Vulnerable Adult Abuse Screening Checklist
Client Information
Full Name
Date of Birth
Assessment Date
Assessor Name
Screening Questions
Evidence or suspicion of neglect (e.g., poor hygiene, malnutrition, unattended medical needs)
Signs of physical abuse (e.g., unexplained bruises, burns, injuries)
Indicators of emotional or psychological abuse (e.g., fearfulness, withdrawal, anxiety)
Possible financial or material exploitation (e.g., missing funds, sudden changes in financial situation)
Suspected sexual abuse or exploitation
Signs of self-neglect
Observations and Comments
Details/Comments
Action Taken
Action(s) Taken / Referrals Made
Signature