/ Life Satisfaction
Indicators (LSI)
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To read more visit http://www.dva.gov.au/site-information/privacy/privacy-notice-%E2%80%93-financial-and-health-information.

Please refer to Goal Attainment Scaling in CLIK for information regarding the LSI.

Client Details
Full name:
Date of birth:
Defcare Case ID:

Satisfaction with Life Indicators

Please circle one number against each indicator below to show how satisfied or dissatisfied you are about your life.
Totally
dissatisfied / Totally satisfied
1 / Your physical health / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
2 / Your psychological health / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
3 / Your sleeping pattern / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
4 / Your relationship with family and friends / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
5 / Your feelings of security / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
6 / Your involvement with your local community / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
7 / Your residence and neighbourhood / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
8 / Your employment opportunities / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
9 / Your amount of leisure time / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
10 / Your financial situation / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10

Continued over leaf
Satisfaction with Job Indicators

If you are currently in paid employment, please circle one number against each indicator below to show how satisfied or dissatisfied you are about your job.
Totally dissatisfied / Totally satisfied
A / Your pay / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
B / Your job security / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
C / Your job tasks / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
D / Your work hours / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
E / Your work/life balance / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
F / How satisfied are you with your job? / 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
If you are completing this form at the CLOSE of your rehabilitation program, provide any comments you would like to make about your experience of rehabilitation.
Client Sign-off
Client Signature: / Date:
ONLY PROVIDER TO COMPLETE:
Tick one box below to show when this form was completed.
Rehabilitation Assessment 6 month Progress Report Plan Closure

Providers scan and email PDF to:

South Australia/Victoria /
Northern Territory/Tasmania/Western Australia /
Queensland (Postcode 4729 and below) and NSW (less Postcodes 2500-2599, 2600-2699 and 2900-2999) /
North Queensland (Postcode 4730 and above) and NSW (Postcodes 2500-2599, 2600-2699 and 2900-2999) /

For assistance phone DVA on 133 254 (metropolitan callers) or 1800 555 254 (regional callers). Last updated 6 February 2017

Client Name: ______Defcare Case ID: ______

Life Satisfaction Indicators – D9230 Page 1