EXAMPLE HEALTH DEPARTMENT ON-SITE SCHEDULE February 3-7, 2014 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY I I II II II MORNING Name (9:00 12:00pm) II VI V X – Please check here if you III Staff Name Staff Name will be participating in the Staff Name optional Quality IX X Improvement Supplement XII Staff Name Staff Name and indicate which staff Name person will participate VII Staff Name II Staff Name IV & VIII Staff Name VIII Name I I II II II AFTERNOON Staff Name (1:00 4:00pm) II VI V X – II III Name VII X Note-The responsible staff’s name need only appear once on the first listing when a multiple day program review occurs unless that party will change.
EXAMPLE HEALTH DEPARTMENT ON-SITE SCHEDULE February 3-7, 2014 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY MORNING (9:00 – 12:00pm) I Name Please check here if you will be participating in the optional Quality Improvement Supplement and indicate which staff person will participate II Staff Name IV & VIII Staff Name VIII Name I II III Staff Name XII Name II VI Staff Name IX Staff Name VII Staff Name II V Staff Name X Staff Name II X AFTERNOON (1:00 – 4:00pm) I Staff Name II Name I II III II VI VII II V X II X Note-The responsible staff’s name need only appear once on the first listing when a multiple day program review occurs unless that party will change.
Users-Guide-2015.docx