List of Personal Possessions on Admission Please …

1 Ventry Residential Care Form Name: Service User Inventory Ref No: Version: 1 Date Issued: Jul 2011 Page 1 of 4 List of Personal Possessions on Admission Please note that we do not accept responsibility for the loss of jewellery, cash or other valuable items. Property is brought into the home at the owner s risk and we advise you to take out your own insurance policy for cover for this. (See page 19 & 20 of our Service User Guide for further information) Name: Home Name: Date: This list sets out all property brought in on the day of Admission . It will not record items brought in, removed or replaced at a later date. Signed: Date: (Service User) (on behalf of Ventry Residential Care) Articles No. Description (eg: colour, size, make, condition etc and any other comments) Please include items worn on Admission Marked with name Day Wear Blouses Skirts Dresses Shirts Trousers Braces Ventry Residential Care Form Name: Service User Inventory Ref No: Version: 1 Date Issued.

2 Jul 2011 Page 2 of 4 Waistcoat Jackets Pullovers Cardigans Overcoats Scarves Gloves Hats Shoes Sandals Boots Handbag/bags Other ( Please specify) Underwear Vests Underpants Petticoats - half Petticoats - full Stockings/Tights Suspender Belt Socks Bras Corsets Other ( Please specify) Ventry Residential Care Form Name: Service User Inventory Ref No: Version: 1 Date Issued: Jul 2011 Page 3 of 4 Nightwear Dressing Gown Slippers Pyjamas Nightdress Bed Socks Bed Jacket Other ( Please specify) Aids Walking Hearing Optical Dentures Other ( Please specify) Belongings Clock Radio Framed Photos Suitcase Chairs Other ( Please specify) Toiletries Medication (See separate opening MARS sheet) Ventry Residential Care Form Name: Service User Inventory Ref No: Version: 1 Date Issued: Jul 2011 Page 4 of 4 Linen Bedding Towels Other ( Please specify) Jewellery (incl that worn on Admission ) and valuables Please note that we cannot store jewellery or large amounts of cash in the Home s safe.

3 Rings Chains/Necklaces Bracelets Earrings Brooches Pins Watch Building Society Books Cash Other ( Please specify) Any other comments/notes.