Caseworker Check-Out Form
Document your end-of-shift activities and confirm completion of all required tasks.
Caseworker Name
*
First Name
Last Name
Employee ID
*
Date of Check-Out
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Shift Type
*
Morning
Afternoon
Night
Other
List of Cases/Clients Handled
*
Summary of Actions Taken During Shift
*
Pending Follow-Up Tasks
Were all required reports submitted?
*
Yes
No
Equipment/Assets Returned
ID Badge
Keys
Mobile Device
Laptop
Other
Supervisor or Handover Recipient Name
*
Issues or Incidents Encountered During Shift
Additional Comments
Signature
*
Submit Check-Out
Submit Check-Out
Should be Empty: