Staffing Tracker

Staffing Tracker

Submitted information will go to the union.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Facility *
Shift*
Hours in a Shift (Don't count unpaid lunch and break time)*
Unit/Floor Name (If you’re filling it out for the entire building write “Whole Building”)*
How many beds are on your unit/floor?*
How many residents are on your unit/floor?*
Calculator: Staff Required by Ratios

For your unit/floor/building
# of CNAs on DAY and EVENING SHIFT:
# of CNAs on NIGHT SHIFT
# of LPNs on DAY SHIFT
# of LPNs on EVENING SHIFT
# of LPNs on NIGHT SHIFT
How Many Staff Do You Actually Have

On your unit/floor/building
CNAs
# of CNAs working*
CNA #1: Hours worked*
CNA #2: Hours worked (If no other CNA, enter "0")*
CNA #3: Hours worked (If no other CNA, enter "0")*
CNA #4: Hours worked (If no other CNA, enter "0")*
CNA #5: Hours worked (If no other CNA, enter "0")*
CNA #6: Hours worked (If no other CNA, enter "0")*
LPNs
# of LPNs working*
LPN #1: Hours worked*
LPN #2: Hours worked (If no other LPN, enter "0")*
LPN #3: Hours worked (If no other LPN, enter "0")*
LPN #4: Hours worked (If no other LPN, enter "0")*
Calculator
FTE - CNA Day
FTE - CNA Evening
FTE - CNA Night
FTE - LPN Day
FTE - LPN Evening
FTE - LPN Night
CNA Care Hours Reported
LPN Care Hours Reported
Compliant with CNA ratios
Noncompliant with CNA ratios
Compliant with LPN ratios
Noncompliant with LPN ratios
CNA Day Calculation
CNA Evening Calculation
CNA Night Calculation
LPN Day Calculation
LPN Evening Calculation
LPN Night Calculation
If your facility is noncompliant, how did the understaffing affect resident care? (Check all that apply.)*

No time to bathe residentsResident was served a cold or old mealStaff had to feed more than 2 residents at onceMedication was not given timely in accordance with Care PlanResidents were transferred with 1 staff when using full body liftsResidents were not able to be changed according to Care PlanResidents were not able to be turned every 2 hoursResidents were not able to be given showers as per Care PlanUnable to assist residents with Activities of Daily LivingUnable to follow up on residents concerns and medication effectivenessResidents treatments are not completed as per Care PlanA fall happened on my shift due to lack of staffA fall happened on my shift that resulted in the resident having to go to the hospitalInsufficient time to fully or accurately chartOther (please specify below)
Hidden: Resident Care Impact List
Other:
Employer Accountability
How many CNAs were scheduled (for your shift and unit/floor)?
How many LPNs were scheduled (for your shift and unit/floor)?
Upload a picture of the deployment sheet or schedule:

Cancelof
Were there call offs (for your shift and unit/floor)?

YesNo
How many CNAs called off?
How many LPNs called off?
Did people come to replace call offs?

YesNo
How many CNAs?
How many LPNs?
CNA replacements: How many hours did they come for?
LPN replacements: How many hours did they come for?
Did a CNA or LPN leave the floor to do a one-on-one (e.g. transport)?

YesNo
For how long did they leave the floor?
Did management send someone who came for work home?

YesNoOther
Why did they send someone home?
Should be Empty:

Staffing Tracker

Calculator: Staff Required by Ratios

How Many Staff Do You Actually Have

Calculator

Employer Accountability