Print/Save |
Original Work Location |
{loc_name} |
Temporary Work Location |
{ReportLabel1} |
Document Date |
{doc_date} |
Coordinator |
{coordinator} |
Medication stored in separate bins for each individual |
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Medication bins labeled properly |
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Pills administered initialed on blister pack |
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Liquids and other bulk medications properly labeled |
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DCed/Expired medication removed from individual medication bins |
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New medications and all PRNs accompanied with PMOF |
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Cabinet neat, organized and devoid of items not belonging to it |
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Controlled drugs under double lock |
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Controlled drug count sheet signed and accurate by previous shift staff |
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All missing pills from controlled drug accounted for |
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Medication cabinet neat and well organized |
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First Aid kit with enough supplies and with no item missing |
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CPR Guard, thermometer/other assigned equipments in cabinet |
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Blood pressure machine in working condition |
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Finger-stick machine work; diabetic supply adequate (if applicable) |
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Medical supply fitting for individual needs adequate |
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MARs neat, stapled together with all binder rings intact |
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All physician orders current, signed and dated |
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All medications entered on MARs as seen in PMOFs & approved by RN |
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All medication labels including Rx #s match physician orders and MAR |
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All documentation in accordance with PMOFs & MTTP policies |
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Medication errors/omissions explanations, RN notification documented |
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All pills missing from bubble pack accounted for on MAR |
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PRN/Stat (one time only) medication recorded correctly |
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Medication cabinet locked and key handed over |
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BP, pulse, blood sugar, weight etc documented as indicated (if app.) |
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Seizure Chart updated (if applicable) |
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Fluid/BM/positioning (if app.)/menstrual (if app.) charts updated |
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Nurse Contact Logs checked for proper notification of RN as needed |
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All verbally reported incidents properly documented/signed by staff |
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Weight recorded for all consumers as indicated |
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Activity schedule and Emergency Contact List current |
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All menus updated to reflect current week |
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Food supply appropriate per menus and adequate for at least 3 days |
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Medical appointments (brown packet) thoroughly reviewed and instructions passed on |
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All monies, receipts and other valuables handed over properly (if app.) |
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All keys, including medication cabinet keys received by incoming staff |
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All individuals accounted for, free of injury/complains, well dressed & well groomed |
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All individual belongings accounted for, have adequate personal need supplies |
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Individuals have adequate seasonal clothing/footwear/linen/towels/hygiene supplies |
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Individual rooms/bathrooms/closets/cabinets/dressers clean and orderly |
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Copy of Current IP/BP (if applicable) with up to date data sheets present |
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Behavioral incidents (if applicable) verbally reported to authority and written report made |
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Evidence of implementation of IP goals and BP (if applicable) present |
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All areas of ALU/floor/carpet/appliances/cabinets etc. clean, neat and orderly |
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Smoke detectors/carbon monoxide detectors/security systems in working order |
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Fire extinguisher tag current/monthly fire drill done before due date |
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Water thermometer (notify supervisor if temperature > 110o) |
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ALU free of lice wires/holes in walls/broken furniture and other safety hazards |
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Water thermometer/vacuum cleaner/kitchen appliances/washer-dryer working |
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All lights including bedroom lamps working |
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Any/all existing maintenance need reported |
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Cleaning/laundry supplies adequate;cooking utensils in good condtion |
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Over (inside & outside)/stove top clean; kitchen sink free of utensils, dishes |
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All crockery & cutlery in complete sets and all other small items accounted for |
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All furniture intact (tables & chairs with no loose legs) & arranged tastefully |
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Hoyer lift/other common equipments (if applicable) in working condition |
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Enough walk space between furniture and room free of fall hazard |
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All household chores completed for the shift |
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Vehicle parked in assigned location with/club lock on (unless in authorized use) |
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Vehicle policy/registration/first aid kit in the glove compartment |
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Vehicle free of unreported damage including minor scrapes/scratches |
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Vehicle clean & neat and free of stains/spills etc. seat belts working |
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Mileage accurately documented and is comparable with approved activities |
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Vehicle keys/mileage log book taken by incoming staff |
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No records |
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