Activity Chart
This chart is for keeping track of daily activities and care routines (such as reading,
napping, bathroom, hobbies, dressing or eating), the assistance needed, and
comments.
5
Time
Activity
Assistance Needed
Comments
8:20 am
Wakeup
Assistance to bathroom, brush
Patient woke up very
teeth, shower
happy and singing
9:00 am
Breakfast: orange juice, one egg, dry
help with drinking coffee and juice
Patient ate all of their
toast, coffee, cream & sugar
breakfast
Caregiver comments : ______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Medication Schedule & Check Off
Breakfast &
Mon _
Tue _
Wed_
Thurs_ Fri _
Sat_
Sun_
Mid Morning
Medication
Dosage
Activity Chart
This chart is for keeping track of daily activities and care routines (such as reading,
napping, bathroom, hobbies, dressing or eating), the assistance needed, and
comments.
10:00 am
Fifteen minute walk outside
Use of walker needed.
Patient was a bit tired
after walk
11:00 am
Nap
Assistance with helping patient
Patient listens to soft
into bed for nap
music when napping
Caregiver Daily Journal
by Sylvia Barron Baca
Copyright © 2007
Page 3 of 201

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