Phone Orientation Log

This form is to be completed for every caregiver orientation that is completed remotely.

Client Name

Caregiver Name

Supervisor Name

Client's Condition

DNR on File?

Yes

No

Is the client on hospice?

Yes

No

Schedule (Varies as needed)

Attendant instructed about tasks to be provided:

Work schedule Safety Emergency procedures Universal precautions Abuse, neglect and exploitation When to call 911

Yes

Attendant instructed to report to supervisor:

Change in client's needs Incidents that affect the client's condition Hospitalization of the client Client's absence or relocation

Yes

Attendant competent to provide personal care task required for client.

Yes

Phone Orientation