Sign Out Staff Sign Out Please complete this form to sign out at the end of the day! Full Name Today's Date MM slash DD slash YYYY Sign Out Time Hours : Minutes AM PM AM/PM Who did you provide supports to today?Select their initials below, you can select more than one. WB JC SV CH Did you complete the following skill building activity with WB?WB expands his knowledge of independent living to stay busy during the day by: collecting eggs, gardening, harvesting fruits and vegetables, and other agricultural-related skills. Yes No Please describe the level of support needed for the activity above: No Support Minimal Support Significant Support Full Support Please list any other activities that you did throughout the day with WB.Please list the activity and the level of supports needed (no supports, minimal support, significant support, total support). You can add more items by clicking on the “+” icon on the right.ActivitySupports Needed Add RemoveDid you complete the following skill building activity with JC?JC expands his independent living skills by: learning reading and spelling. Yes No Please describe the level of support needed for the activity above: No Support Minimal Support Significant Support Full Support Please list any other activities that you did throughout the day with JC.Please list the activity and the level of supports needed (no supports, minimal support, significant support, total support). You can add more items by clicking on the “+” icon on the right.ActivitySupports Needed Add RemoveDid you complete the following skill building activity with SV?SV expands his knowledge of nature-based art projects and mediums by: drawing/sketching, practicing other art-related skills. Yes No Please describe the level of support needed for the activity above: No Support Minimal Support Significant Support Full Support Did you complete the following skill building activity with SV?SV practices emotional-regulation activities to calm himself by: practicing emotional-regulation skills and meditation/mindfulness. Yes No Please describe the level of support needed for the activity above: No Support Minimal Support Significant Support Full Support Please list any other activities that you did throughout the day with SV.Please list the activity and the level of supports needed (no supports, minimal support, significant support, total support). You can add more items by clicking on the “+” icon on the right.ActivitySupports Needed Add RemoveDid you complete the following skill building activity with CH?CH expands his knowledge of agriculture and land management to stay busy during the day and explore agricultural volunteer and employment skills by: Managing trails, collecting eggs, gardening, harvesting fruits and vegetables, and other agricultural related skills. Yes No Please describe the level of support needed for the activity above: No Support Minimal Support Significant Support Full Support Please list any other activities that you did throughout the day with CH.Please list the activity and the level of supports needed (no supports, minimal support, significant support, total support). You can add more items by clicking on the “+” icon on the right.ActivitySupports Needed Add RemovePlease add any other notes about the day below. This can include, but is not limited to, any insights about the day, behavior changes or concerns, activity or improvement ideas, etc.NOTE: For any urgent matters or needs, including reporting serious incidents, please speak with a supervisor immediately. Before I leave, I will confirm that the electric fence charger (red box in the hallway) is plugged in and all lights/electronic devices are turned off.(Required) I agree By typing my name in below, I confirm that all information provided above is accurate to the best of my knowledge.(Required) Δ
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