Coaching Log

Date : *

Staff’s Name : *

Supervisor : *

COMPLIANCE

ADP : *

Yes
No

CAV : *

Yes
No

DEPUTY : *

Yes
No

CSR : *

Yes
No

BEHAVIOR LOG : *

Yes
No

SLEEP LOG : *

Yes
No

MED/MAR LOG : *

Yes
No

NARC LOG : *

Yes
No

FOOD LOG : *

Yes
No

TABLET LOG : *

Yes
No

JOURNALS : *

Yes
No

INCIDENT REPORTING : *

Yes
No

CLIENT ISP : *

Yes
No

DSP INCENTIVE PROGRAM : *

Yes
No

SOCIAL MEDIA REVIEW : *

Yes
No

ADDITIONAL COACHING REVIEW:

App Clock in/out Importance of staying within 5 minutes either way when clocking in/out. Overnight transfers need to happen at midnight as it is the start of a new day. *

Yes
No

Attendance / Call off policy 7-day advance notice for requests off (submit it through deputy) *Reminder that it may not be approved based on staffing needs / holidays / etc, - Last minute call offs require a Dr. note to be submitted *

Yes
No

Med Protocols If not med cert, alert Service Manager AHEAD OF TIME; if med pass is needed. If not med cert do NOT touch anything pertaining to the clients’ medications. *

Yes
No

Representation of self on shift Be positive, have good energy. Be genuine and show others you care. *

Yes
No

Incident Reporting Policy Submit to Service Manager, use the link provided by Service Manager on Deputy, confirm post after completion, sign form after emailed to you. *

Yes
No

Non Compliance Policy Staff must stay with clients until relieving staff arrives, staff cannot leave clients unattended. If over 5 minutes late or early clocking in/out alert Work Force Management immediately so the schedule can be updated. *Client Behavior Policy Staff MUST be involved and assist with behaviors - no tolerance policy. *

Yes
No

Client Behavior Policy Staff MUST be involved and assist with behaviors - no tolerance policy. *

Yes
No

Gossiping Policy No tolerance. Redirect convo or remove yourself from the negativity. *

Yes
No

Shift Cleaning No tolerance policy – must post pics at the end of shift. *

Yes
No

Training Any training scheduled. Note: if training is missed, the cost will be deducted from paycheck. *

Yes
No

Client Appointment Policy Get visit summary, turn into office, send new appointment info to Service Manager. *

Yes
No

Future Concerns :

Staff’s Strengths :

Staff’s Work-on :

Action Plan :

Acknowledgement : *

I Agree

By signing this form, you confirm that you understand and acknowledge the information in this coaching. You also confirm that you and your manager have discussed the coaching details and an improvement plan.

Sign-off : *