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Worksheets & Night-Contact Sheet
All 20 sheets are available here. Open the worksheets associated with a module, or use the standalone night-contact sheet. Responses save on this device only. Most worksheets have optional completed examples.
Module 1
Three Times You Fell
Short notes from your own life. Choose memories you can manage today. Leave any field blank, or write "I don't remember."
Module 2
Window Check
Before a visit or during a pause. A note for yourself; your person doesn't need to see it.
Module 2
Your Own Breakfall: Support and a Break
Name what helped you stay present once, and the help you can arrange today.
Module 3
What You Saw
One observation per sheet. Enough detail that the team understands what happened, without a diagnosis. For sudden changes or distress, call the team first and write later.
Module 4
One Door a Day
One copy per invitation, or per decision not to ask. Write afterward. Record a refusal without guessing why.
Module 4
My Worry, Their Wishes
For yourself, when you feel the urge to persuade. Use what your person has said, not what you think they ought to feel. Take your worry to someone else.
Module 5
Comfort and Questions
One page for your person's current concerns. Keep their words separate from your observations. Date any wishes they stated earlier.
Module 5
Who to Call
Copy the details from the team. Ask them to confirm anything missing. This is not a medication record.
Module 5
Decisions and Documents
Fill this in with your person, and confirm with the team where each document belongs.
Module 6
One Story
For your person, with a supporter writing only with permission. Dictation counts. One sentence is enough.
Module 6
One Unfinished Thing, or One Legacy Message
For one matter or letter your person chooses. Write their words, not yours.
Module 7
Goodbye Circle Plan
Your planning sheet, not a task for your person. Record their choices; write "unknown" where you still need to ask.
Module 7
Words That Are True
Draft for yourself. You may share none of it.
Module 8
Program Questions
For one program, study, or prescriber, with your person's permission to ask. This is a question list, not an eligibility check.
Module 8
Your Person's Choice for Now
After a conversation your person wants. Include a decision to decline or leave it alone.
Module 9
Vigil and Contact Sheet
For the next stretch of coverage. Share it with the supporters on the roster. Record only hours people have agreed to.
Module 9
Words, Quiet, and Permission to Stop
Prepare a short visit. You can write without speaking.
Module 10
First-Days Support Plan
The next day or two. Small jobs, not life after the death.
Module 10
A Return Ritual, If You Want One
Choosing no ritual is enough.
Standalone Sheet
A Contact Sheet You Can Find at Night
Complete this with the hospice or palliative team. Keep a copy beside the phone and give one to anyone covering for you. It is not an advance directive, a DNR, or a medication chart.