Better Together Mesa
Case Notes
Location
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KJ House
Summary of Shift
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Description of youths day including recent triggers
Chris Tynes
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Connor O'Donnell
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Tegan Croft
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Fey/Zach Bell
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Brendon Cardwell
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Ryan McMahon
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Fabian Castillo
*
Ethan Contreras
*
Luke Andez
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Brenden Bako
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Trystan Youngblood
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Jakavious Jones
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Kid 10
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Are all kids accounted for?
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Yes
No
If no please explain
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Recommendations or Suggestions
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House Condition
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Rows
Excellent
Average
Below Average
Unacceptable
Cleanliness Of House at Start of Shift
Cleanliness of House at End of Shift
Explain Above Response if below average
Are any Meds running low? Or need Med sheet
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Grocery list items needed
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Fuel in Van
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Full
3/4
Half
1/4
Empty
Household supply items
*
Any damages to house or repairs needed
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Staff Lead Name
*
First Name
Last Name
Second staff on shift
First Name
Last Name
Time
*
Hour Minutes
AM
PM
AM/PM Option
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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