Daily Record Form - MC - CM252 & 253 - Night Shift

Daily Record Form – MC – CM252 & 253 – Night Shift

Name of Wake Support Worker*

First

Last
Name of Sleep Support Worker*

First

Last
Date of Support Session*

MM slash DD slash YYYY
Time Shift Started*

:
Hours

Minutes
Time Shift Ended*

:
Hours

Minutes
1. Did you complete personal care prior to bed time?
2. What support did Mahdi need to get to bed?*
3. Did you put Mahdi in his sleep system?*
4. Did you complete a bedtime routine? Was there music, reading of stories etc…..please give details*
5.What time did Mahdi go to bed?*
6. What time roughly did Mahdi go to sleep?*
7. Did you put the epilepsy monitor on?*
8.Did you ensure that the baby monitor was on and working?*
9. Please detail Mahdi's status every hour through the night (example……..11pm M asleep )*
10. Did Mahdi need any support through the nights time? If yes please give details*
11. Did you ensure that Staff mobile phone was on charge?*
12. Did you ensure that hoist was on charge?
13. Did you ensure that wheelchair was on charge?*
14. Did you ensure that staff room was clean and tidy?*
15. Did you ensure that the community bag was ready for following day?*
16. Did you ensure that medication cabinet was tidy?*
17. Did you ensure that Medication is all in place?*
18. What time did Mahdi wake?*
19. Did you give him breakfast? What did he eat and drink?*
20. What support did Mahdi need to get ready for the day?*
21. Was Home / School Communications book updated?
22. Communication from Mum and Dad.*
(Please record all calls from mum or dad here, time of calls and what was discussed)
23. Any other information?*

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