| Category | Item |
| Household management | Home cleanliness |
|
| Trash |
|
| Grocery shopping |
|
| Nutrition |
| Personal hygiene | Body washing |
|
| Laundry |
| (social) Participation | Daily Structure/Working |
|
| Activities (social, community) |
| Psychosocial Stability | Medication (regular intake) |
|
| Sleep habits |
|
| Psychopathological state (drive, psychotic) |
|
| Dealing with drugs (alcohol, drugs) |
|
| Type of Contacts |