SAMPLE Activities Progress Notes Residents Name Room Date

SAMPLE Activities Progress Notes Residents Name__________________________________ Room_________ ___________________Date__________________________________________ Group Programs 1-1 And/or Small Group _____________________________ _______________________________ Programs that resident are Resident is interested

________________________________________________________ in interested in. in attending ________________________________________________________ Musical Events Cart Programs (R/R) ________________________________________________________ Sing-a-long Activity Review ________________________________________________________ Socials Mail Delivery Parties Volunteer Visits ________________________________________________________ Seasonal Events Cart ________________________________________________________ Pampering Snack/Soup ________________________________________________________ Refreshment Carts Games ________________________________________________________ Craft/Stamping Cart Bingo Sensory Cart ________________________________________________________ Trivia Seasonal Carts ________________________________________________________ Game/Puzzle Cart Cards__________ ________________________________________________________ Hidden Pictures Hobbies ________________________________________________________ Puzzles Cooking ________________________________________________________ Smoking ________________ ________________ ________________________________________________________ Gardening Puttering ________________________________________________________ Family Visits ________________________________________________________ Discussion Programs ________________ Current Events ________________ ________________________________________________________ Men’s Group ________________________________________________________ Veterans Programs TV ________________________________________________________ Resident Council News Bible Study ________________________________________________________ SU Sports ____________ Baseball/Football/ ________________________________________________________ ____________ Basketball ________________________________________________________ Soap Opera Educational Talk ________________________________________________________ Shows Intergenerational Shopping ________________________________________________________ Outings Specific TV watching ________________________________________________________ Luncheons Schedule Movies __________________ ________________________________________________________ Crafts __________________ ________________________________________________________ Art Programs ________________________________________________________ Living Roomies Newspaper Bowling Radio_______________ ________________________________________________________ Religious Services Tabloids ________________________________________________________ Protestant Romance/ Fiction Novels ________________________ Catholic Magazines Socializing with Staff See Back for Additional Other___________ Socializing with other Activities Sensory Programs Residents Involvement Exercise Volunteering for facility Family in daily

Activities Progress Note Resident Name_________________________________________ ________________________________________________________ Needs reminders Individual (1-1) and ________________________________________________________ from nursing staff Independent ________________________________________________________ to attend group Activities Resident programs daily ________________________________________________________ participates in ________________________________________________________ regularly Goes to group ________________________________________________________ programs on own People Watching ________________________________________________________ with reminder from staff and help ________________________________________________________ Own Hobbies ________________________________________________________ Word Need assistance ________________________________________________________ Searches getting to group Crossword ________________________________________________________ programs from Pencil Games staff ________________________________________________________ Art Projects ________________________________________________________ Craft Goes out on own ________________________________________________________ Projects Computer ________________________________________________________ Goes to church Reading ________________________________________________________ regularly ________________________________________________________ ______________ Goes put with ________________________________________________________ family/friends ________________________________________________________ Smoking regularly (Socializing with ________________________________________________________ others in smoking Family in Daily ________________________________________________________ area) ________________________________________________________ Family provides ________________________________________________________ Initiates Own activity for Activities ________________________________________________________ resident ________________________________________________________ Visits with other Volunteers visit ________________________________________________________ residents on their own regularly ________________________________________________________ Socializes with staff ________________________________________________________ Participates in Bedside ________________________________________________________ Activities Prefers own routine (1-1 and R/R) ________________________________________________________ and friends who ________________________________________________________ he/she have cultivated ________________ on their own ________________________________________________________ ________________ ________________ ________________________________________________________ ______________________ 205©KH