New Activity Planning Sheet - Activity Director Today

1 1. Title of Activity : _____. The Activity Director 's Office 2. Date of Activity : _____ 3. Time of Activity : _____ New Activity Planning Sheet 4. Type of Activity : 5. Intended Population: 6. Location needed 7. Stimulation: ( size appropriate). ___ Small Group _ _ _ Male ___ Mental ___ Large Group ___ Female ___ Large group area ___ Physical ___ Individual Physical Status: ___ Small group area ___ Creative ___ ___ Independent ___ Quiet room ___ Social ___ ___ Minimal assist ___ ___. ___ ___ Complete assist ___ Mental Status: 9. Staffing needed: ___ Alert & oriented ___ Activity Staff 8.

2 Results Expected: ___ Gently confused ___ Volunteers ___ Disoriented Other Departmental Assistance: ___ Improve socialization Age Appropriate: ___ Need Date Note Sent Response ___ Improve mental health Nursing _____. ___ All ___. status Dietary _____. ___ Under 60 ___. ___ Boost morale Social services _____. ___ Under 50 ___. ___ Improve physical health Administration _____. ___ Under 40 ___. ___ Pride in creativity Housekeeping _____. ___ Other _____ ___. ___ Maintenance _____. ___ ___. ___. 10. Supplies Needed: 11. Pre-preparation: _____ _____. _____ _____. _____ _____.

3 _____ _____. _____ _____. _____ _____. 12. Steps for Doing the Activity _____. _____. _____. _____. _____. _____. _____. _____. _____. _____. _____. Copyright 2006 The Activity Director 's Office, . Permission is granted to duplicate this form without restrictions.