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Run: Activity Participation Attendance Log

Track resident attendance, engagement, and follow-up needs for each scheduled activity in one daily log. Use it to support senior living programming records ...

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Log Details

Date of Activity Session (required)

Select the date on which this activity took place.

Staff Member Completing Log (required)

Staff Title / Role (required)

Unit / Neighborhood (required)

Select the unit or neighborhood where the activity was held.

Scheduled Activity Information

Activity Name (required)

Activity Category (required)

Select the category that best describes this activity for programming analysis.

Scheduled Start Time (required)

Scheduled End Time (required)

Actual Duration (minutes) (required)

Activity Location (required)

Activity Format (required)

Adaptive Equipment or Accommodations Used

Select all accommodations provided to support resident participation (ADA reasonable accommodation).

Attendance and Participation

Total Residents Invited / Scheduled (required)

Total Residents Who Attended (required)

Total Residents Who Declined

Total Residents Unable to Attend (health, appointment, etc.)

Individual Resident Participation Log (required)

Enter one row per resident who attended. Engagement levels: 4 = High (active, enthusiastic); 3 = Moderate (engaged, responsive); 2 = Low (present, minimal interaction); 1 = Passive (present, no observable interaction). Aligns with MDS Section F0400 coding guidance.

Overall Group Engagement Rating (required)

Rate the overall engagement level of the group during this session (1 = Very Low, 5 = Excellent).

Follow-Up and Review

Notable Observations or Behavioral Changes

Is Follow-Up Action Required? (required)

Type of Follow-Up Needed

Select all that apply.

Follow-Up Details

Programming Feedback (for Activity Director Review)

This feedback is used to evaluate and improve the activity calendar. It is not part of the resident clinical record.

Flag for Supervisor Review

Check this box if this log entry requires review by the Activity Director or Department Head before filing.

Yes No N/A

Staff Signature (required)

By signing, you confirm that the information recorded in this log is accurate and complete to the best of your knowledge.

Log Submission Time

Automatically recorded when the form is submitted. Used for audit trail purposes.

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