
Personal Information
NOTE: Please fill out each day that you worked as well as what duties you performed for your client. Timesheets must be submitted by 3:00 p.m. every friday. Thank you
* First name:
* Last name:
* Social Security No.:
* Your email address:
* Confirm email address:
* Address:
* City:
* State:
* Zip Code:
* Phone:
Weekly Time Sheet
Saturday
Date:
Time In:
Time Out:
Hours:
Client Signature:
Sunday
Date:
Time In:
Time Out:
Hours:
Client Signature:
Monday
Date:
Time In:
Time Out:
Hours:
Client Signature:
Tuesday
Date:
Time In:
Time Out:
Hours:
Client Signature:
Wednesday
Date:
Time In:
Time Out:
Hours:
Client Signature:
Thursday
Date:
Time In:
Time Out:
Hours:
Client Signature:
Friday
Date:
Time In:
Time Out:
Hours:
Client Signature:
NOTE: All caregivers are to check off each task performed during their shift. Initial each day under that day worked.
Initial Duties Performed
Assist Shower:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Assist Bath:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Assist Shave:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Wash Hair:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Assist Dress:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Oral Hygiene:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Trim Fingernails:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Trim Toenails:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Apply Lotion:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Peri Care:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Change Attends:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Put To Bed:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Turn In Bed:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Transfer:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Walk / Wheel:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Exercise:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Prepare Meals:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Serve Meals:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Feed Meal:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Use Hoyer Lift:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Make Bed:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Change Bedding:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Do Laundry:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Dust Furniture:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Vacuum Floors:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Clean Kitchen:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Clean Bathroom:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Clean Bedroom:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Clean Living Room:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Clean Walls:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Wash Windows:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Take Out Trash:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Run Errands:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Grocery Shop:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
Pick Up Medicine:
Days Duties Performed	Sat Sun Mon Tue Wed Thur Fri
* Caregiver Initials:
* Total Hours Worked:
* Caregiver Signature:
* Comments: