TIMESHEET

Sunny Days PA TimeSheet Form
Clock in Time
Clock out Time

LOCATION SERVICES WERE PROVIDED

TASK PERFORMED DURING SHIFT

Homemaker Services: light housekeeping, laundry, shopping, companionship, securing transportation, errands
Toileting: bowel/bladder management, incontinence
Hygiene: bathing, hair care, lotion/ointment, dressing, wound care
Meals: meal preparation, eating, drinking
Range In Motion: transfers, ambulating, supervised walks,using prosthetics
IADLs: appointments, device use, medication reminders, social activities
I, hereby attest that this information is true, accurate and complete to the best of my knowledge. I understand that all signatures must be authentic and by the authorized signer to prevent fraud/forgery. I understand that any falsification, omission or concealment of information fact may subject me to administrative, civil or criminal liability
Instructions: This is a legal document. Verify your assignment and care plan for accuracy. Check off all duties completed. If the client is hospitalized, visit the Emergency Room (ER), in an in-patient facility, on vacation, away from home, receiving other services, deceased or is unable to be serviced due to other reasons; per regulation as a mandated reporter, you are required to report immediately to your supervisor.

Note: A Timesheet does not replace the regulated EVV method to submit attendance. This may cause a delay in compensation as a manual review is required.

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