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Household Maintenance > 01 Maintenance Handbook (114+ docs) > 05 Maintenance Forms (27 docs)

05 Maintenance Forms (27 docs)

Free Forms, caregiving, nursing forms, policies, Licensing, Training, Case Management, Home Care, Assisted Living, DD, MI, HCBS

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Documents in 05 Maintenance Forms (27 docs) (27)

Replacement log form. AC Filter Replacement Log
A form used in community based care homes and various types of assisted living facilities to report accidents, incidents, and/or injury to an employee. Accident Incident Injury Report Form - Employee
Form used to complete quarterly automobile safety inspections. Auto Safety Quarterly Inspection
A free form to be completed when inspecting a facility Bus/Truck on a monthly basis. Bus/Truck Maintenance & Safety Inspection
Contact Numbers form. Contact Numbers Vendors and Supplies
Cover sheet Cover Maintenance Forms
Communication and suggestion form used by employee's regarding unsafe conditions and/or occupational health concerns. Employee Safety Communication and Suggestion Form
Form to draw facility floor plan for licensing purposes. Facility Sketch
This fire drill evaluation form is used by the care home staff to evaluate how they performed during a fire drill. Good for assisted living facilities, group homes and residential care homes.

Was the local fire district notified that you are going to be conducting a drill?
Was your alarm monitoring company notified of the fire drill?
Emergency Phone Number called? (fake one)
Portable telephone or cell phone taken to re-grouping area?
Was fake fire found, and residents removed from danger, first aid administered? ...... Fire Drill Evaluation
Free CARE Equipment Safety Checklist Free CARE Equipment Safety Checklist
A form used to track communication and phone calls regarding incidents that concern the care business or care facility in general. Incident Call and Communication Log - Company
Independent Contractor Agreement Form. Independent Contractor Agreement
Independent Contractor Agreement sample to show how the form should be completed. Independent Contractor Agreement (Sample)
A thorough form covering payment, schedules, services to be performed, contractor tax identification number, etc. when using an Independent Contractor in your organization. Independent Contractor Questionnaire
Before hiring an Independent Contractor to do maintenance at your Residential Care, Assisted Living, or Nursing Facility, have them complete this simple form.  It contains a checklist of all the various maintenance jobs that need to be completed. Independent Contractor's Skills and Abilities
Form for completed tasks. Job Completed Report
Job form. Job Inquiry Form
Facility lighting order form. Lighting Order Form
A form used in the Maintenance Department to plan goals. Maintenance Department Goals & Plans
Checklist of documents that need to be reviewed on a monthly or quarterly basis. Maintenance Documentation Audit
This form is used to request repairs needed in the facility. Maintenance Repair Request (Form)
Work time form. Maintenance Work Time Report
Form with emergency contact information and phone numbers to be kept in the Material Safety Data Sheets (MSDS) Binder. MSDS Emergency Contact Information
Form used to audit a residential care home, Skilled Nursing Facility, or Assisted Living facility's pest control policies and procedures, and pest status. Pest Control Audit
Important procedures to observe. Quality Assurance Maintenance
A form list of items to check to make sure a room is ready for a resident to occupy in a community based care setting, also good for nursing homes. Room Ready Check-off List
A great form for organizing meetings, topics, reports, issues to discuss when having a meeting with supervisors, managers and heads of the various departments in your organization, i.e. Nursing Home, Residential Care, Assisted Living Facilities. Weekly Department Head Meeting (Form)
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