Positioning Schedule Daily Data Sheet

Revision date:

POSITIONING SCHEDULE DAILY DATA SHEET

BY:

NAME:

MONTH_______

YEAR___________

TIME

POSITION

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Day Shift Staff

Trainer

Day Hab Staff

Initials

Evening Shift Staff

Night Shift Staff

√ - POSITIONED PROPERLY

CODE:

X - POSITION ATTEMPTED

0 - NOT POSITIONED PROPERLY

NP - NOT PRESENT

Comments:

Bathing/showering position is:

Toileting or personal care position is:

Oral Care position is:

Medication Position is:

Person is to be elevated at ALL times: Yes / No

OR-FM-AS-PS-63(11-10-09)

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Parent category: Miscellaneous