Title Page

  • Resident

  • Date

  • Social Leave


  • Shift

  • What did I have for Breakfast

  • What did I have for lunch

  • What did I have for dinner

  • What did I have to drink

  • Snack

Personal Care

  • Did I have a Bath/Shower

  • Did I wash my hair

  • Did I brush my teeth


  • Did I take my medication

  • Did I Require PRN

  • Reason for PRN

  • Did I require a medical visit


  • What did I do today

  • Activity tracker completed


  • Did I have an incident today

  • Forms Completed


  • Is my epilepsy monitored

  • Did I have a seizure today

  • Was my epilepsy folder completed

  • Are my bowel movements monitored

  • Type

  • Did I show signs of discomfort

Family Contact

  • Did I see my family or advocate today

  • Did I have contact with my family or advocate today

  • Who

Completed by

  • Staff member

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.