Simplified Activity Recorder:
Name of Establishment
Person filling out form:
Week Ending:
-
Month
-
Day
Year
Date Picker Icon
Report For:
First Name
Last Name
Activity ON Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Physical Exercise:
Ch
Ba
Wa
Si
Tc
He
Ar
Bo
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Cognitive activity:
CgR
CgW
CgN
CgM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
One To One Conversations:
OtO1
OtO2
OtO3
otO4
OtO5
OtO6
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Craft Activity
Pt
Dr
Co
DtD
Pd
Co
Mk
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Relaxing Activity
TV
Ra
Cd
DVD
New
Mag
Gm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Trips Outside of Home:
Gc
Sh
Ch
Fa
Me
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Visitors
Dc
De
Sh
Hr
Sw
Fa
Fr
Po
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Weekly Target Objectives:
In
Mo
Sp
Gr
Pc
Mg
Gh
Ag
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Each Days Rating :
1
2
3
4
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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