Use this form to record your evidence that you have made and used playlists. You can enter information into the form then save it and return to it at a later date by using the 'Save progress' button at the foot of the form. Once you submit the form we will review your evidence and get back to you if we have any questions or believe we need to see more detail.

It is best to choose one person to be responsible for filling in the form. That way they will have an overview of everything you’re submitting and can make sure it’s all consistent.

We think it should take you under an hour to fill in this form. And you can save time by simply copying information from the records you have been keeping as you get your playlist project up and running. But we know that a blank form can be quite daunting so take a look at this completed version of the form which shows what good evidence looks like.

As part of your implementation you will have created a playlist for one chosen resident.

Firstly, please tell us the first name of the patient / resident you have selected as your 'One'. You may use a made-up name to preserve the anonymity of your 'One' if you wish.

It's not enough just to make a playlist for your 'One'. Different people have different care needs and respond in unique ways to their playlist.

This means that that it's important to consider the best way to use the playlist and record that information so that everyone who cares for them know how to use it and shares best practice.

In this section we want to see evidence that you have tried different ways of using the playlist and put in place a plan for your 'One'.

Evidence of use

Your One's care plan

Feedback from staff

Please ask at least three of the people you have ticked above what they have got out of being part of your playlist project. Then tell us what role they perform and copy their answers in the boxes below. You can add more than three responses by clicking on the Add more staff feedback button.

Your playlist plan

Please tell us about your plan to ensure that you will embed playlists throughout your organisation.

Your plan demonstrates your commitment to residents, their families, and your own staff that you will use playlists in a consistent way to improve well-being. It's important that everyone in your home is aware of your plan so we like to know it's displayed in a public place to remind everyone of that commitment. You can either copy your plan into the box below or take a photograph of it displayed in your organisation and upload that using the button below.