Sleep Assessment Form With Steps

Back Stomach Side

Yes No

1 2 3 4 5

Yes No

Propped up by pillows/cushions Wedges Sleep in armchair

1 2 3 4 5

Too hot Too cold Just right

Soft Medium Firm

3ft 4ft 4ft 6in 5ft 6ft

Yes No Not sure

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No