SCCS Activity Log - MAY NOT BE NEEDED (Excel Sheet?)

Activity Log

South Central Crisis Service Activity Log
To be completed and submitted for each on-call sheet
On-Call Clinician Name:

First Name Last Name
Date:

Month Day Year
Date
Total Hours with Pager:
Hours/Minutes Worked:
Client Name

First Name Last Name
Agency Number:
Problem with Case:

Yes No
Time Spent:
Fax/Voicemail Sent:

Yes No
Client Name

First Name Last Name
Agency Number:
Problem with Case:

Yes No
Time Spent:
Fax/Voicemail Sent:

Yes No
Client Name

First Name Last Name
Child Client:

Yes No
Agency Number:
Problem with Case:

Yes No
Time Spent:
Fax/Voicemail Sent:

Yes No
Client Name

First Name Last Name
Child Client:

Yes No
Agency Number:
Problem with Case:

Yes No
Time Spent:
Fax/Voicemail Sent:

Yes No
Client Name

First Name Last Name
Child Client:

Yes No
Agency Number:
Problem with Case:

Yes No
Time Spent:
Fax/Voicemail Sent:

Yes No
Client Name

First Name Last Name
Child Client:

Yes No
Agency Number:
Problem with Case:

Yes No
Time Spent:
Fax/Voicemail Sent:

Yes No
1. BHcare Shoreline

2. BHcare Valley

3. Bridges Healthcare, Inc.

4. CMHC (West Haven, SATU)

5. BHSH

6. No Agency Affiliation

7. Client in treatment with other community provider

8. 211

9. The Connection

10. Family Healthcare (BHcare)
Should be Empty: