FREE FAMILY WORKSHEET

Living-alone contact agreement

Use this companion to “A contact plan for a parent who lives alone”. Tick the preparation steps, then fill in only the details you need. This is a household record, not a medical assessment.

Read the guide

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1. Before you start

Tick an item only when you have checked it. A tick records preparation, not a safety or health result.

Agree the preferred way to make contact.Record an ordinary contact time.Agree how changes will be communicated.Ask a backup person for permission and availability.Agree a missed-contact sequence.Discuss home access privately if needed.Choose who updates the family after contact.Check numbers and agree when to revisit.

2. Details to keep

Living-alone contact agreement · Date __________________

Usual contact time / methodIf plans change, tellFirst caller / phoneBackup person / availability / phoneAgreed next steps if contact is missedFamily update person / last checked date