Chores Details LogChores Details Log Please Fill out This Form: Date * Facility Program * Staff Name * Staff Name First Name First Name Last Name Last Name Staff Phone Number * Staff Email address * Shift * 12:00 AM – 8:00 AM8:00 AM – 4:00 PM4:00 PM – 11:59 PM How was the staff completing their chores during the shift:Activity Staff First & Last Name * Person First & Last Name Initial * Please select each chores completed by staff during their shift. TA PA VP Self Refused N/ASweep and Mop kitchen and dining area TA PA VP Self Refused N/AWash bathroom rugs TA PA VP Self Refused N/AVacuum living room TA PA VP Self Refused N/AVacuum hallways and stairs TA PA VP Self Refused N/AVacuum Client’s bedroom TA PA VP Self Refused N/AMop & Sweep hallways and stairs TA PA VP Self Refused N/AMop & Sweep living room TA PA VP Self Refused N/AMop & Sweep client’s bedroom TA PA VP Self Refused N/AMop & sweep bathrooms TA PA VP Self Refused N/AClean toilette, bathtub sink and Mirror TA PA VP Self Refused N/AClean oven and stovetop TA PA VP Self Refused N/AWash dishes TA PA VP Self Refused N/AOrganize person’s bedroom (change bedsheet, fold clothes) TA PA VP Self Refused N/AWipe down tables, shelves, chairs and any other furniture TA PA VP Self Refused N/AClean all Windows with Windex TA PA VP Self Refused N/ATake trash out TA PA VP Self Refused N/AClean inside Microwave TA PA VP Self Refused N/AWipe down refrigerator TA PA VP Self Refused N/ADisinfect all door knobs with disinfectant TA PA VP Self Refused N/ALandscape inspection (pick up debris) TA PA VP Self Refused N/AOil Check in basement TA PA VP Self Refused N/AFood expiration check TA PA VP Self Refused N/A plus1 Add Staff minus1 Remove StaffStaff Acknowledgement Date * Supervisor Name * Enter the name of the supervisor who will review the chores details log. Staff Signature * signature keyboard Clear Submit If you are human, leave this field blank.
