Daily Activity Log (DAL)

Daily Activity Log (DAL)
This form is to be used to mark all care services provided for each client and is to be turned in directly after your shift ends.
- Please mark ALL care duties performed during the shift whether they are on the Care Plan or not.
- Please provide any joyful or challenging moments the client experienced during your shift. These may be shared with the client's family.
- Please note any and all changes in physical, mental or emotional health.
Date Care Provided*

MonthDayYear
Date
Shift Start Time*

:HourMinutesAM/PM Option
Shift End Time*

:HourMinutesAM/PM Option
CarePro Name*

First NameLast Name
Client's Name *

First NameLast Name
2nd Client's Name (only if you're caring for more than one person at this same location)

First NameLast Name
Home Management / Reminders ((select all that apply - if OTHER is selected, please explain in NOTES Section)

Grocery ShoppingLight HousekeepingLaundry / FoldingChanged LinensDustedMedication RemindersEmptied TrashAssisted with PlantsAssisted with PetsBathroom MaintenanceKitchen MaintenanceOther
Meals / Eating (select all that apply - if OTHER is selected, please explain in NOTES Section)

Meal PlanningMeal PreparationPrepared SnacksFeeding AssistanceOther
Bathing / Hygiene (select all that apply - if OTHER is selected, please explain in NOTES Section)

Shampoo HairDress/ UndressBed BathTub BathShower AssistAssist with Personal HygeineOther
Did you read the client's blood pressure?*

YESNO
What was blood pressure if read?
Toileting (select all that apply - if OTHER is selected, please explain in NOTES Section)

Changed BriefsIncontinence CareAssisted to BathroomAssisted with ToiletingProvided Personal CleanupOther
Bowel Movement during Shift?*

YESNO
Transfers (select all that apply - if OTHER is selected, please explain in NOTES Section)

Transfer from BedTransfer from ChairHoyer LiftTransfer BeltOther
Activities (select all that apply - if OTHER is selected, please explain in NOTES Section)

Light ExcerciseWalkedPhysical Therapy ReminderPlayed Music / SangPlayed GamesHad Meaningful ConversationsRead to ClientOther
Were PT Exercises Performed? (If client REFUSED, please explain in NOTES Section)*

YESNOREFUSED
Transportation / Errands (select all that apply - if OTHER is selected, please explain in NOTES Section)

Incidental ErrandsAccompanied Outing/AppointmentRan Unplanned ErrandsOther
TRIUMPHS / CHALLENGES (these are great for us to share with the family)
CHANGES IN CLIENT'S CONDITION
NOTES FOR NEXT SHIFT
ADDITIONAL NOTES
Were there any safety incidents to report? If YES, please include a brief description of what happened in the ADDITIONAL NOTES section above.*

YESNO
Was this a Safe Shift?*

YESNO
CarePro Signature*

Clear
Should be Empty: