Daily MAR Check ReportDaily MAR Check Report Please Fill out This Form: Date * Facility Program * Supervisor * Overnight (12am – 8am) Staff Name * Staff Name First Name First Name Last Name Last NameWas Med Passed? * Yes NoWas Med Recorded? * Yes NoWas Med Refused? * Yes NoCoaching Completed? * Yes No Person Initial * Comments * plus1 Add Staff minus1 Remove StaffDaily (8am – 4pm) Name * Name First Name First Name Last Name Last NameWas Med Passed? * Yes NoWas Med Recorded? * Yes NoWas Med Refused? * Yes NoCoaching Completed? * Yes No Person Initial * Comments * plus1 Add Staff minus1 Remove StaffNight (4pm – 12am) Name * Name First Name First Name Last Name Last NameWas Med Passed? * Yes NoWas Med Recorded? * Yes NoWas Med Refused? * Yes NoCoaching Completed? * Yes No Person Initial * Comments * plus1 Add Staff minus1 Remove StaffSupervisor Contact Date * Supervisor Name * Enter the name of the supervisor who reviewed the fire drill. Supervisor Signature * signature keyboard Clear Submit If you are human, leave this field blank.
