Run Daily Staffing Grid Compliance Log — Free

Inspection Setup

Date of staffing review recorded critical (required)

Record the calendar date and shift period being reviewed.

Facility unit or nursing neighborhood identified critical (required)

Identify the unit, wing, hall, or facility-wide staffing grid covered by this log.

Posted staffing plan available for comparison critical (required)

Confirm the posted staffing plan or daily staffing grid was available at the time of review.

Yes No N/A

Resident census documented critical (required)

Enter the resident census used to calculate nursing hours per resident day.

Shift Staffing Review

Day shift actual staffing matches posted plan within variance threshold critical (required)

Compare day shift actual nursing coverage to the posted staffing grid and note any deficiency.

Yes No N/A

Evening shift actual staffing matches posted plan within variance threshold critical (required)

Compare evening shift actual nursing coverage to the posted staffing grid and note any deficiency.

Yes No N/A

Night shift actual staffing matches posted plan within variance threshold critical (required)

Compare night shift actual nursing coverage to the posted staffing grid and note any deficiency.

Yes No N/A

Licensed nurse coverage documented for each shift critical (required)

Confirm RN/LPN/LVN coverage is documented by shift as applicable to the facility plan and state requirements.

Yes No N/A

CNA or nurse aide coverage documented for each shift

Confirm nurse aide coverage is documented by shift and aligned to the posted staffing plan.

Yes No N/A

Hours Per Resident Day Calculation

Total nursing hours worked recorded critical (required)

Enter total nursing hours worked for the day across all shifts and disciplines included in the log.

Nursing hours per resident day calculated critical (required)

Calculate total nursing hours divided by resident census to determine hours per resident day.

Calculated PPD aligns with posted staffing target critical (required)

Confirm the calculated PPD is consistent with the posted staffing plan or approved staffing target.

Yes No N/A

Variance from posted staffing plan documented

Record the difference between actual PPD and the posted staffing plan target.

Compliance and Documentation Quality

Staffing variance explanation documented when applicable

Document the reason for any staffing shortage, call-out, census change, or agency coverage variance.

Yes No N/A

Agency or contract staff identified separately

Confirm agency, contract, or float staff are identified separately from facility employees for PBJ alignment.

Yes No N/A

Documentation is complete, legible, and time-stamped critical (required)

Verify the log is complete, readable, and includes time stamps or shift times for audit readiness.

Yes No N/A

No unresolved non-conformance noted

Confirm any deficiencies were escalated and tracked for follow-up.

Yes No N/A

Corrective Action and Sign-Off

Corrective action entered for any staffing deficiency critical (required)

Document the immediate corrective action taken for any shift shortage or staffing plan deviation.

Yes No N/A

Supervisor or designee review completed critical (required)

Confirm the staffing log was reviewed by the nurse supervisor, DON, or designee.

Yes No N/A

Reference to supporting staffing record or PBJ source available

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Run: Daily Staffing Grid Compliance Log

Inspection Setup

Shift Staffing Review

Hours Per Resident Day Calculation

Compliance and Documentation Quality

Corrective Action and Sign-Off

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