Direct Care Staff Daily Report
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DIRECT CARE STAFF DAILY REPORT
On Duty Today
/
/
Facility Name:
Nursing Staff Directly Responsible for Resident Care
(See shift ratio/staff type(s)/exceptions below.)
Day Shift
Evening Shift
Night Shift
Resident Census:
Resident Census:
Resident Census:
Staff Type
Number of Staff Hours Worked
Staff Type Number of Staff Hours Worked
Staff Type Number of Staff Hours Worked
RN
RN
RN
LPN
LPN
LPN
CNA**
CNA**
CNA**
NA**
NA**
NA**
Authorized by:
Authorized by:
Authorized by:
**Mandatory Minimum Shift Ratio
Staff Types
Exceptions
Day: 1 CNA/NA per 7 Residents
RN
Registered Nurse
CMA’s / RA’s are not required staffing
Evening: 1 CNA/NA per 11 Residents
LPN
Licensed Practical Nurse
positions.
Night: 1 CNA/NA per 18 Residents
CNA**
Certified Nursing Aide
CMA’s/RA’s/or Charge Nurses (RN/LPN
NA**
Nursing Aide (non-certified)
assigned as Charge Nurse.) may not be
STAFFING QUESTIONS
CMA
Certified Medication Aide
counted toward meeting the direct care
OR CONCERNS CALL
minimum staffing ratios.
RA
Restorative Aide (certified)
(503) 945-6748
SDS 0717 (04/09)
Retention : 18 months from date posted
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