Date
Day/Night DayNight
Counsellor name
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
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
Was anyone discharged or left the program on this shift? YesNo
If yes, description (their reason for leaving)
Does any client have an upcoming appointment that other staff need to know about?
Is this your last shift for the week? ( If yes you need to fill in time sheet ) YesNo
