Date
Day/Night DayNight
Counsellor name
Email address *
Short description of shift
Has any urines been done for the shift YesNo
If yes, description
Has any one been breath tested for the shift YesNo
Has any client had to be spoken to for doing the wrong thing YesNo
Is there a feeling that there may be some people using or drinking YesNo
Has any client brought up any important issues to you that you think other staff needs to know about YesNo
Has any client particularly impressed you over the shift with their attitude and participation in the program YesNo
Have you written a Case Note and sent with your shift report YesNo
Have you had to write anything on the maintenance / WHS log YesNo
Did you do any COMS surveys ? YesNo
Did you clean the office/staff sleepover/staff quarters (Whichever is applicable) ? YesNo
Is this your last shift for the week? ( If yes you need to fill in time sheet ) YesNo
How Was Lunch Today GoodBadNeutral
