介護状況調査書兼日常生活状況調査書
childrenseniorsadmin
This is a nursing care status and daily living situation survey form addressed to the director of the Koto City Welfare Office. It provides fields to record the daily and weekly caregiving schedules of the caregiver and care recipient, as well as the recipient's physical and communication status and household housework support needs.
| What | 介護状況調査書兼日常生活状況調査票（自宅介護用）の記入・提出用様式 |
|---|---|
| Who | 介護を行っている者および被介護者（申込児童との続柄を記載） |
| When | 記載なし |
| Where | 江東区福祉事務所長 宛（保育支援課使用欄あり） |
| How | 1日の介護状況、1週間の介護状況、被介護者の状況（起居動作・移動・食事・排泄など）、世帯の家事力等の必要項目を記入またはチェックして提出 |
| Deadline | 記載なし |
| Contact | 記載なし |
Open the original PDF ↗ 2 pages
Source page: https://www.city.koto.lg.jp/280308/hoikuenmoushikomi-r9.html
Checked 2026-09-20. This page restates the PDF in a fixed structure; nothing is added or removed. Where the PDF does not say, the field reads "not stated". The original Japanese PDF is authoritative — confirm dates and conditions there.