Form Hcs 500 - Registered Home Care Aide Training Log

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CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY
COMMUNITY CARE LICENSING DIVISION
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
HOME CARE SERVICES BUREAU
REGISTERED HOME CARE AIDE
INSTRUCTIONS: This form is intended to provide Home Care Organizations with method to
maintain a training verification log for each Affiliated Home Care Aide. Although maintenance of a
TRAINING LOG
Training Log is required per section 90-067(c)(1) of the Written Directives, the use of this specific
form is not required. Home Care Organizations have flexibility to document training requirements
that best fit their business needs.
HOME CARE ORGANIZATION REQUIREMENTS: The Home Care Organization licensee must maintain a verification log of training for each affiliated Home Care Aide which
includes the information listed in 90-067(c)(1) of the Written Directives. Documentation must be kept in personnel file for Department review.
AFFILIATED HOME CARE AIDE, LAST NAME
FIRST NAME
PERSONNEL ID (optional)
POSITION TITLE
HIRE DATE
REGISTRATION DATE
TRAINING HOUR
DATE
LOCATION
REQUIREMENTS
TRAINING
INSTRUCTOR
BRIEF DESCRIPTION OF TOPICS
TRAINING
(Enter hours in
OF TRAINING
ORGANIZATION
TRAINING TITLE
FIRST NAME & LAST NAME
COMPLETED
COVERED
NAME
(If online, specify
applicable column)
(If in-person training)
(MM/DD/YY)
website)
ENTRY
ANNUAL
LEVEL
HCS 500 (4/16)
PAGE ____ OF ____

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