Time Log
Staff Member
*
Ben
Christopher
Bailee
Staff Member 2
Ben
Christopher
Bailee
*If two support are Required
Date
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date of Support
Client Name
*
First Name
Last Name
Assistance with Daily Living
Assistance with Social and Community Participation
Assistance with Self Care Activities
Food Preparation
Specialised Items
Travel Time - 30 Mins
Yes
Other
Notes on the Day/Session
Progress Notes, or notes from the day
How did today's session meet the {name}'s Goals?
Is {name} willing to sign today's session?
*
Yes
No, please provide more information
Reason for Not Signing
Physical Disability
Unable or Unwilling to sign
Unsupported Technology
Agreed not to sign
Select One
Please Provide Further Detail
{Name}'s Signature
{staffMember}'s Signature 1
*
{staffMember26}'s Signature 2
Was there an Incident Today?
Yes - Please complete incident report form AFTER Submitting this form
Submit
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