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Daily Record Form - Jose Farrington
Daily Record Form – Jose Farrington
Name of Support Worker
*
First
Last
Date of Support Session
*
Date Format: MM slash DD slash YYYY
Time shift started
*
:
HH
MM
Please use 24hr clock
Time shift ended
*
:
HH
MM
Please use 24hr clock
1. Did Jose smoke any cannabis during your shift today?
2. Did Jose take his prescribed mediation today? Did he take any PRN medication, if so what? What support did Jose require to take his medication? Any changes or issues to report regarding medication?
3. How many hours sleep did Jose have last night? Did he report any trouble sleeping?
4. Was the garden clean and tidy without dog faeces? Was support provided to Jose to keep the garden clean?
5. Did Jose experience any incontinence today or last night?
6. What meals did Jose eat today? Did Jose prepare his meals himself? What support or prompting was provided around meal preparation?
7. Did Jose consume coffee today. How many cups of coffee did he drink?
8. What other fluids did Jose drink today?
9. Did Jose experience back pain today? If so, what level of pain did Jose experience and how did this affect him and how long did it last?
10. Did Jose experience any fatigue today? What support was provided to Jose to manage his fatigue and was this successful?
11. What activities/tasks did Jose complete today? What support was provided with this? Did Jose require prompting or encouragement to engage in activities?
12. Were there any health and safety concerns today? How were these managed?
13. Was Jose involved in any incidents or accidents today? What action was taken? Please complete an incident form if required.
14. Did Jose engage in any risky behaviour today? Please provide details of risks and how this was managed.
15. Did Jose complete his personal care routine today? Was any support required in this area?
16. How was Jose's mood today? Describe any feelings that Jose communicated to you or how he appeared to be feeling. Detail any emotional support provided.
17. Did Jose become aggressive today? Detail support provided to de-escalate. Complete an ABC chart if required.
18. Did Jose have any visitors or appointments today? Please provide details
19. Any concerns to report?
20. Any positive progress to report?
21. How are you feeling in your role as support worker? Do you require any additional support?
