Shadowing Sign Off Form
Details of Shadowing
New Staff Member
First Name
Last Name
Staff Shadowed
Shadowing
Activity Being Observed
Rows
Yes
No
Observations/comments (From staff performing shadowing)
Is the Care Worker punctual?
1
2
Does the Care Worker alert the Service User upon arrival/has key safe number?
3
4
Care Worker wearing a valid and current ID badge?
5
6
Does the Care Worker practices safe hygiene (use of PPE clothing, gloves/aprons etc)?
7
8
Care Worker checks Service User Care Plan/Communication Sheets upon arrival?
9
10
Equipment (hoists etc) used properly and care worker has required level of training?
11
12
Care Worker practices proper Food Safety & Hygiene principles?
13
14
Care Worker is vigilant for hazards in the Services User's home?
15
16
Care Worker communicates with the S/User re. tasks to be done maintaining confidentiality?
17
18
Care Worker is respectful of S/User's beliefs, culture, values and preferences?
19
20
Care Worker completes Daily Report forms satisfactorily?
21
22
Snacks left for the Service User are covered and stored properly?
23
24
Care Worker leaves premises, locking doors behind him/her if requested?
25
26
OPINION: Care Worker is suited to the Service Users? Friendly/Personable/Professional
27
28
Care Worker reports they are confident in the role?
29
30
Shadowing Feedback
Care Worker Shadowing Sign Off/ Deemed Competent To Work Unsupervised
Name
First Name
Last Name
Job Title
Please Select
Care Worker
Care Supervisor
Care Manager
Date
 /
Day
 /
Month
Year
2 digit day, 2 digit month, 4 digit year
31
Signature
Submit
Should be Empty: