Weekly Timesheets

Services

	Service Month	Service Day	Bathing (Tub/Shower/Bed)	Grooming/Shampooing/Nail Filing/Mouth/Dentures	Assisting with Dressing	Assisting with Toileting	Other:	Observing/Reporting changes in clients condition	Prescription pick-up	Accompanying on Medical Appointments	Medication Reminder	Providing watchful Supervision/Oversight	Other:	Vacuuming/ Sweeping/ Dusting/ Mopping	Laundry/Changing Linens	Assisting with Transfers/Walking/Physical Activities	Assisting with Simple Exercise	Other	Assisting with Errands/Bill Payment/Grocery Shopping	Assisting with Food Stamps or Other Applications	Other:	Proper Nutrition:	Preparing Meals/Clean up/Assisting with Eating	Observing/Reporting Meal Accumulation	Observing/Reporting Food Storage	Observing/Reporting Cooking Equipment Failure	Client's Initials	Caregiver's Initials	Arrival Time	Departure Time	Total Service Time for this Client	Total Hours for Client for Week
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Mon
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Thurs

I affirm that the dates, times, amount of service, initials, and signatures indicated on this document are accurate to the best of my knowledge
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From:
Pay Period
To:
Caregiver's Signature

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Date
Client's Signature

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Date
Note:
Supervisor's Signature

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