Support Worker name*Support Worker mobile numberFull Name of Service User* First name Surname Date of contact:Contact start time:Contact finish time:Persons mood at the start of the session*Please tick the relevant boxIs there a planned activity?YesNoWhat activity did you and the person agree to do?About the activityPlease describe the activity, how long you stayed there for, did the person enjoy it?Other activities completed during the sessionPlease describe the activity, how long you stayed there for, did the person enjoy it?What did the person eat during this session?Did the person eat all their food?YesNoDid the person ask for more food after eating what they had?YesNoWhat were the high points during the session?Describe any positive communication, interaction, gestures and actions.What were the low points during the session?Describe any difficult moments, poor communication, aggressive gestures and negative actions.What were the learning points for the person during the session?What did the person learn during this session about communication, life skills, basic skills, interaction with others and support staff?What were the learning points for support staff during the session?What did the support worker learn during this session about the person or about how they managed the support session?Persons mood at the end of the session:*Please tick the relevant boxWere there any comments are views from the person that need to be noted and shared with management and/or family?Were there any comments are views from the persons family/guardian that need to be noted and shared with management and/or social worker?Any other feedback?Your name*Privacy* By using this form you agree with the storage and handling of your data by this website. More information >> NameThis field is for validation purposes and should be left unchanged.
