Shift Report – TEST ONLY Shift Report v14 Fields marked with an * are required Declaration These Reports have the same status as statutory declarations. If they are not filled out truthfully, serious disciplinary action could follow. Support Date * Lifestyles? Yes No Participant's Code (ALL CAPS!) * 5 of 5 Character(s) left IC Participant's Name Support Worker's Name * Other Support Workers Divider Shift Start Shift End Actual Start Actual End Health Events Support Plan Followed Health Doctor/Specialist Visit Dentist's Visit Medication Administered Family Visit Body Map Used Behavioural Incident Visitors Incident/Accident/Near Miss Seizure Activity PRN Medication Administered SC/On-Call Contacted HTML Please enter the Temperatures taken at 8am and 8pm* 8amTemp 8pmTemp HTML Copy * Call your Service Coordinator if the temperature is elevated above 38 degrees . Divider Copy Did you use your PRIVATE vehicle? * Yes No Did you use a NWSS vehicle? * Yes No Divider Copy Copy Did you wear a mask when closely supporting people and driving in a vehicle where social distancing isn’t possible? * Yes No COVID-19 * Divider Copy Copy Copy Health and Wellbeing In Community Lifestyle Divider Lifestyle Calendar Activity/Event attended? Lifestyle Calendar Activity/Event NOT attended Divider Copy In Home Lifestyle Visitors to the Home & Reason Comments Main Meal during THIS shift time client retired to bed If you are a human seeing this field, please leave it empty. Print This Page
