Getting Around

Backup Caregiver Checklist

Use this checklist to leave information for a backup caregiver. Be sure to include under "Details" any additional information that will be helpful, such as where specific items can be found in the home.

Routine

Details

Breakfast
Help/Utensils
Medication

Nap Time(s)

Lunch
Medication

Snack

Activities

Dinner
Medication

Evening
Undressing
Medication

Bedtime
Special Needs

Personal Needs

Details

Cane/Walker

Dentures

Glasses

Hearing Aid(s)

Incontinence Aids

Other

Watch For:

Details

Agitation

Wandering

Confusion

Other

Emergency
Contact