CBS Log Timesheet

Supports

(Not applicable when delivering daily rate version of Individual Supports. Only used for 15 minute unit version)

Name:

Service Plan Year:

Service Strategies (check all that apply):

Assistance with Activities of Daily Living (such as getting dressed, eating, personal hygiene, etc.)
Assistance with Increasing Community Participation (such as daily errands, attending events, restaurant, purchasing items, travel training, etc.)
Assistance with Increasing Independence (such as helping the individual learn to do laundry, cook, clean, dress, grocery shop, pay for items, etc.)
Assistance with On-The-Job Support (such as safety awareness, using the restroom, attending to task, lunch/breaks, etc.)
Assistance with Learning Activities (such as basic tutoring – math, reading, writing; support in attending a class; etc.)

Date / Start Time

Date

Time

End Time

Individualized Activity

Tell us about the day, and how the activities will help the individual reach the above outcome

Date

Time

Completed by

Home Care