Title Page

  • Client

  • Date

  • Shift

  • Supported By

Personal Care

  • What time did I get up

  • Did I have a bath/shower

  • Did I clean my teeth

  • Did I wash my hair


  • Did I have breakfast

  • What did I have for reakfast

  • Did I have a drink

  • What did I drink


  • Am I on Medication

  • Did I take my medication

  • Did I require PRN

  • Reason for PRN

  • Any medical treatment

  • Is my epilepsy Monitored

  • Did I have a seizure today

  • Type of Seizure

  • Are my bowel movements monitored

  • Did I open my bowels today

  • Type

  • Did I show any signs of discomfort

  • Is my fluid levels recorded

  • Has my fluid levels been recorded


  • What activity did I do today

  • How have i been feeling today

  • Did I have an incident today

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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.