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Shift Notes
The Purpose of this form is to provide us with detailed shift notes after each shifts.
Support Worker Full Name
Participant Full Name
(Required)
Shift Date
(Required)
DD slash MM slash YYYY
Shift Start Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Shift Finish Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Goal of this shift
(Required)
Assistance in Daily Living / Assistance in Self Care Activities
Access to Community Participation
Capacity Building Activities
MILEAGE – Did you travel today with the client or during the shift? If yes, please put details
(Required)
The details should include KMs, locations and purposes.
How was Participant's HEALTH today?
(Required)
Any MEALS prepared or served during the shift? If Yes, Please mention what was prepared or served?
(Required)
How was Participant's BEHAVIOUR today? How was the mood today?
(Required)
Describe client temperament, mood of the day – note any behaviour showing anxiety, frustration, or any situation that upsets the client
Was there any Incident?
Yes
No
Please share the Incident details?
Hygiene
Describe client’s physical tidiness Note any practice or activity that you do to keep things healthy and clean
Housekeeping?
Needs to be specific – bullet points of task completed e.g. ● Fix clients bed ● vacuumed client room ● wash clients clothes
Social
Note specific activity that aligns with client goals – Specify any social activity e.g. ● We went to the park today and client had a small chat with … ● We went to see her dr. and it was observed that the client was very conversational with her/his doctor.
Any photos or videos you want to upload related to the shift
Max. file size: 256 MB.
Consent
(Required)
I agree that all information about the shift I have put above is true and filled up by myself.