New Daily Tracker - Traditional Services
Please complete this form
DAILY
for each participant on your caseload (even if you don’t see them personally, but know they are receiving services e.g. zoom classes or Friendship Line). Information from Daily Trackers will be used for Billing and Grant reporting.
Participant Name (First Last)
Date of Service Provided
Participant UCI #
Service
Please select...
ArtReach
CCS-Marin
CCS-San Mateo
CCS-SF 1:2
CCS-SF 1:3
CCS-SF 1:4
CES-Internship
CFS
DOR Supported Employment
DOR Traditional Employment
FLM
ILS 520
ILS 896
Job Development/ESS
JPS - Supported Employment
One-to-One
Skills
SLS 7.1 - Joe N
SLS 7.1 – Eric D
SLS 7.2
TDS
Service Manager Name
Please select...
Aja Lawson
Diodel Carbonel
Frances Blues
Jay Frantz
Jonathan "Jono" Barnes
Marieflor Bauzon
Mark Williams
Mona Nazemi
Monique Irving
Nancy Bautista
Ngozi Iyorah
Stephen Wallace
Steve Huebner
Todd Owens
Victor Scaggs
Vivian Ovadya
Kelly Noelke
Staff Name (First Last)
CFS Type of Support
Select one or more service(s) and duration of service in 15-minute increments
Advance Care Planning
Appointments
Communications
Education
Face to Face (usually at The Arc or other program)
File Review
Home Visit
Medication
Other
Service Coordination
Training
(Job Development) Select one or more service(s) and duration of service in 15-minute increments
B - In-person job coaching at
employer site
C - In-person services in the
community
D -
Off-site
job
coaching support, such as completing employer training, counseling/intervention
E -
Remote services,
such as zoom classes, phone/video sessions
F -
Remote
IT
support
from Staff, such as computer training, help with logging onto zoom
G -
I
n-person IT support
from Staff, such as computer training, help with logging onto zoom
H - In-person services at
The
Arc
I - In Person Advocacy/Employer Communication (
Participant
not
present
)
Select one or more service(s) and duration of service in 15-minute increments
A - In-person services at
participant’s home
B - In-person job coaching at
employer
site
C - In-person services in the
community
D -
Off
-
site
job
coaching support, such as completing employer training, counseling/intervention
E -
Remote services
,
such as zoom classes, phone/video sessions
F -
Remote
IT
support
from Staff, such as computer training, help with logging onto zoom
G -
I
n-person IT support
from Staff, such as computer training, help with logging onto zoom
In-person services at
participant’s home
Duration/Hours of Service Provided
Please select...
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
8.25
8.50
8.75
9.00
9.25
9.50
9.75
10.00
10.25
10.50
10.75
11.00
11.25
11.50
11.75
12.00
In-person services in the
community
Please select...
0.25
0.5
0.75
1
1.25
1.5
1.75
2
2.25
2.5
2.75
3
3.25
3.5
3.75
4
4.25
4.5
4.75
5
5.25
5.5
5.75
6
6.25
6.5
6.75
7
7.25
7.5
7.75
8
8.25
8.5
8.75
9
9.25
9.5
9.75
10
10.25
10.5
10.75
11
11.25
11.5
11.75
12
In-person job coaching at
employer site
Duration/Hours of Service Provided
Please select...
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
8.25
8.50
8.75
9.00
9.25
9.50
9.75
10.00
10.25
10.50
10.75
11.00
11.25
11.50
11.75
12.00
Off-site
job
support, such as completing employer training, counseling/intervention, or meetings at The Arc.
Duration/Hours of Service Provided
Please select...
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
8.25
8.50
8.75
9.00
9.25
9.50
9.75
10.00
10.25
10.50
10.75
11.00
11.25
11.50
11.75
12.00
Remote services
, such as zoom classes, Friendship Line, phone/video sessions Duration/Hours of Service Provided
Please select...
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
8.25
8.50
8.75
9.00
9.25
9.50
9.75
10.00
10.25
10.50
10.75
11.00
11.25
11.50
11.75
12.00
Remote
IT
support
from Staff, such as computer training, help with logging onto zoom Duration/Hours of Service Provided
Please select...
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
8.25
8.50
8.75
9.00
9.25
9.50
9.75
10.00
10.25
10.50
10.75
11.00
11.25
11.50
11.75
12.00
I
n-person IT support
from Staff, such as computer training, help with logging onto zoom Duration/Hours of Service Provided
Please select...
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
8.25
8.50
8.75
9.00
9.25
9.50
9.75
10.00
10.25
10.50
10.75
11.00
11.25
11.50
11.75
12.00
I
n-person advocacy
or employer communication, participant was not present during this time.
Please select...
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
8.25
8.50
8.75
9.00
9.25
9.50
9.75
10.00
10.25
10.50
10.75
11.00
11.25
11.50
11.75
12.00
In-person services at
The Arc
Please select...
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
8.25
8.50
8.75
9.00
9.25
9.50
9.75
10.00
10.25
10.50
10.75
11.00
11.25
11.50
11.75
12.00
Was any ISP/personal goal/ milestone achieved?
Yes (Please Write Details in Additional Notes Section
No (Still working on goals)
Additional Notes (Optional) DO NOT Include P&I notes here.
Appointments
(Managing scheduling and transportation to attend social services, medical and other appointments)
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Advanced Care Planning
Supporting with:
-
Preparing for future decisions about medical care
- Completing advance directives
- Communicating with circles of support and medical providers
- Advocating for appropriate services and resources
- Developing an emergency backup care plan
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Communications
(Includes emails/phone calls/texts)
- With participants, providers, and support systems
- Advocating for appropriate services and resources
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Education
- Supporting client to adhere to goals and tracking progress toward goals
- Providing education and promotion of self-management
- Completing face to face counseling with clients
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Face to Face
(With participant, usually at The Arc or another program)
- Providing education and promotion of self-management
- Completing home visits/face to face counseling
- Communicating with participants, providers, and support systems
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
File Review
- Checking to make sure all necessary information is up to date in the SharePoint file (see checklist)
- Salesforce up to date with correct information and relationships
- Reviewing appointments
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Home Visit
- Assess home environment for safety, accessibility, general cleanliness and condition
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Medication
- Developing reliable system for following medication directives/management
- Routine medication reconciliations
- Providing education and promotion of self-management
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Training
- Training for the consumer and their family in navigating comprehensive services and supports
- Training and/or providing additional information or resources on the consumer's diagnosis and identified supports
- Coordinating consistency in training across providers specific to the needs of the consumer and their family.
- Providing education and training to participants to maximize their independence.
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Service Coordination
- Advocating and researching for appropriate services and resources
- Connecting participant to appropriate services and community resources
- Assisting with scheduling of service delivery of resources
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Other
Please select the time and fill in the "Explanation" box.
Please select...
.25
.50
.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
3.75
4.00
4.25
4.50
4.75
5.00
5.25
5.50
5.75
6.00
6.25
6.50
6.75
7.00
7.25
7.50
7.75
8.00
Other Explanation
Contact Information