Module 1 Workbook — Documentation Culture (Print / PDF)

How to use this workbook

Complete the facility header and fear-vs-defensible commitment with your DON and administrator.
Work through each pillar — check actions as implemented and note owners and dates.
Post the pre-transmission checklist at the MDS workstation; use it on every assessment.
Schedule the weekly IDT huddle and assign letter-response roles before you need them.
Track culture metrics monthly; bring this workbook to Modules 2–4.

Facility: _________________________________	Date: _________________
Completed by (name / title): _________________________________	CCN: _________________

Resident name / ARD: _________________________ MDS coordinator: _________________________

Check	Item	Initials

Reviewing nurse / DON sign-off: _________________________ Date: __________

Step	Primary owner (name / role)	Backup

Record baseline and track trend (not perfection panic):

Metric	Month 1	Month 2	Month 3

We will say aloud in huddle and staff meetings:

Administrator signature: _________________________ Date: __________

DON signature: _________________________ Date: __________

MDS coordinator signature: _________________________ Date: __________