Date: Click here to enter a date.	From (time): to

Inmate Name: IDOC#:

Status: Choose an item.

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Time	Wash/Sanitize Hands	Breakfast	Lunch	Dinner	Dental Hygiene	Water	Shower	Mattress & Bedding	Staff Check	MHP Initials	Staff Initials	Explanation/Comments

Symbols: X = Activity Completed, IR = Inmate Refused , O = other

Note: When symbol is other, an explanation must be stated.