Caregiver's Report Record

Fill out this assessment to provide parents/guardians with a comprehensive update on their child's day.

Household Rules and Discipline

What the Child Did/Did Not Do What I Did

Safety

Date/Time Name or Visiting Reason for Calling Visitor's Phone Number
Date/Time What Happened Where it Took Place What I Did What the Child Did

Play

Basic Care

went to bed at slept for (hrs/mins) woke up times.
went to bed at slept for (hrs/mins) woke up times.
For , I changed the diaper/helped with toileting times.
For , I changed the diaper/helped with toileting times.

Other Comments

I gave the following medications and amounts exactly as instructed by .