Home Healthcare Log
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1Home Healthcare Log
Client Name
Employee Name
Check or “X” the box for each item performed on the appropriate day.
Duties Performed
S
M
T
W TH
F
SA
Laundry
Housekeeping
Dusting/Vacuuming
Cooking
Bathing/Showering
Grooming
TOTAL HOURS EACH DAY
TOTAL HOURS FOR THE WEEK
Client
Signature:
Date:
Employee
Signature:
Date:
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Parent category: Miscellaneous