Daily Record Form – Luke H – Day Shift

User's Email
Username:
Client Name*
Name (s) of all Support Workers on shift today*
Date of Shift*
Date Format: DD slash MM slash YYYY

If you are undertaking night shifts, please remember to enter the correct date the shift started.
Shift Start Time*

: HH

MM
Shift End Time*

: HH

MM
Did you have to prompt Luke to get up and if so how many times?
Brief Overview of today (what, when, how)*

Slips, Trips and Falls
Did Luke experience any instances today of unsteadiness which could have resulted in a slip, trip or fall?*
- Yes
- No
If yes, please describe please provide detail*

General
Did Luke charge his Embrace seizure alert today?
- Yes
- No
Why not?
Was Luke's ALERT app connected to the embrace ( switched on) on his phone today?
Was Luke wearing his Embrace alert today? If not , why did he take off ( i.e. to go into the sea etc.)
Has Luke purchase any cannabis ? If yes, from whom?
Did Luke have any visitors today?*
Do you have any other concerns that either Luke's case manager or Libertatem Healthcare need to be made aware of?*
- Yes
- No
If yes, would these concerns fall under a safeguarding concern
- Yes
- No
If you answered yes to either of the question above, please give details
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