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Resident Name:

Room Number:

400 James Hill Road, Regina, SK, S4W 0N1


Phone: (306)-550-6432 Fax: (306)-559-3092
Daily Record of Care
MM/YR:- 12/2021 1 2 3 4 5 6 7 8 9 10
Morning care
Bed alarm off Y/N
Bed bath
Peri-care
Shower
Hair wash /Shampoo
Shaving/Grooming
Change Dressing for day
Mouth Care
Day Shift

Hearing Aide in
Bowels (size S,M,L,XL)
For No BM plz write
D1, D2 ,D3
Voided Y/N
Breakfast ¼, ½, ¾, all
Lunch ¼, ½, ¾, all
Positioning Y/N
Safety
Call bell in reach
Side rails U/D
Staff Initials
Evening care
Bed bath
Peri-care
Shower
Dressing for bed
Side rails U/D
Mouth Care
Evening Shift

Hearing Aide out


Bowels (size S,M,L,XL)
For No BM plz write
D1, D2 ,D3
Voided Y/N
Supper ¼, ½, ¾, all
Safety
Call bell in reach
Bed alarm on Y/N
Positioning Y/N
Staff Initials
Sleep: Good/Fair/Poor
Positioning Y/N
Bowels:- For No BM
Night Shift

plz write D1, D2 ,D3


Voided Y/N
Safety
Side rails U/D
Staff Initials

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Resident Name:
Room Number:

400 James Hill Road, Regina, SK, S4W 0N1


Phone: (306)-550-6432 Fax: (306)-559-3092
Daily Record of Care
MM/YR:- 12/2021_ 11 12 13 14 15 16 17 18 19 20
Morning care
Bed alarm off Y/N
Bed bath
Peri-care
Shower
Hair wash /Shampoo
Shaving/Grooming
Change Dressing for day
Mouth Care
Day Shift

Hearing Aide in
Bowels (size S,M,L,XL)
For No BM plz write
D1, D2 ,D3
Voided Y/N
Breakfast ¼, ½, ¾, all
Lunch ¼, ½, ¾, all
Positioning Y/N
Safety
Call bell in reach
Side rails U/D
Staff Initials
Evening care
Bed bath
Peri-care
Shower
Dressing for bed
Side rails U/D
Mouth Care
Evening Shift

Hearing Aide out


Bowels (size S,M,L,XL)
For No BM plz write
D1, D2 ,D3
Voided Y/N
Supper ¼, ½, ¾, all
Safety
Call bell in reach
Bed alarm on Y/N
Positioning Y/N
Staff Initials
Sleep: Good/Fair/Poor
Positioning Y/N
Bowels:- For No BM
Night Shift

plz write D1, D2 ,D3


Voided Y/N
Safety
Side rails U/D
Staff Initials

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