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Daily Record Form - G M - CM278
Daily Record Form – G M – CM278
Name of Support Worker
*
First
Last
Date of Support Session
*
DD slash MM slash YYYY
Session Start time
*
:
Hours
Minutes
Please use 24hr clock
Session End time
*
:
Hours
Minutes
Please use 24hr clock
1. What time did Graeme get up?
2. Did Graeme have a shower? Did he require prompting to have a shower? (comment on whether Graeme has told you he has had a shower or if you have seen evidence of this)
3. Did Graeme require any support to make breakfast? What support was provided? (include prompts)
4. What activities were planned for today?
5. What support did Graeme require to participate in his activities? (ie prompts to remember equipment or a lift to the golf club)
6. What activities were undertaken today? Did this differ from the plan?
7. Did Graeme spend any time alone in his flat today? How did he cope with this?
8. Did Graeme eat lunch out today or prepare lunch at home? What support did he require?
9. Did Graeme complete any shopping today? What support did he require with this?
10. Did Graeme complete any house work today? (ie laundry), what support did he require with this?
11. Did Graeme require support to make dinner? What support was provided? (include prompts)
12. Did Graeme take his medication today? What support did he require with this?
13. Were Graeme and buddy’s temperatures taken today? What were they? (during covid only)
14. Were there any incidents of inappropriate behaviour today? Detail the behaviour and record what you did to manage this.
15. Were there any incidents of aggressive or dangerous behaviour today? Detail the behaviour and record what you did to manage this.
16. Any health and safety concerns to report?
17. Did Graeme have a shower before bed? Did he require prompting to do this?
18. Did Graeme drink alcohol today?
19. Did Graeme smoke today?
20. What time did Graeme retire to bed?
21. What went well today? Positive progress to report?
22. Any other comments.
Daily Record Form – G M – CM278
Name of Support Worker
*
First
Last
Date of Support Session
*
DD slash MM slash YYYY
Session Start time
*
:
Hours
Minutes
Please use 24hr clock
Session End time
*
:
Hours
Minutes
Please use 24hr clock
1. What time did Graeme get up?
2. Did Graeme have a shower? Did he require prompting to have a shower? (comment on whether Graeme has told you he has had a shower or if you have seen evidence of this)
3. Did Graeme require any support to make breakfast? What support was provided? (include prompts)
4. What activities were planned for today?
5. What support did Graeme require to participate in his activities? (ie prompts to remember equipment or a lift to the golf club)
6. What activities were undertaken today? Did this differ from the plan?
7. Did Graeme spend any time alone in his flat today? How did he cope with this?
8. Did Graeme eat lunch out today or prepare lunch at home? What support did he require?
9. Did Graeme complete any shopping today? What support did he require with this?
10. Did Graeme complete any house work today? (ie laundry), what support did he require with this?
11. Did Graeme require support to make dinner? What support was provided? (include prompts)
12. Did Graeme take his medication today? What support did he require with this?
13. Were Graeme and buddy’s temperatures taken today? What were they? (during covid only)
14. Were there any incidents of inappropriate behaviour today? Detail the behaviour and record what you did to manage this.
15. Were there any incidents of aggressive or dangerous behaviour today? Detail the behaviour and record what you did to manage this.
16. Any health and safety concerns to report?
17. Did Graeme have a shower before bed? Did he require prompting to do this?
18. Did Graeme drink alcohol today?
19. Did Graeme smoke today?
20. What time did Graeme retire to bed?
21. What went well today? Positive progress to report?
22. Any other comments.
