Daily Record Form - K B CM239 - Night Shift -KBDS

Name of Staff member completing the form*

First Name

Last Name
Please select Agency or DP staff
Names of all staff on shift*
Please select Agency or DP staff
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
SLEEP RECORD
Waking Night Staff
1. Time, Position (side/back/sat up), Asleep, Awake, Comments & Actions Taken (restless, settled, repositioned, personal care)
Sleeping Night Staff
2. Time, Position (side/back/sat up), Asleep, Awake, Comments & Actions Taken (restless, settled, repositioned, personal care)
3. Depending on what time KB goes to bed, either both the SN and WN carer to:
Put washing machine on? Yes / No. Please comment.
Dry washing? Yes / No. Please comment.
Fold and put clean washing away? Yes / No. Please comment.
(Whilst Mum working from home) – Prep breakfast utensils for KB (cup, cutlery, breakfast bowl & plates), fill water bottles and place all in projector room ready for the morning.
Empty kitchen bin as required. Please comment.
General tidy and clean (as per infection control routine)? Yes / No. Please comment.
What time did Kyle go to bed?

:
Hours

Minutes
4. Has the dishwasher been empted in morning (Kath puts it on at night). Yes / No. Please comment
5. Pad count (please add number of pads)
6.Has all medication this evening been given and all guidelines followed. Yes / No. Please comment.

Save and Continue Later

Registered in England & Wales Company number: 09125760

Registered office: Villa House 7 Herbert Terrace, Penarth CF64 2AH

SLEEP RECORD