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Table 2.6. Sample Completeness Report Tracking Tool

On-Time Quality Improvement Manual for Long-Term Care Facilities

#Reason

Date

Date

Date

Date

Date

Date

 

Meal Intake below 75 percent

1

Day shift having problems

      

2

Evening shift having problems

      

3

Night shift having problems

      

4

New staff/agency staff this week

      

5

Specific individuals having problems, require inservice

      

6

Cause unknown

      

7

Other

      

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Page last reviewed January 2011
Internet Citation: Table 2.6. Sample Completeness Report Tracking Tool: On-Time Quality Improvement Manual for Long-Term Care Facilities. January 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/ontimeqimanual/qimanltab2-6.html