Brooklyn Unit 2 Shift Report
Supervisor Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Shift Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Staff on current shift
*
Staff #1
Staff #2
Staff #3
Staff #4
Overtime
Mandated
616 E 18th 2-E
616 E 18th P-suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
Is the site above minimum?
*
YES
NO
616 E 18th 2-E
616 E 18th P-suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
What site(s) is above minimum and why?
*
DID YOU CALL TO ENSURE PRECISION CARE WAS COMPLETED FOR ALL INDIVIDUALS IN ALL OF YOUR SITES?
*
YES
NO
N/A
616 E 18th 2-E
616 E 18th P-suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
ARE THERE ANY ISSUES WITH PRECISION CARE? if so, what is the issue and what location?
RECREATION
*
TRIP
Staff attended
Resident(s) attended
Where was/is the trip
Comments
616 E 18th 2-E
616 E 18th P-suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
Did anyone stay home?
*
NAME
REASON
NAME
REASON
NAME
REASON
COMMENTS
616 E 18th 2-E
616 E 18th P-suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
Did anyone visit the home?
*
VISITOR NAME
WHO THEY ARE VISITING
PURPOSE
COMMENT
VISITOR NAME
WHO THEY ARE VISITING
PURPOSE
COMMENTS
616 E 18th 2-E
616 E 18th P-suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
Sick calls
Name
Location
Time
Replacement
Comment
Full Name
Full Name
Full Name
Full Name
Full Name
Full Name
Full Name
Full Name
Full Name
Full Name
Hospitalizations/ appointments/ Nursing Home
Name
Location
Dcc attending
#2 Staff
Appt/Hosp Location
Comment
Full Name
Full Name
Full Name
Full Name
Full Name
Full Name
Concerns
*
Physical Plant
Heating
Water
Electricity
Incidents
Other
No concerns
616 E 18th 2-E
616 E 18th P-suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
Elaborate on any Concerns selected above
Shift Activities
In-Services
Walk-through
Money deposited
Work orders
Fire Drills
Guidances
Evaluations
N/A; Work off site
616 E 18th 2-E
616 E 18th P- Suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
Record Review
Communication Log
Toileting, Re-positioning documentation
Incidents
Training Book
Community Inclusion
Appointment Calendar
Nova-Time Edits
Financial Ledgers
N/A; Work offsite
616 E 18th 2-E
616 E 18th P- Suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
Please ensure there are no blanks. If blanks are found in documentation please address immediately. Please include concerns below.
Observations
Mealtime Preparation
Mealtime Guidelines
Medication pass
Programming activities
Money count/ inter-shift count
N/A; Work offsite
616 E 18th 2-E
616 E 18th P- Suite
1818 New Kirk 5-K
1818 New Kirk 2-H
2922 86th street
If Guidance/Eval was completed, write below names of staff that received it, what in-service was completed? any issues with fire drill?
Submit
Should be Empty: