting up food, eating and drinking (Q35) | |||
| Medicines and treatment (Q36) | |||
| Communicating: phone, letters, being understood (Q37) | |||
| Hobbies, social or religious activities (Q39) | |||
| Someone needed to keep an eye on me in the day (Q40) |
Night, from when the household closes down until I get up the next morning
| What (form question) | Times tonight | Who helped or was awake | Minutes each time |
|---|---|---|---|
| Help in the night: turning over, settling, the toilet, medicines, changing sheets (Q42) | |||
| Someone awake to watch over me (Q44) |
Anything else about today, and what I did without help because nobody was there
Day 4
Date
Good day In between Bad day
Daytime, from getting up until the household closes down for the night (the form counts the evening as day)
| What (form question) | Times today | Who helped, and what they did | How long, and pain, breathlessness or danger |
|---|---|---|---|
| Getting out of bed, getting into bed (Q29) | |||
| Toilet, commode, incontinence, cleaning myself (Q30) | |||
| Washing, bathing, showering, appearance (Q31) | |||
| Dressing and undressing (Q32) | |||
| Moving around indoors, stairs, getting out of a chair (Q33) | |||
| Falls or stumbles (Q34) | |||
| Cutting up food, eating and drinking (Q35) | |||
| Medicines and treatment (Q36) | |||
| Communicating: phone, letters, being understood (Q37) | |||
| Hobbies, social or religious activities (Q39) | |||
| Someone needed to keep an eye on me in the day (Q40) |
Night, from when the household closes down until I get up the next morning
| What (form question) | Times tonight | Who helped or was awake | Minutes each time |
|---|---|---|---|
| Help in the night: turning over, settling, the toilet, medicines, changing sheets (Q42) | |||
| Someone awake to watch over me (Q44) |
Anything else about today, and what I did without help because nobody was there
Day 5
Date
Good day In between Bad day
Daytime, from getting up until the household closes down for the night (the form counts the evening as day)
| What (form question) | Times today | Who helped, and what they did | How long, and pain, breathlessness or danger |
|---|---|---|---|
| Getting out of bed, getting into bed (Q29) | |||
| Toilet, commode, incontinence, cleaning myself (Q30) | |||
| Washing, bathing, showering, appearance (Q31) | |||
| Dressing and undressing (Q32) | |||
| Moving around indoors, stairs, getting out of a chair (Q33) | |||
| Falls or stumbles (Q34) | |||
| Cutting up food, eating and drinking (Q35) | |||
| Medicines and treatment (Q36) | |||
| Communicating: phone, letters, being understood (Q37) | |||
| Hobbies, social or religious activities (Q39) | |||
| Someone needed to keep an eye on me in the day (Q40) |
Night, from when the household closes down until I get up the next morning
| What (form question) | Times tonight | Who helped or was awake | Minutes each time |
|---|---|---|---|
| Help in the night: turning over, settling, the toilet, medicines, changing sheets (Q42) | |||
| Someone awake to watch over me (Q44) |
Anything else about today, and what I did without help because nobody was there
Day 6
Date
Good day In between Bad day
Daytime, from getting up until the household closes down for the night (the form counts the evening as day)
| What (form question) | Times today | Who helped, and what they did | How long, and pain, breathlessness or danger |
|---|---|---|---|
| Getting out of bed, getting into bed (Q29) | |||
| Toilet, commode, incontinence, cleaning myself (Q30) | |||
| Washing, bathing, showering, appearance (Q31) | |||
| Dressing and undressing (Q32) | |||
| Moving around indoors, stairs, getting out of a chair (Q33) | |||
| Falls or stumbles (Q34) | |||
| Cutting up food, eating and drinking (Q35) | |||
| Medicines and treatment (Q36) | |||
| Communicating: phone, letters, being understood (Q37) | |||
| Hobbies, social or religious activities (Q39) | |||
| Someone needed to keep an eye on me in the day (Q40) |
Night, from when the household closes down until I get up the next morning
| What (form question) | Times tonight | Who helped or was awake | Minutes each time |
|---|---|---|---|
| Help in the night: turning over, settling, the toilet, medicines, changing sheets (Q42) | |||
| Someone awake to watch over me (Q44) |
Anything else about today, and what I did without help because nobody was there
Day 7
Date
Good day In between Bad day
Daytime, from getting up until the household closes down for the night (the form counts the evening as day)
| What (form question) | Times today | Who helped, and what they did | How long, and pain, breathlessness or danger |
|---|---|---|---|
| Getting out of bed, getting into bed (Q29) | |||
| Toilet, commode, incontinence, cleaning myself (Q30) | |||
| Washing, bathing, showering, appearance (Q31) | |||
| Dressing and undressing (Q32) | |||
| Moving around indoors, stairs, getting out of a chair (Q33) | |||
| Falls or stumbles (Q34) | |||
| Cutting up food, eating and drinking (Q35) | |||
| Medicines and treatment (Q36) | |||
| Communicating: phone, letters, being understood (Q37) | |||
| Hobbies, social or religious activities (Q39) | |||
| Someone needed to keep an eye on me in the day (Q40) |
Night, from when the household closes down until I get up the next morning
| What (form question) | Times tonight | Who helped or was awake | Minutes each time |
|---|---|---|---|
| Help in the night: turning over, settling, the toilet, medicines, changing sheets (Q42) | |||
| Someone awake to watch over me (Q44) |
Anything else about today, and what I did without help because nobody was there