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The form organizes daily staff attendance across Monday through Sunday with In/Out tracking and supports provided sections tied to resident initials. It also includes fields for live-in care provider selection, backup operator and caregiver contact information, operator signatures, dates, and a retention note for maintaining staffing plans with facility 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caregiver contact information, and license/class details for the backup operator.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},392330,1791398587,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","| Staffing Plan for the Week of |  |  |  |  |  |  |  | to |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Operator: |  |  |  |  | Resident Manager: |  |  |  |  |  |  | License \\#: |  |  |  |\n| Adult Care Home Address: |  |  |  |  |  |  |  |  |  |  |  | Phone: |  |  |  |\n| Live-In Care Providers: |  | ☐ Operator |  | ☐ Resident Manager |  |  | ☐ Caregiver(s): |  |  |  |  |  |  |  |  |\n|  |  | Monday |  | Tuesday |  | Wednesday |  | Thursday |  | Friday |  | Saturday |  | Sunday |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Full Name | Role | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Not scheduled to work but available in the home: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Nurse Consultant Name & Phone Number: |  |  |  |  |  |  |  | Backup Operator Name & Number: |  |  |  |  |  |  |  |\n| Name & Contact Number for Backup Caregiver: |  |  |  |  |  |  |  | License \\#/Class for Backup Operator: |  |  |  |  |  |  |  |\n| Operator signature: |  |  |  |  |  |  |  | Date: |  |  |  |  |  |  |  |\n| Retention: Retain staffing plans with facility records for minimum of three years. |  |  |  |  |  |  |  |  |  |  |  | Recommended staffing plan updated 3/2 7/2024 |  |  |  |\n\n| Staffing Plan for the Week of |  |  |  |  |  |  |  | to |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Operator: |  |  |  |  | Resident Manager: |  |  |  |  |  |  | License \\#: |  |  |  |\n| Adult Care Home Address: |  |  |  |  |  |  |  |  |  |  |  | Phone: |  |  |  |\n|  |  | Monday |  | Tuesday |  | Wednesday |  | Thursday |  | Friday |  | Saturday |  | Sunday |  |\n|  |  | Date |  | Date |  | Date |  | Date |  | Date |  | Date |  | Date |  |\n| Staff Name | Resident Initials | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Supports provided: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Staff Name | Resident Initials | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Supports provided: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Staff Name | Resident Initials | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Supports provided: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Staff Name | Resident Initials | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Supports provided: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Staff Name | Resident Initials | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out | In | Out |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Supports provided: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Operator signature: |  |  |  |  |  |  |  | Date: |  |  |  |  |  |  |  |","cbCaibBdj5xq64T5","https://ap.wps.com/l/cbCaibBdj5xq64T5","pdf",174414,"English","# Staffing schedule\n## Personnel and daily In/Out tracking\n# Backup and signatures\n## Backup contacts and operator signature","[{\"question\":\"What information is recorded for the operator and resident manager?\",\"answer\":\"The form includes operator and resident manager names, license number, adult care home address, and phone number fields.\"},{\"question\":\"How does the form track staffing during the week?\",\"answer\":\"It provides a Monday-to-Sunday table with staff names (or resident initials in supports sections) and In/Out entries for each day.\"},{\"question\":\"What backup details are required?\",\"answer\":\"The document collects backup operator name and number, backup caregiver contact information, and license/class details for the backup operator.\"}]","Staffing Plan for the Week of - Staffing Schedule and Signatures | PDF",1790367347]