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Forms > 01 Activities (142 docs)

01 Activities (142 docs)

Free Forms, caregiving, nursing forms, policies, Licensing, Training, Case Management, Home Care, Assisted Living, DD, MI, HCBS

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Documents in 01 Activities (142 docs) (142)

This great form is used by various types of community based care facilities to report an accident, incident, and/or injury to a resident. This detailed form takes the care provider step-by-step through essential information needed when this type of occurrence takes place.  This form also contains recheck information.  

If the accident, incident or injury causes a legal action to be filed, then the information on this form could be very instrumental in showing the steps the care provider took after the event to ensure for the resident's well being. Accident Incident Injury Report Form - Resident Community Care Homes Assisted Living
Administration of the Activity Department.

The Activity Director is responsible for making sure the following areas are addressed:

Outing Safety
Driving Procedures
Emergency Plans
Activities for Special Illness and Diseases: ... Activity Administration
Blank Activity Calendar ready to be filled out. Activity Calendar Form
Sample of what an activity calendar might look like. Activity Calendar Sample
Blank form on which to list contacts for activities. Activity Contact List
Setting goals helps create a successful activity program.  This Form is used to help the Activity Director formulate goals for their department.

This form can be used in all types of community based care homes, nursing homes, and other types of care facilities. Activity Department Goals and Plans
The public would be surprised to see how many lawsuits are brought against a care facility due to a resident's involvement in an activity.  It is essential for every activity director and volunteer to ensure resident(s) safety at all times.
These rules have been updated numerous times over a 20 year period.  Every time a lawsuit or accident happened that the staff of ProvidersWeb became aware of, we updated the safety rules accordingly to prevent the event from happening to anyone else.  The process of discovering a risk, and creating policies and procedures to advert the risk like safety rules, is called risk management.

All interior decorations are required to be non-flammable.  Decorations must not be hung in such a manner that will interfere with the fire sprinkler system or block fire doors. Activity Department Safety Rules
Activity safety rules acknowledgment form for all personnel and volunteers to acknowledge their understanding of the safety rules and duty to abide by the rules. Activity Department Safety Rules Form
A Pledge the Activity Director makes acknowledging their responsibility to meet state requirements.

The following job descriptions, policies and duties are those this company expects the Activity Director to follow.  They are not conclusive, and will need to be updated as the need indicates.... Activity Director Pledge
Safety procedures for all volunteer or staff drivers to follow in order to transport residents for activities.

All employees or volunteers that transport residents must maintain a valid driver's license and proof of auto insurance. For each driver used, the Activity Director is required to submit copies of the potential driver's license, proof of insurance, and good DMV record to the Office prior to allowing any residents to be transported.  In addition all employee's volunteers shall review, and sign the following auto accident procedures: Activity/Volunteer Driving Procedures
An evaluation of an activity program for quality assurance.

At least annually, or more often if needed, the Administrator is to evaluate the Activities program for quality assurance.  The Activity Director is responsible for maintaining the following records. Administrator Activity QA Report
Information on a resident's adult life for their Life Journal. Adult Life Information
Resident's Life Journal Page. Beautiful Places I Have Seen
This form is used to report exposure to any pathogens, such as blood. Care Facility Exposure Report Form
Resident's Life Journal Page. Changing the Past to Make the Present Better
A worksheet for listing community contacts for the Activity Program. Community Contacts Worksheet
Form used to gather information about the resident's activity interests.  

Previous Occupation(s):
Describe your daily routine:
What is/was your favorite thing to do at home? Current Activity Questionnaire (Short)
Form used to post the current community activity goals for the facility. Current Community Activity Goals
A list of questions used to lead a discussion group on politics. Discussion Group - Politics
Resident's Life Journal Page. Family Recipes and Favorite Recipes
Family Tree for Life Journal. Family Tree
Resident's Life Journal Page. Favorite Childhood Memories
Resident's Life Journal Page. Favorite Foods and Drinks
Form used to plan goals for residents. Goal Card
Form to keep track of attendance at group activities. Group Activities Attendance Record
Form to help plan group activities. Group Planned Activities
Application filed by volunteer group. Group Volunteer Application
Form used to keep track of group volunteer's activity assignments. Group Volunteer Assignment Record
Form used for recording information about the volunteer group. Group Volunteer Record Form
Form to record group volunteer's time at facility. Group Volunteer Time Sheet
A birthday poster. Happy Joyful Birthday
Form used to plan an event at your facility.

Title & Theme: Example: Hosting an Event
This is a self-value exercise to help a resident see his/her positive attributes.  With this exercise, the resident asks 5 people to list a couple of positive things they notice about the resident. How Others See Me
Form used by residents to write about their own characteristics and how they feel about things, encouraging use of their imagination. I AM
Independent Contractor Agreement Form. Independent Contractor Agreement
Independent Contractor Agreement sample to show how the form should be completed. Independent Contractor Agreement (Sample)
A thorough form covering payment, schedules, services to be performed, contractor tax identification number, etc. when using an Independent Contractor in your organization. Independent Contractor Questionnaire
Form used to review individual resident's progress with activities. Includes sections such as current participation level, social interactions, challenges, and goals. Individual Activity Plan Review
Description of job duties and responsibilities of an Activity Director in a care facility. This form also includes the purpose, good features, and challenges of this job.

The Challenges:
~Getting people to volunteer.
~Getting residents to attend activities, getting residents motivated. 
~Managing volunteers
~Supervising volunteer school kids 
~Compliance with all the state rules and regulations, and company policies and procedures at all times. Job Description - Activity Director
This is a form used to list job tasks that may be encountered which will place care facility staff at risk of occupational exposure to blood or other potentially infectious materials.

The following is a list of job tasks that the Activity Director & volunteers may encounter, which will place them at risk of occupational exposure.  This list is not conclusive, and new risks should be added as they are identified. Job Exposure Determination - Activity Director & Volunteers
Overview of job duties and responsibilities of an Activity Director of a care facility.

Personal Abilities: Good Moral Character. Good Assessment and observation skills. Ability to multi-task. Good vision and hearing. Good communication skills. Clean and neat in appearance. Must be energetic, enthusiastic and with out going personality. Job Overview - Activity Director
Resident's Life Journal Page. Known Family Medical Problems
Information on the resident's life in more recent years for the Life Journal. Later Life Information
The Life Journal Activity Booklet is a workbook providing comprehensive forms inspiring your loved ones and residents to fully embrace the purpose of their life, and much more.  Far more than simply urging seniors to reminisce about the past, the Life Journal allows you to know and record what your parent or resident thinks, feels, and has learned in their lifetime. Life Journal Activity eBook
Serves as table of contents and suggested order for residents individual Life Journal. Life Journal of
Check off list for completed pages of the Resident's Life Journal. Life Journal Pages Check Off
Resident's profile page for the Life Journal. Life Journal Profile
List of long-term care services.

The following long-term care services for the elderly are available in various areas of the State.  The local Area on Aging has the telephone numbers, address and service information for many of these organizations.
When a resident shows signs of needs, which must be met by outside community agencies, the following list should be utilized. Long Term Care Community Based Services Checklist
Make A Difference - Volunteers Needed
Master list of organizational group activities for interactive recreation, entertainment, and outings.

Complete the blank with the name of Organization assigned.   (The idea is to get all assigned)

Group - Interactive

______________ Adopt a Senior Library
______________ Airplane Show, Fly Residents
______________ Annual Fashion Show
______________ BINGO ... Master List - Organizational Group Activities
Master list for volunteer activities for one-to-one visitors and instructor/leader visitors.

Complete the blank with the name of Organization assigned.   (The idea is to get all assigned)

One to One Visitors
__________ Life Journal, One on One Attention
__________ Love Tag Program
__________ Walking 
__________ Sunshine Program
__________ Nail Care ... Master List - Volunteer Activities
Resident's Life Journal Page. Modes of Transportation
This form is used to plan and map out activities. Monthly/Weekly Worksheet
Resident's Life Journal Page. Most Important Thing I Know
Resident's Life Journal Page. My Advice for Future Generations
Resident's Life Journal Page. My Children Growing Up
Resident's Life Journal Page. My Children's Teenage Years
Resident's Life Journal Page. My Family's Holiday Traditions
Resident's Life Journal Page. My Favorite Thing I Did When I Was Young
Resident's Life Journal Page. My First Kiss
Resident's Life Journal Page. My Grandparents
Resident's Life Journal Page. My Heritage
Resident's Life Journal Page. My Parents
Resident's Life Journal Page. My School Days
Resident's Life Journal Page. My Wedding Day
Resident's Life Journal Page. My Work History
Resident's Life Journal Page. My Worldly Travels
Form used for organizations and groups to list what areas of activities they are interested in. Organizational and Group Activity Interest Form
This great form is a 2-page Outing Check Off List
Permission slip signed by a residents responsible party before taking them out on outings. Outing Permission Slip
A form used to explain the responsibility for resident safety during activity outings.

Residents love to go on outings. The following was designed to help address common safety issues for outings.  The list is not conclusive, and therefore good safety judgment should be exercised at all times.  Remember, Outing Safety Responsibility Form
Form for pet owner information.

Last Immunization (If applicable):
Visitation Information: Pet Owner Information for Community Care Facilities
Form to keep track of petty cash for administrative, maintenance, and activities. Petty Cash Report
This consent form is to get permission to use and reproduce of any photograph, digital video, multi-media format or other audio-visual materials for residents, staff and volunteers. For residential care and assisted living facilities. Photograph & Media Release Form for Community Based Care Homes
Form to get approval from a Physician for a special activity. Physician Approval for Special Activity
A resident survey used to check quality assurance of the activities program.

Do you attend the current events program?
Are your Rights and Privacy protected?
Are your safety needs met during activities? ... Quality Assurance Activities Program (Resident Survey)
Area review to assure that your facility has a high quality activity program in place. Quality Assurance Area Review Report
Form used to assist residents to change negative attitudes to positive attitudes by reframing the way they think. Reframing, My New Thinking
Resident's Life Journal Page. Relatives I Was Closest To
A list of documents that should be kept by the Activity Director of a Care Facility. Required Activity Documentation
Form used to plan and set goals for each residents activities.

Personal Orientation and Relationships:	
Distinguishes Between Past & Present Events
Is Over Concerned With Self
Aware Of Surroundings
Accepts Personal Limits
Desires Recognition ... Resident Activity Goal Plan Review
Form used by resident's to indicate their preferred activities, can be used by various types of community based care businesses. Resident Activity Interest Form for Community Based Care Homes
Form used in assessing residents level of activity. Resident Activity Record Form
A flier for resident council meeting notification. Resident Council Meeting Sign
Sign in sheet for the resident council meetings. Resident Council Meeting Sign In Sheet
Form to record Resident Council meeting minutes. Resident Council Minutes (Form)
A form for the resident to list the goals he/she would like to achieve. 

When I need emotional support I know I can: ________________________________.
To enhance my knowledge or education I can: ________________________________. Resident Performance Goals Form
This form is used to complete a profile of the resident's personal life in order to make sure his/her social needs are met. Resident Personal Life Profile
Form used to list resident's personal social data. Resident Personal Social Data
Form used to profile an individual resident.

Childhood Information	
Family size:
Family still remaining:
Do they live nearby?
Where did you spend your childhood? Resident Profile (Short Version)
A form used to list the names of all residents going on an outing to check-off that all of the residents needs are being met before leaving. Resident Ready for Outing Check-off List
Pre-planning Activity Survey.  This simple form is designed to help the Activity Director periodically find out the current activity interests of the individual residents.  Interests can change for residents living in assisted living facilities, nursing homes, group homes and residential care communities.  This form will help the activity program keep up with residents' current interests. Resident(s) Activity Likes Survey Form
This good Resident's Health Status Form used to access resident's physical abilities for performing activities.  It can be used in tandem with the Pre-Admission Appraisal Form and/or the Levels of Care Form. Resident's Health Status - Assessment of Abilities
Form used to record an individual resident's visitation. Resident's Individual Visitation Record
Form used to help a resident plan ways to care for themselves. Self-Care Plan
An important check off list for a resident's sensory care issues. Sensory Care Check Off
A special flyer to pass out when looking for resident support for planned activities. Special Flyer
This form encourages residents to write down their unique personal qualities. Specially Me
Miniature spiritual cards can be made from this template and decorated to hand out to others. Spiritual Cards
Worksheet used by residents and staff to learn about his/her spirituality.  Also used in a discussion group to write what each person would like to share with others. Great activity for nursing homes, assisted living facilities and all type of community based care homes. Spiritual Worksheet
Resident's Life Journal Page. Sports In My Life
Residents personal rights.

II. All persons accepted to facilities, or the responsible persons, shall be personally advised and given a copy of these rights at admission.  The licensee shall have all residents or their responsible persons sign a copy of the rights and the signed copy shall be included in the resident's record. Statement of Resident Rights
A diagram used to show residents the individuals in their support system. Support System Diagram
A sample cover letter used when replying to a potential individual or group volunteer. Used normally with the Thank You For Your Interest - Group
A sample cover letter used when replying to a potential individual or group volunteer. Used normally with the Thank You For Your Interest - Individual
Resident's Life Journal Page. The Best Friends I Have Had
Resident's Life Journal Page. The Best Time of My Life
Resident's Life Journal Page. The Coolest Thing
Resident's Life Journal Page. The Dumbest Thing
Resident's Life Journal Page. The Most Exciting Thing
Resident's Life Journal Page. The Most Important Thing I've Ever Done
Resident's Life Journal Page. The Most Trouble I Got In To
Resident's Life Journal Page. The Pets I Have Known
Resident's Life Journal Page. The Purpose of Life Is
Resident's Life Journal Page. Things Are Not Like They Used To Be
Free activity form for the Thanksgiving Holiday. Things I am Thankful For
Resident's Life Journal Blank Page for additional Topics not listed. Topic
Resident's Life Journal Page. TV Shows and Movies
A Free Activity Game used to describe person's characteristics. Unique Game
A video release for making a movie with the resident. Video Making "Yesterday's Memories and Tomorrow's Dreams"
Visitor Information form. Visitor Information
Form for visitors to sign in and out of the facility. Visitor Sign In and Out Record
Agreement between the facility and individual volunteer to perform activities with the residents.

I agree to serve as a volunteer for ________________________.   I have been accepted into the volunteer program, and I understand my responsibility to the residents and staff of the community. Volunteer and Facility Agreement
Application to be filed from individual volunteers. Volunteer Application
Form used to record individual volunteers assignments. Volunteer Assignment Record Form
Used to give Volunteers feedback on their performance.  Often required by the High School for student volunteers who are receiving class credit. Volunteer Evaluation Form
Statement signed by the volunteer that they are in good health for performing activities with the residents.

I, _________________ hereby attest that I am in good health, free of communicable diseases, and have the mental and physical agility to handle the volunteer job(s) that I have been assigned to do. Volunteer Good Health Statement
Agreement between the facility and volunteer group for volunteer services performed.

We agree to serve as volunteers for ________________________.   We have been accepted into the volunteer program, and we understand the responsibility we have to the residents and staff of the community.  We will respect others Rights, Cultures and Beliefs.  We will protect both the residents and the company's confidentiality. Volunteer Group & Facility Agreement
Safety training for volunteer groups.

Having a safe and secure environment for the residents and volunteers in which to do activities is essential.  Safety considerations build confidence, security, and competency and overcome the initial anxieties related to participating in activities. Please read this to the members who will be volunteering for the volunteer activity. Volunteer Group Safety Training
Form used to list the interests of an individual volunteer. Volunteer Interests - Individual
This is an easy to use form to help the Activity Director conduct the interview of the prospective volunteer. Volunteer Interview Form
A description of the volunteer's job duties.

Not Allowed:

Do not talk about residents, and always keep their confidentiality.
Do not touch bodily fluids
Do not assist someone to the bathroom or out of bed, only to be done by correctly trained direct care staff ... Volunteer Job Description
This is an excellent form to create a basic job description for each volunteer job you create.  The volunteer should be given a copy during training. Volunteer Job Worksheet
Form used by a care facility's Activity Director to check off the necessary documentation and training required for volunteers. Volunteer Orientation Check Off List
It is important for the Activity Director to survey their volunteers to gather their input, where changes need to be made to the Volunteer Program.

I volunteered for this position because:

Do you feel you were properly trained?

What do you like best about volunteering? Volunteer Quality Assurance Survey
Form used to record information about an individual volunteer. Volunteer Record Form
Safety training of individual volunteers. 

Having a safe and secure environment for the residents, and volunteers to do activities is essential.  Safety considerations build confidence, security, and competency and overcome the initial anxieties related to participating in activities.  Please read this to the members who will be volunteering for the volunteer activity. Volunteer Safety Training
Form used to record individual volunteers time spent working with residents. Volunteer Time Sheet
Report used for training volunteers. Volunteer Training Report
Resident's Life Journal Page. What I Think About God
Resident's Life Journal Page. What I Would Like to See in the Future
Resident's Life Journal Page. When I was Born
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