Resident Activity Survey Printable | Activity Director Resources | Nursing Home Forms | Senior Living Printable | Assisted Living Survey

Resident Activity Survey

A clean, large-print, 2-page printable for Activity Directors, Activity Assistants, and Life Enrichment Coordinators in nursing homes, assisted living, and memory care. Hand it to residents to learn what they love, what they want more of, and what's getting in the way—perfect for MDS interest documentation, care planning, and quarterly program reviews.

What's Included

• 1 Instant-Download PDF (US Letter, 8.5x11)

• Large-Print 14pt Arial Font—designed specifically for older adults to read and fill out independently

What's on the Survey

• Overall satisfaction with current activities

• Frequency of participation

• Favorite current activities (10 common options with a check-all-that-apply layout)

• What residents want MORE of (8 distinct categories)

• Specific activity requests (open write-in section)

• Best time of day for programs

• Group-size preferences (Large group, small group, 1:1, or in-room)

• Barriers to participation (Evaluates hearing, vision, mobility, and communication needs)

• Communication preferences (How they want to be reminded about activities)

• Open comments section for additional feedback

Perfect For

• Activity Directors in skilled nursing facilities (SNF)

• Assisted Living and Memory Care communities

• Adult Day Programs

• Recreation Therapists

• Activity Assistants and new Life Enrichment Coordinators

• MDS Coordinators gathering authentic resident voice for care plans

• Quarterly Resident Council preparation

How It Works

1. Purchase → Files appear instantly in your Etsy downloads.

2. Customize → Print the PDF as-is, or open the Word document to add your facility name and logo.

3. Distribute → Pass them out to residents to complete independently, or use the form as a guide during 1:1 admission interviews.

4. Implement → Use the data to refresh your monthly activity calendar and document compliance-ready resident preferences.

Important Note: This is a DIGITAL DOWNLOAD—no physical item will be shipped. Licensed for personal and single-facility use only. Please do not resell, redistribute, or share the digital files.