Work and Social adjustment scale

This service is only available within South Australia. Check our services page for specific locations. Or contact Head to Health directly on 1800 595 212 or visit website www.headtohealth.gov.au for alternative services in their area.

Choose a number from the scale that best describes your situation. Write the number in the box opposite the situation

0 (Never impaired)12 (Mild Impairment)34 (Moderate Impairment)56 (Marked Impairment)78 (Severely impaired)
Because of my problem my work/study is impaired
0 (Never impaired)
1
2 (Mild Impairment)
3
4 (Moderate Impairment)
5
6 (Marked Impairment)
7
8 (Severely impaired)
Because of my problem my home management is impaired (paying bills, housework etc.)
0 (Never impaired)
1
2 (Mild Impairment)
3
4 (Moderate Impairment)
5
6 (Marked Impairment)
7
8 (Severely impaired)
Because of my problem my social life is impaired (outings, visiting friends, parks etc.)
0 (Never impaired)
1
2 (Mild Impairment)
3
4 (Moderate Impairment)
5
6 (Marked Impairment)
7
8 (Severely impaired)
Because of my problem my private leisure is impaired (hobbies, activities done alone)
0 (Never impaired)
1
2 (Mild Impairment)
3
4 (Moderate Impairment)
5
6 (Marked Impairment)
7
8 (Severely impaired)
Because of my problem my family relationships are impaired
0 (Never impaired)
1
2 (Mild Impairment)
3
4 (Moderate Impairment)
5
6 (Marked Impairment)
7
8 (Severely impaired)