SERVICE & TIMESHEET RECORD
Live-In Companion Services
Employee Name
First Name
Last Name
Employee ID:
Client Name
First Name
Last Name
Client Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Daily Tasks
01 - Bathing/Grooming/PC
02 - Dressing/Undressing
03 - Oral Hygiene
04 - Toileting
05 - Turning/Positioning
06 - Ambulate/mobility/transfers
07 - Monitor Skin Condition
15 - Meal Preparation
16 - Feeding
17 - Meds-reminder/cueing
18 - Laundry
19 - Light Housework
22 - Make bed
23 - Grocery Shop
26 - Socialization
27 - Accompany to Doctor
90 - Monitor safety
92 - Accompany on walks
BEGIN Client Care (on duty)
Hour Minutes
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BEGIN Client Care (Rounded)
BEGIN Client Care (Rounded)2
END Client Care (off duty)
Hour Minutes
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Total Hours (On Duty)
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Total Unpaid Hours (Break/Sleep)
Interruption
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Total Interruption Time
Weekly Timecard
BEGIN Client Care (on duty)
Break
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Sleep
END Client Care (off duty)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Calculation
Overtime
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