Employee Flow Sheet Posted on February 28, 2017February 28, 2017 by Thomas W. Tull * indicates are required entry Employee & Client Information Your name * : Your email * : Your Employee ID#* : Today's Date* (MM-DD-YYYY) : Client Name * Time In* : Time Out* : Total Hours* : Personal Hygiene - Task Completed Tub BathHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed ShowerHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Sponge BathHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Peri CareHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed ShampooHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Hair CareHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Skin CareHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Oral HygieneHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed ShaveHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Dressing - Task Completed UpperHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed LowerHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Movement - Task Completed WalkHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed TransferHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed RepositionHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Exercise ProgHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Meal Prep - Task Completed BreakfastHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed LunchHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed SupperHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed SnacksHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed AppetiteGoodFairPoor Housekeeping - Task Completed DustHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed VacuumHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Clean BathroomHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Clean KitchenHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Clean BedroomHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Wash ClothesHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Wash LinensHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Wash DishesHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Miscellaneous - Task Completed ShoppingHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed ErrandsHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Dr. AppointmentHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed OtherHHA/CNA completedHHA/CNA AssistedCompleted by ClientCompleted by FamilyRefusedNot Completed Medication - Task Completed HHA/CENA's are not licensed to administer or "set up" any prescription or non-prescription medication. MedicationYesNo Precautions Taken Equipment used properly: YesNo Walkways clear and well lit: YesNo Universal Precautions followed: YesNo Daily Comments: Your Signature: Client Signature:
