Physical Appearance/Hygiene

General Survey Form

Objective: Conduct a General survey on a person of your choice. The purpose of this interaction is observation only.

1. Physical Appearance/Hygiene:
   1. General appearance:
   2. Gender
   3. Apparent age
   4. Ethnic group
   5. Appears overall healthy
   6. Well-groomed or disheveled (Note the general color of skin and hygiene)

1. Body Structure and Movement (Observe general stature):
   1. Height appropriate for apparent age
   2. Appears well nourished
   3. Weight suitable for the height
   4. Position or posture (comfortable and relaxed)
   5. Obvious deformities
   6. Walks with ease
   7. Gait balanced and smooth
   8. Limitations to range of motion
   9. Involuntary movements
   10. Using assistive devices

1. Emotional/Mental Status and Behavior:

Level of alertness

Appear well rested or tired

Converse appropriately

Behavior appropriate for the situation

Dress suitable for the weather

1. Document observations with detailed responses in a narrative format. For example, if a client appears tired provide a description adequate for the reader to visualize the client, “Client is alert and appears tired, slumped in a chair with eyes half closed.”

1. Describe one strength and one weakness you observed (can be psychosocial and/or physical). Provide rationales to support why you chose this strength and weakness.

1. Complete a spell and grammar check on your work before submission using Grammarly,

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