Floor Plan Questionnaire
Care@Home™ Pro System Installation Guide
31
Appendix A
Floor Plan Questionnaire
The following is an example of the questions to include in a questionnaire for the resident or the
resident’s family. It is important to complete the questionnaire prior to determining the configuration
of the Care@Home
™
Pro system to be installed in the resident’s premises. The responses may have an
impact on the equipment to bring to the premises.
Does the resident live alone?
Does a care professional live with the resident?
If so, which room is occupied mainly by the care professional?
Does a care professional regularly visit the resident?
If so, what is the schedule of these visits? Daily? Weekly? What are the hours of the visit?
How many rooms are on the premises?
What is the classification of each room?
Define the classification of each room in terms of activity:
Living room
Bedroom
Dining room
Bathroom
Toilet
Kitchen
Other room
How many exits are there?
Define the classification for each exit:
Front door
Back door
Patio or balcony door
Entrance door from garage
Other
Is there more than one bathroom on the premises?
If so, does the resident use more than one bathroom?
Is there more than one restroom on the premises?
If so, does the resident use more than one restroom?
Is there a bathroom on the premises which includes a toilet?
Are there pets living on the premises?
