Timesheet

FSCC Timesheet
Employee First & Last Name
Employee First & Last Name
First Name
Last Name
Consumer First & Last Name
Consumer First & Last Name
First Name
Last Name

Shift

Monday
Tuesday
Wednesday

Thursday

Friday
Saturday

Sunday

Duties

BATHING
BLADDER CARE/BOWEL, TOILET
RANGE OF MOTION: ASSIST WITH MOVEMENT
DRESSING, SKIN CARE, LOTION
MEAL PREP
HOUSEHOLD CLEANING
IADL: SHOPPING, COMPANIONSHIP, APPOINTMENTS

EMPLOYEE NOTE: By your signature, I do hereby attest that this information is true, accurate, and complete to the best of my knowledge and I understand that any falsification may subject me to administrative, civil or criminal liability.

If a consumer is in the hospital, a nursing home, or another facility, away from home for any reason, or has passed away and cannot receive services, you must inform the Administrator IMMEDIATELY at 267-297-7395.

Timesheets are due within 24 hours of receiving notification.