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Developmental and Intellectual Disability Services
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Home
About
Services
Developmental and Intellectual Disability Services
Personal Care
Companion Care
Skilled Nursing
Dementia Care
Homemaking Services
Post-Surgery Care
Blog
Service Areas
Careers
Forms
Contact
Schedule A Consultation
Caregiver Time Sheet & Task Check-Off (Seniors + DDA)
Use this form for all clients. Check all tasks performed this shift. Signature required.
Caregiver Name
Client Name
Date
Shift Start
Shift End
Total Hours
Tasks Performed (check all that apply)
Personal Care: bathing / grooming / oral care / toileting
Meal prep & feeding assistance (incl. special diets)
G-tube: monitoring / site observation (no skilled tasks)
Medication reminders (no medication administration)
Mobility / transfers / positioning / fall prevention
Community & transportation (appointments, errands)
Housekeeping & laundry (light)
Companionship / supervision / safety monitoring
Behavior support strategies followed as written
Sleep monitoring / overnight checks logged
Care coordination / communication (family, providers)
Shift Notes / Observations
Caregiver Signature
Clear
Date
Submit
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