Employee Timesheet Form

* Required Information

Weekly Start Date (Monday)

Weekly Ending Date (Sunday)

Date	Date	Visits		Total	Client Initials	Aide Initials

Choose One

Private Pay

CLTC

Waiver

Other

Total Weekly Hours

Housekeeping	M	T	W	TH	F	S	S
Kitchen
Bathroom
Living Room
Bedroom
Make Bed/change Linen
Laundry
Take Out Trash
Vacuum
Sweep
Mop
Dusting
Refrigerator
Transportation/Errands
Mobility	M	T	W	TH	F	S	S
Transfer
Assist with Ambulation Supervise for Safety
ROM Exercise
Walking
Turn & Position
Personal Care	M	T	W	TH	F	S	S
Assist with Bath-Bed/ Tub/Shower
Hair Care/Shampoo
Assist w/ Dressing
Incontinence Care
Oral Hygiene
Shaving
Foot Care
Empty Colostomy Bag
Toileting
Skin Care/Non-medicated
Bedpan/Urinal/ Bedside Commode
Catheter Bag
Nutrition	M	T	W	TH	F	S	S
Meal Preparation/Assist Client
Assist with Feeding
Encourage Fluids/ Record intake
Medication Reminder
Other:

Client Name *

Employee Name *

*All time sheets are due into the office every Tuesday by 5:00pm. Time sheets submitted after the deadline will be held until the following pay period. Please make sure that your time sheets are completed entirely, accurately, and that they are legible. NO WHITE-OUT! (You will be required to come into the office to fill out a new one.) If there is a mistake made, please draw a line through it and initial it.

Client Signature *

Clear

Date

Employee Signature *

Clear

Date

This is the property of Live Love & Laugh Home Care. The form and information therein, is confidential and proprietary