Nursing Home Activity Attendance Log Form
Please complete the Nursing Home Activity Attendance Log Form to record resident participation in scheduled activities.
Resident Full Name
*
First Name
Last Name
Resident Room Number
*
Date of Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Activity Name
*
Please Select
Arts & Crafts
Music Session
Exercise Class
Movie Night
Board Games
Reading Group
Gardening
Other
Activity Start Time
Hour Minutes
AM
PM
AM/PM Option
Activity End Time
Hour Minutes
AM
PM
AM/PM Option
Attendance Status
*
Present
Absent
Left Early
Staff Member Recording Attendance
*
First Name
Last Name
Notes or Comments
Signature of Staff Member
Submit Attendance
Submit Attendance
Should be Empty: