Case Notes-KJ House

Better Together Mesa

Case Notes
Location*

KJ House
Summary of Shift*
Description of youths day including recent triggers
Chris Tynes*
Connor O'Donnell*
Tegan Croft*
Fey/Zach Bell*
Brendon Cardwell*
Ryan McMahon*
Fabian Castillo*
Ethan Contreras*
Luke Andez*
Brenden Bako*
Isaiah Guerra*
Trystan Youngblood*
Jimi Ibarra*
Are all kids accounted for?*

YesNo
If no please explain*
Recommendations or Suggestions*

House Condition*

	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*
Grocery list items needed*
Fuel in Van*

Full3/4Half1/4Empty
Household supply items*
Any damages to house or repairs needed*
Staff Lead Name*

First NameLast Name
Second staff on shift

First NameLast Name
Time*

Hour Minutes

AM/PM Option
Date*

MonthDayYear
Date
Should be Empty: