Appendix 1

OCCUPATIONAL THERAPY
BATH / SHOWER ASSESSMENT TOOL
Name: Date of Birth

Address: Telephone number:

GP’s Name/Address/Telephone No: NHS Number:

CONSENT:
Has the reason for the bathing Yes / No*
assessment been explained?

Has the client given informed consent? Yes / No*

Is a best interest decision necessary? Yes / No*

HEALTH
Diagnosis:

Medication / reported side effects:

Epilepsy:
If yes, state type, frequency, pattern, Yes / No *
warnings, past injuries sustained

Sensory Impairment:
For example, visual impairment Yes / No *

Energy Levels
For example, fatigue, hyperactive Yes / No *

Continent
If no, detail, including skin integrity, Yes / No *
bathing medical needs, wounds

Protocol for the safe bathing and showering of people with epilepsy
Version 1
February 2016
ENVIRONMENT
Ward/ Own home/Residential
care/Supportive living etc.

If community – who does the patient

live with and support available:

Location of, access to and description

of Bathroom and shower room
For example, size, flooring, shower/
bath, location of bathing suite, hazards,
clutter

Aids used at time of assessment:

For example, shower chair, bath seat,
hoist, bath lift, grab rails

VOLITION
For example, is this a valued activity, is
the client motivated, client’s preference
for bath/shower, ability to make
choices.

ROUTINE - BATHING/SHOWERING
For example, frequency, time of day, is
there a specific routine

OCCUPATIONAL PERFORMANCE -

BATHING/SHOWERING
Independent / Requires minimal or
moderate support / Dependent*

Gross motor skills affecting

bathing/showering
For example, mobility, transfers

Fine Motor Skills affecting

bathing/showering
For example, holding soap, flannel

Sensory Skills affecting

Protocol for the safe bathing and showering of people with epilepsy
Version 1
February 2016
bathing/showering
For example, vision, tactile, vision,
lighting

Cognitive and Perception Skills

For example, logical sequencing, depth
awareness

COMMUNICATION
For example, how does the client
communicate, does the client
understand what is being asked.

RISKS IDENTIFIED
AT TIME OF ASSESSMENT

RECOMMENDATIONS
Such as, personal care assessment /
skills teaching, adaptations,
compensation techniques

OT PLAN

Occupational Therapist: Cc: Client

GP
Date: Primary Nurse
Client’s notes

Protocol for the safe bathing and showering of people with epilepsy
Version 1
February 2016