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Daily Record Form - Tye Hawkins
Daily Record Form – Tye Hawkins
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. What was planned for the session?
2. Did Tye engage in the session? If not what was the reason for this?
3. What community activities took place?
4. What support was provided with daily living tasks and what tasks were completed?
5. How was Tye’s mood?
6. Medical / Health appointments attended? (Document the outcome of appointments and any planned appointments not attended and why).
7. Are there any medication concerns?
8. Any issues to report?
9. Any new appointments added to Tye’s diary?
10. General comments.
11. Time spent with Tye today (please list start time, finish time and total hrs in box)
MOOD
12. Were there any incidence of angry outbursts today? Y/N. If yes, How many outbursts? If more than one, please list each outburst separately and in each account note
13. What was happening before the incident?
14. How did the behaviour manifest (ie was Tye verbally aggressive, physically aggressive, angry/upset/crying, did it escalate and if so how)
15. How did you manage the behaviour?
16. How long did the incident last?
17. What happened after the incident?
18. Can anything be learned from the incident?
19. What could be done differently to avoid incidents moving forwards?
