Personal Assistant Daily Charting Sheet

Client Name Employee Name Week Ending Date (Friday)
Date Arrival Time Time Finished Errand Miles
Sa Su Mo Tu We Th Fr
Telephony
Univ. Prec. Inf. Control Followed
Med Reminder
Complete Bed Bath
Shower
Shampoo
Shave
Skin Care/Body Lotion
Pericare
Nail Care (Do Not Cut)
Oral Hygiene
Dress
Assist With Toileting
Bowel Movement
Ambulate w/o Aide Assist
Ambulate w/ Aide Assist
Walker
Cane
Wheelchair
Safety Cues
Sa Su Mo Tu We Th Fr
Hoyer Lift
Slide Board
Turn & Position In Bed
Range of Motion Exercise
Purchase Food/Shopping
Prepare/Serve Meals
Assist/Feed Client
Clean Kitchen
Clean Bathroom
Dust
Vacuum
Make Bed
Change Linen
Do Laundry
Socialization Activities
Take to Appointment
Live In: 3 x 30 Min Breaks
(Initial At End of Each Shift)
Live In: 5 Hrs Unint. Sleep
(Initial At End of Each Shift)
Housekeeping
(Initial At End of Each Shift)
Housekeeping Guidelines
1 Hour: 12 Min
2 Hours: 24 Min
3 Hours: 36 Min
4 Hours: 48 Min
5 Hours: 60 Min
6 Hours: 1Hr 12 Min
7 Hours: 1 Hr 24 Min
8 Hours: 1 Hr 36 Min
9 Hours: 1 Hr 48 Min
10 Hours: 2 Hrs
11 Hours: 2 Hr 12 Min
12 Hours: 2 Hr 24 Min