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Home
About Us
Our Official Charity Partner
Meet the Team
Clients
Testimonials
Acquired or Traumatic Brain Injury
Spinal Injury
Other Medical Conditions
Live Vacancies
Register CV
Candidates
Apply online
Supporting Our Official Charity Partner
Subject Access Requests
Refer a Friend Scheme
Care Packages for Brain and Spinal injury
Contact Us
Submit a Daily Record
Daily Record Form - Jordan T
Step 1 of 9
11%
User's Email
Username:
Client Name
*
Name (s) of Support Workers on shift today
*
Today's Date
*
Date Format: DD slash MM slash YYYY
Shift Start Time
*
:
HH
MM
Shift End Time
*
:
HH
MM
Brief Overview of today (what, when, how)
How difficult was your shift with Jordan and why?
What time Jordan got up?
:
HH
MM
How Jordan sleep last night?
Comments on how support worker thought shift went?
Describe any support given planning the day:
Describe any support given recording spending & managing money:
Observations about Jordan's mood:
Did Jordan had a hangover?
Yes
No
Details of any support around memory:
Details of any support around initiation and motivation:
The amount of motivation and interactions.
Details of any support around problem solving or decision making:
Did Jordan had an argument with his partner when you were with Jordan?
Yes
No
How do you feel Jordan's motivation was today?
Accessing the community
Has Jordan access community today?
*
Was Jordan involved in any activities in the community today?
*
Did Jordan require your intervention when out and about?
Did Jordan put himself at risk out in the community?
*
If you answered yes to the previous question then please dive details.
Have you driven Jordan's car today?
Yes
No
Why did you had to use Jordan's car? Please record the mileage.
Medical/expert appointment, gym, any kind of activities etc.
Details of support given with meal preparation, planning and prep:
Please indicate Jordan’s level of participation in keeping the house clean.
Details of support given with domestic tasks
Meals eaten today by Jordan
Observations about Jordan’s fatigue levels:
Has Jordan's schedule been affected by fatigue today?
*
Yes
No
If yes, what time it was?
Any further information relating to fatigue and it’s impact on Jordan?
*
Yes
No
If yes, please provide details
Did this interrupt planned activities?
Yes
No
Were rest periods required?
Yes
No
If so, what times were these to and from?
Rate fatigue levels out of 5.
1 - Not very fatigued
2- Showed signs of fatigue
3 - Showed moderate levels of fatigue but continued with day
4 - Quite fatigued and rest required
5 - Very fatigued and hard to engage
Approximate amount of alcohol Jordan drank today:
Details of any other support given:
Has Jordan got any plans that you know of?
Yes
No
If yes, please provide more details:
Any feedback form Lisa?
Do you have any safeguarding concerns?
*
Yes
No
Please provide full details
*
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