Recording Sheet for High Level intermittent observations - 10 Minute frequency Patient Label DATE: ………………………………….. WARD: ………………………………… Reasons and Special Instructions Reason for observation : Risks : Instructions for bathroom/toilet : Instructions for when asleep : Specific staff gender required male/female or any : – Number of staff to carry out the observation : Mental state, behaviour, interaction with staff and Signature Signature of new patients allocated staff, agreeing they have taken over and know the risks
Recording Sheet for High Level intermittent observations - 10 Minute frequency Patient Label DATE: ………………………………….. WARD: ………………………………… Reasons and Special Instructions Reason for observation : Risks : Instructions for bathroom/toilet : Instructions for when asleep : Specific staff gender required – male/female or any : Number of staff to carry out the observation : Mental state, behaviour, interaction with staff and patients Signature Signature of new allocated staff, agreeing they have taken over and know the risks
81719.docx