CAREGIVER CHARTING
Client Name: ___________________________
Month __________________
Year ____
Initials indicate tasks was completed and WNL.
“ * ” indicates
a problem noted on back with call to supervisor.
DAY OF WEEK |
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DATE |
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SHIFT START |
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SHIFT END TIME |
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Vacuum |
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Dust |
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Tidy |
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Change Linen |
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Clean Bathroom |
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Clean Kitchen |
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Wash dishes |
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Shopping |
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Prepare Meals |
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Assist with Dressing |
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Assist with hygiene |
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Assist with eating |
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Assist with exercises |
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Assist to ambulate |
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Outings |
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Other: |
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Staff Initials/Signature
________/_______________________________________
Mail
charting and payroll every Monday.
