Caregiver Icebreaker - Bloom Homecare

Icebreaker & Compassion Questionnaire

Caregiver Icebreaker & Compassion Questionnaire Form designed for your non-medical home care business to assess a caregiver’s personality, compassion, and sense of responsibility when caring for seniors. It includes open-ended and multiple-choice questions, and ends with an internal Compassion Rating Scale (for our team)

What inspired you to become a caregiver?

What do you enjoy most about working with seniors?

Describe one personal quality you believe makes you a great caregiver?

What does "compassion" mean to you, and how do you show it in your work?

Caregiving Skills & Accountability

Are you able to provide transportation for our clients?

Are you trained in incontinence or toileting assistance?

Do you speak any other languages besides English?

If a client refuses care (For example, a shower or medication reminder), what do you do?

Have you ever had to report an incident or concern? What was it, and how did you handle it?

How do you ensure a client’s safety in the home?

Are you comfortable working with clients who have memory loss or Dementia? Please explain.

Availability & Commitment

How would you rate yourself on punctuality and reliability showing up to your clients home?

What days and hours are you generally available to work?

How far are you willing to travel?

CAREGIVER PERSONALITY TRAITS

Are there languages or cultures you are familiar or fluent with? (Short answer)

Company

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Name

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Icebreaker & Compassion Questionnaire

Caregiving Skills & Accountability

Availability & Commitment

CAREGIVER PERSONALITY TRAITS

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