Caring Hearts Companions, LLC

Time Sheet for HHA, PCA and Respite Care

Day Date Time In
(PC)
Time Out
(PC)
Time In
(Respite)
Time Out
(Respite)
Total
(PC)
Total
(Respite)
Total Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
For each shift, please check the items you worked on with the client to reflect care plan
Personal Care Home Management
Su M Tu W Th F Sa Su M Tu W Th F Sa
Dress/Undress House Keeping
Bath or Shower Changed Linens
Oral Hygiene Vacuumed
Shampoo Clean Bathroom
Eating Clean Kitchen
Urinary Grocery Shopping
Meal Preparation Dusted
Med Reminders Mopped Floors
Made Bed
Take out Garbage
Toileting Transfer
Su M Tu W Th F Sa Su M Tu W Th F Sa
Bathroom From the Chair
Urinal From the bed
Attend Brief In/Out of Car
Hoyer Lift
Activities Activities
Su M Tu W Th F Sa Su M Tu W Th F Sa
Escort to Appt. Errands
Pet Care Recreational
Mail letters/Bills Transportation

EMPLOYEE AGREEMENT: I agree not to accept employment with the Client for the term of employment with Caring Hearts. By signing this time sheet, I certify that all services have been provided in accordance with the Client's CARE assessment and I have delivered all service hours shown on the time sheet. In order to be paid I understand this time sheet must be completed and signed by both me and the client. This information is necessary for our records. All completed time sheets must be returned to the office by Sunday 12 PM. Email to Renae@CaringHeartsCompanions.com or fax to 800.376.2079. Failure to comply will result in a delay of your payroll payment.

Download Time Sheet