Day of Month A Time Service Began B Time Service Ended C Total Hours Each Day D Mileage Day of Month A Time Service Began B Time Service Ended C Total Hours Each Day D Mileage INDIVIDUAL PROVIDER S NAME CM NAME MONTH/YEAR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTALS CHECK TASKS PEFORMED DURING MONTH AS ASSIGNED IN CLIENT S SERVICE PLAN (PERSONAL CARE PROVIDERS ONLY) Meal Preparation Eating Esc.
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How to fill out the WA DSHS 15-051 online
The WA DSHS 15-051 form is essential for documenting hours worked by individual providers in home and community services for clients with developmental disabilities. This guide provides step-by-step instructions to help you fill out the form accurately and efficiently.
Follow the steps to complete your time sheet accurately
- Click the ‘Get Form’ button to access the document and open it in your chosen editing interface.
- Enter the client or employer's name in the designated field at the top of the form.
- Fill in the section for each day of the month. Start by recording the day of the month in column A.
- In column B, indicate the time service began by entering the time along with AM or PM.
- Next, in column C, provide the time the service ended, making sure to specify AM or PM.
- Calculate the total hours worked each day and enter this information in column D.
- Document any mileage traveled while providing services, as required, in the appropriate section.
- Repeat the previous steps for each day of the month until the end of the month.
- Check the tasks performed during the month by marking the appropriate boxes for personal care tasks as assigned in the client's service plan.
- Complete the signature fields by having the client sign and then signing as the individual provider.
- Review all entries for accuracy before finalizing the document.
- Upon completion, save your changes, download, print, or share the form as necessary.
Complete your WA DSHS 15-051 form online today.
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