Checklist for Decisions Regarding My Death

Part I: My Body, Following My Death

I would like to be:     口 Buried     口 Cremated

For Burial:

I’d like my body to be buried in:

口 _________________________ Cemetery 

I’d like to be buried in:

口 conventional section of cemetery

口 natural burial section of cemetery

If natural burial, I’d like to be buried in:

口 a biodegradable box

口 a biodegradable shroud

I’d like my casket / shroud to be:

口 built/sewn by:

口 decorated by/how:

口 purchased, locally if possible

口 purchased, cardboard

口 purchased through a funeral home

For Cremation:

                I’d like my body cremated using

口 fire

口 aquamation, or alkaline hydrolysis, if available

I’d like my cremation box to be

口 built by:

口 decorated by/how:

口 purchased, locally if possible

口 purchased, cardboard

口 purchased through a funeral home

I’d like my cremated remains to be

• buried in:

• scattered over:
• placed:

I’d like my funeral arrangements to be made by:

• Community-Led Death Care, if possible – I’d like to die at home or have my body brought home following my death, and/or have family and friends tend to my body and return it to the earth as outlined above

• I have prepared the documents requested by Community-Led Death Care

• Funeral provider in Campbell River

• Boyd’s Funeral Services
• Sutton’s CR Funeral Home
• Island Funeral Services
• Other:

• I have prepaid my funeral arrangements

In preparation for death, I have:

• Created a contact list of friends and family, including the best way to reach them, so that my loved ones will be able to quickly contact them on my death
• Written down what I’d like included in my eulogy and/or obituary, and where I’d like this posted

Part II: End of Life Planning

This is a simple overview of a complicated subject matter. For a more comprehensive list see Memorial Society BC Checklist.

ln the event I become mentally incapable of taking care of my financial or legal affairs before I die, I have a legal document called an:

• Enduring Power of Attorney. This gives the Attorney(s) I appointed (in this case an attorney does not mean a lawyer) the legal power to take care of financial and legal matters for me while I am still alive.

I have a right to consent to or refuse medical treatment. In the event that I am incapable of making these decisions, or cannot communicate them, I have a legal document called a:

• Representation Agreement. This gives the Representative(s) I appointed the legal power to make decisions regarding my health and personal care matters.
• Advance Care Directives. I have written instructions for my future health care decisions (note that this has significant limitations as a stand-alone document. Combining this with a Representation Agreement can be helpful), or chosen to only use the Representation Agreement.

To make things easier for my executor,

I have:

• A detailed list of everything of value I own and owe. My taxes are up-to-date.
• Shared where my important documents are stored and ensured access to these.

I have:

• made provisions for those I am responsible for. There are also funds available for my executor to take care of my immediate expenses.

I have left instructions about what I would like done with my property and obligations after I die. I have a legal document called a:

• Will, which gives the executor(s) I appointed the authority and responsibility to settle my affairs according to the instructions in this document.
  

Part III: More Preferences Regarding My Death

I’d like to die:

• if possible, at home surrounded by family and friends
• let my family and friends decide what works best for them
• other comments:

After death I’d like my body to be cared for

• if possible, by family and friends
• let my family and friends decide what works best for them
• other comments

I’d like my body dressed in:

• specific clothes (if a natural burial biodegradable materials):
• your choice, something:
• other notes (eg. make-up, hair, earrings, anything special):
  

On or in my casket I’d like

• words:
• pictures:
• foliage and/or flowers:
• other:
  

Other preferences I have are

• type of music I enjoy:
• type of books I enjoy:
• kind of foliage or flowers I especially like:
• scents I especially enjoy:

What I’d like at my service:

Type of location:

• Graveside

• Special Place; garden, beach, etc.
• Community Hall
• Place of Worship
• Funeral Home
• Other:

Type of music or specific songs:

Kind of foliage, flowers, or objects:

Who I’d like to speak:

Favourite food:

Who to include (organizations, service clubs):

Pallbearers 

Quotes, Readings, Poems, Prayers 

Donations can be made to 

Other 

What I’d like in my obituary / eulogy / epitaph / plaque:

In addition to the list of family members, I’d also like you to mention:

What I did that I’m proud of:

A few words to sum up my life:

Other notes:

______________________________________               ________________________

Signature                                                        Date

______________________________________

Print Name