Daily Functioning Checklist

About this checklist

Tracks the basics that keep you going: food, water, hygiene, daylight, movement, one human contact. A record, not a report card, for the hardest stretches.

Best for. Severe stretches, measuring wins that count.

Format and version

• Format. PDF, 1 page, prints on U.S. letter.
• Current version. 1.0
• Updated. March 15, 2026
• Reviewed by. Shariq Refai, MD, MBA

Usage rights

Free to print, share, and use in clinical, educational, and personal settings. Please link to the worksheet page rather than uploading a copy so readers reach the current version.

How to use it

This checklist is an educational tool, not medical treatment or diagnosis. Use it with a clinician when possible. If you are new here, start with the orientation guide. If you are wondering whether what you are feeling is depression, the screening tools page has validated self-assessments like the PHQ-9.

Customization

You can print the PDF as-is or open it in a PDF editor and adapt the field labels, examples, and prompts to your own situation or your clinical practice. If you adapt it for a practice or organization, please keep the source note attributing it to DepressionResource.org so downstream readers can find the current version.

Related

• Start here
• Browse the full worksheet library

These worksheets are provided by DepressionResource.org, part of The Shrink Network, for educational and informational purposes only. They are not medical advice, diagnosis, or treatment, and downloading or using them does not create a doctor-patient relationship. They are not a substitute for care from a licensed clinician who knows your situation. Do not start, stop, or change any treatment based on a worksheet. If you may be in danger or are thinking about suicide, call or text 988 in the US, or call 911 in an emergency. Read the full medical disclaimer.

Version 1.0. Updated March 15, 2026. Reviewed by Shariq Refai, MD, MBA.