Complete the appropriate sections of the report card below at the end of a days / evening care for a child(ren).
1 Phone / Visitors
You received the following phone calls and visitors.
Date/time __________________________________________________________________________
Caller or visitor__________________________________________________________________________
Reason for call__________________________________________________________________________
Date/time __________________________________________________________________________
Caller or visitor__________________________________________________________________________
Reason for call__________________________________________________________________________
Date/time __________________________________________________________________________
Caller or visitor__________________________________________________________________________
Reason for call__________________________________________________________________________
2. Safety
I provided the following first aid care for___________________(child’s name).
What happened: __________________________________________________
__________________________________________________
__________________________________________________
Where was the injury: _________________________________________
When did it happen: _________________________________________
What the child reported: _________________________________________
What I did: _________________________________________
I provided the following first aid care for___________________(child’s name).
What happened: __________________________________________________
__________________________________________________________________________________________________________________________________________
Where was the injury: _________________________________________
When did it happen: _________________________________________
What the child reported: _________________________________________
What I did: _________________________________________
3. Play
a. We played with the following games and toys:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
b. I noticed these good behaviors while we were playing:
__________________________________________________
__________________________________________________
__________________________________________________
_________________________________________________
4. Food
a. We ate the following foods
Breakfast_______________________________________________
Morning tea____________________________________________
Lunch__________________________________________________
Afternoon tea __________________________________________________
Dinner__________________________________________________
5. Sleeps
___________________(child’s name) went to bed for evening at _________________________________________________
___________________(child’s name) went to bed for evening at _________________________________________________
___________________(child’s name) went to bed for evening at _________________________________________________
___________________(child’s name) went to bed for evening at _________________________________________________
___________________(child’s name) went to bed for evening at _________________________________________________
6. Toileting / nappy change
For _____________ I changed the nappy /helped with toileting
_____ times and I noticed ________________________
_________________________________________________.
For _____________ I changed the nappy /helped with toileting
_____ times and I noticed ________________________
_________________________________________________.
For _____________ I changed the nappy /helped with toileting
_____ times and I noticed ________________________
_________________________________________________.
7. Medicine
I gave _____________ (child’s name) the following
medications and amounts exactly as instructed by
___________________________ (parent or guardian):
Time: _____________Medicine: _____________
Amount Given:____________
Any Reactions: _____________________________________
