Caregiver Shift Handoff

Ensure seamless care transitions between caregivers

Date:

Outgoing Caregiver

Shift Ended

Incoming Caregiver

Shift Started

Overall Status

Current Mood/Demeanor:

Energy Level (1-10):

Pain Level (1-10):

Meals & Nutrition

Meal	Time	What Was Eaten	Amount	Notes
Breakfast
Lunch
Dinner
Snacks

Fluid Intake (approximate oz/cups):

Any Appetite Issues:

Medications Given

	Medication	Dose	Time Given	Notes/Reactions

PRN (As Needed) Medications Given:

Caregiver Shift Handoff

Date:

Personal Care Completed

Bathing/Shower

Oral Care

Hair Care

Dressing

Toileting Assistance

Incontinence Care

Skin Care/Lotion

Nail Care

Shaving

Notes on Personal Care:

Bathroom/Elimination

Time	Type	Amount	Notes (color, concerns, assistance needed)

Activities & Mobility

Walked/Exercised

Physical Therapy

Watched TV

Read/Was Read To

Had Visitors

Phone Calls

Games/Puzzles

Went Outside

Napped

Mobility Notes (falls, unsteadiness, use of walker/wheelchair):

Vital Signs (if applicable)

Blood Pressure:

Pulse:

Temperature:

Blood Sugar:

Weight:

Sleep (Previous Night)

Bedtime:

Wake Time:

Quality (Good/Fair/Poor):

Sleep Disturbances (woke up, bathroom trips, restlessness):

Caregiver Shift Handoff

Date:

⚠️ Urgent Issues / Concerns

Behavioral Notes

Any agitation, confusion, or behavioral changes:

What seemed to help or trigger behaviors:

Upcoming Tasks for Next Shift

_________________________________________________

Appointments / Scheduled Events

Today or Tomorrow:

Supplies Needed

Medications refill

Incontinence supplies

Groceries/food

Personal care items

Medical supplies

Other: ___________

📝 Additional Notes / Messages for Family

Outgoing Caregiver Signature

Incoming Caregiver Signature

Quick Reference Card

Post in visible location for all caregivers

Care Recipient Information

Name:

Date of Birth:

Primary Diagnosis:

Allergies:

Emergency Contacts

Primary Family Contact:

Phone:

Backup Contact:

Phone:

Primary Doctor:

Phone:

Daily Medication Schedule

Time	Medication	Dose	Special Instructions
Morning
Noon
Evening
Bedtime

Important Preferences & Routines

Likes:

Dislikes:

Calming Techniques:

🚨 Call 911 If:

• Chest pain or difficulty breathing • Signs of stroke (face drooping, arm weakness, speech difficulty) • Unresponsive or unconscious • Severe bleeding • Fall with head injury • Severe allergic reaction