You are on page 1of 3

MISSION INC.

EBENEZER
PERIOD : 2019 AUGUST ~

OUTING
COMMUNITY PARTICIPATION

LOG BOOK
LOG: DAY / /
Time - Leader Written by

Location Supervisor

Purpose Things to Bring

Participant Disability Support Worker Pick Up Point Transportation Etc.

Y/N Train/Bus/Car

Y/N Train/Bus/Car

Y/N Train/Bus/Car

Participant / Y/N Train/Bus/Car


Support
Worker List

Y/N Train/Bus/Car

Y/N Train/Bus/Car

Y/N Train/Bus/Car

Y/N Train/Bus/Car

Y/N Train/Bus/Car
REPORT ACTIVITY 1 REPORT ACTIVITY 2
Written By Written By

Food intake Food intake

Comment Comment

Participant Participant
Poor Fair Good Poor Fair Good
Engagement Engagement

Incident Yes No Incident Yes No

ex) Seizure/ ex) Seizure/


Incident Incident

Details Details

**More details will be given in separate form **More details will be given in separate form

You might also like