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What services have you provided with this customer?

What activities have you been doing in the last 2 weeks?

What meals has customer been cooking?

Have you been able to complete all your duties?

Have there been any noticeable changes with the customers behaviour/mood in the last 2 weeks?

What activities of daily living has the customer been involved in?

Has there been any issue that you have witnessed in the last 2 weeks?

Are there any WHS issues?

Any further comments.

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.