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[]
[]
["AIT Name : ________________________________________________________"]
[]
["PRECEPTOR Name : ________________________________________________________"]
["Please indicate an \"X\" by the Length of the AIT Program : "]
["1,000 Hours"]
["2,000 Hours"]
[]
["64B10-16.001(5), F.A.C. The AIT shall serve his/her training in a normal work-week, containing a minimum of 30 hours and a maximum of 50 hours, with not less than six hours to be served daily between the hours of 7:00 a.m. and 10:00 p.m., except that during the year a minimum of 40 hours and a maximum of 160 hours are to be served between 10:00 p.m. and 7:00 a.m."]
[]
["Please complete each section as it reflects the work of the AIT.  The reporting requires completion of three quarters for the 1000 hour program, s. 468.1695(2)(a) F.S. and four quarters for the 2000 hour program, s. 468.1695(2)(b) F.S., with the total column completed for the final reporting.  The checklist contains sub functions which summarize the overall domains and serve as a synopsis of work completed.  Please use the same checklist for each reporting quarter.  Copies with original signatures are acceptable."]
[]
["NOTE:  In addition to submitting this checklist as part of a quarterly report, the AIT shall also submit narrative describing relevant learning experiences.  This narrative should show how the trainees may have used the following methods to further his/her training: on-the-job experience, meetings attended, surveys completed, written reports, texts or periodicals, visits to other facilities, academic programs, college, or continuing education seminars, Rule 64B10-16.005(1)(d) F.A.C."]
[]
[]
["PERSONNEL"]
[]
["AIT Name : ________________________________________________________"]
[]
["PRECEPTOR Name : ________________________________________________________"]
[]
[]
[]
["Domain/Subfunctions Quarter ","Q1","Q2","Q3","Q4","TOTAL"]
["PERSONNEL 64B10-16.005(2)(a), F.A.C. [15%] "]
["Demonstrates an understanding of job descriptions and job-specific competencies. ",{"$nulls":4},0]
["Possesses the ability to plan and develop basic staff development procedures. ",{"$nulls":4},0]
["Possesses the ability to use audit procedures to evaluate effectiveness of training. ",{"$nulls":4},0]
["Demonstrates the ability to plan, implement, and evaluate associate health and safety programs.",{"$nulls":4},0]
["Understands the importance of and proper process for exit interviewing. ",{"$nulls":4},0]
["64B10-16.005(2)(a)1 "]
["Understands proper interviewing techniques. ",{"$nulls":4},0]
["Demonstrates an understanding of how to effectively train individuals to perform their duties. ",{"$nulls":4},0]
["Demonstrates an understanding of effective recruiting procedures. ",{"$nulls":4},0]
["Possess knowledge of workplace culture as it relates to the prevention of workplace violence, harassment, & hostility.",{"$nulls":4},0]
["64B10-16.005(2)(a)2 "]
["Demonstrates the ability to implement effective human resource management in a facility. ",{"$nulls":4},0]
["Demonstrates a working knowledge of staff professional development. ",{"$nulls":4},0]
["Demonstrates knowledge of performance based evaluation procedures. ",{"$nulls":4},0]
["Possesses the ability to plan, implement, and evaluate personnel policies. ",{"$nulls":4},0]
["Able to apply proper staff disciplinary procedures. ",{"$nulls":4},0]
["Demonstrates the ability to predict the overall effect of personnel policies on the organization. ",{"$nulls":4},0]
["64B10-16.005(2)(a)3, 4, 5 "]
["Displays an understanding of how to manage a diverse workforce. ",{"$nulls":4},0]
["Possesses the ability to negotiate wages, salaries, and benefits. ",{"$nulls":4},0]
["Understands how to match qualifications of candidates to job requirements. ",{"$nulls":4},0]
["Understands the functions of the Nursing Services team and effective management of the Nursing Department.",{"$nulls":4},0]
["Understands the function of the Activities Department. ",{"$nulls":4},0]
["Demonstrates an understanding of the various clinical pathways in rehabilitation. ",{"$nulls":4},0]
["Understands how to manage Physical Therapy staff. ",{"$nulls":4},0]
["Possesses an understanding of the various roles and services of Occupational therapy team members. ",{"$nulls":4},0]
["Understands the services provided by Speech Therapy. ",{"$nulls":4},0]
["Understands the role of Audiological Services. ",{"$nulls":4},0]
["Understands the functions of the Social Services team and the management of Social Services.",{"$nulls":4},0]
["Understands the functions of the Dietary team and how to manage the Dietary department. ",{"$nulls":4},0]
[]
[]
[]
["Understands the functions of the Housekeeping team, and how to effectively manage the Housekeeping department.",{"$nulls":4},0]
["Possesses a working knowledge of the organization and management of Laundry services. ",{"$nulls":4},0]
["Understands the functions of the Maintenance team. ",{"$nulls":4},0]
["Demonstrates a working knowledge of the functions and management of Maintenance personnel.",{"$nulls":4},0]
["Understands the functions of the Medical Records team. ",{"$nulls":4},0]
["Displays a working knowledge of pay scale administration. ",{"$nulls":4},0]
["Understands the application of employee retention techniques. ",{"$nulls":4},0]
["Understands proper overtime administration and non-exempt status. ",{"$nulls":4},0]
["Possesses knowledge of CNA training requirements. ",{"$nulls":4},0]
["Demonstrates a working knowledge of risk management policies. ",{"$nulls":4},0]
["Fully understands the process of physician credentialing. ",{"$nulls":4},0]
["Understands the Americans with Disabilities (ADA) law and its application. ",{"$nulls":4},0]
[]
["Domain/Subfunctions Quarter - 1,000 Hr Program","Q1","Q2","Q3",null,"TOTAL"]
["PERSONNEL [15%] (Minimum = 150 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,null,0]
[]
["Domain/Subfunctions Quarter - 2,000 Hr Program","Q1","Q2","Q3","Q4","TOTAL"]
["PERSONNEL [15%] (Minimum = 300 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,0,0]
[]
["INITIALS","Q1","Q2","Q3","Q4"]
["AIT"]
["PRECEPTOR"]
[]
[]
["FINANCE"]
[]
[]
[]
[]
["Domain/Subfunctions Quarter ","Q1","Q2","Q3","Q4","TOTAL"]
["FINANCE 64B10-16.005(2)(b), F.A.C. [15%] "]
["Possesses a working knowledge of key financial indicators. ",{"$nulls":4},0]
["Understands the difference between cash and the financial statements. ",{"$nulls":4},0]
["Possesses a working knowledge of financial planning and interdepartmental financial/budgetary management.",{"$nulls":4},0]
["Demonstrates a working knowledge of capital purchases. ",{"$nulls":4},0]
["Understands billing systems and methods. ",{"$nulls":4},0]
["Demonstrates the ability to perform payroll analysis. ",{"$nulls":4},0]
["Demonstrates a working knowledge of proper inventory management. ",{"$nulls":4},0]
["Demonstrates a working knowledge of the interconnectedness of the Prospective Payment System (PPS), the Minimum Data Set (MDS), and Resource Utilization Groups (RUGs).",{"$nulls":4},0]
["64B10-16.005(2)(b)1 "]
["Understands accounting procedures, including the chart of accounts ",{"$nulls":4},0]
["Understands profit and loss statements, and balance sheets ",{"$nulls":4},0]
["Understands policies relating to accounts payable and collection of accounts receivable ",{"$nulls":4},0]
["Understands Medicaid & Medicare methods and systems, cost reports ",{"$nulls":4},0]
["Understands business office segregation of duties and internal controls. ",{"$nulls":4},0]
["64B10-16.005(2)(b)2 "]
["Demonstrates knowledge of budget process. ",{"$nulls":4},0]
["64B10-16.005(2)(b)3 "]
["Understands how and possesses the ability to manage cash. ",{"$nulls":4},0]
["Demonstrates understanding of cash forecasting. ",{"$nulls":4},0]
["64B10-16.005(2)(b)4 "]
["Possesses an understanding of third party payment organizations. ",{"$nulls":4},0]
[]
["Domain/Subfunctions Quarter - 1,000 Hr Program","Q1","Q2","Q3",null,"TOTAL"]
["FINANCE [15%]  (Minimum = 150 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,null,0]
[]
["Domain/Subfunctions Quarter - 2,000 Hr Program","Q1","Q2","Q3","Q4","TOTAL"]
["FINANCE [15%]  (Minimum = 300 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,0,0]
[]
[]
["INITIALS","Q1","Q2","Q3","Q4"]
["AIT"]
["PRECEPTOR"]
[]
[]
["MARKETING"]
[]
[]
[]
[]
["Domain/Subfunctions Quarter ","Q1","Q2","Q3","Q4","TOTAL"]
["MARKETING 64B10-16.005(2)(c),  F.A.C. [5%] "]
["Possess knowledge of referral patterns. ",{"$nulls":4},0]
["Demonstrates a working knowledge of referral conversion rates. ",{"$nulls":4},0]
["Demonstrates the ability to lead facility tours. ",{"$nulls":4},0]
["Possesses the skills to identify needs in the community and develop services to meet the needs. ",{"$nulls":4},0]
["Possess a knowledge of contract negotiations, contract management, and purchasing agreements. ",{"$nulls":4},0]
["64B10-16.005(2)(c)1 "]
["Demonstrates knowledge of primary and secondary customer groups. ",{"$nulls":4},0]
["Has a working knowledge of the process for developing and implementing a marketing plan. ",{"$nulls":4},0]
["64B10-16.005(2)(c)2 "]
["Displays an understanding of community volunteer agencies. ",{"$nulls":4},0]
["Demonstrates the ability to utilize community volunteer agencies’ resources in the care of residents. ",{"$nulls":4},0]
["Has a working knowledge of community liaisons (e.g. hospice) and resources. ",{"$nulls":4},0]
["64B10-16.005(2)(c)3 "]
["Understands the importance of receiving and interpreting customer feedback. ",{"$nulls":4},0]
["Knows the most effective techniques for soliciting, receiving, and integrating customer feedback. ",{"$nulls":4},0]
[]
["Domain/Subfunctions Quarter - 1,000 Hr Program","Q1","Q2","Q3",null,"TOTAL"]
["MARKETING [5%] (Minimum = 50 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,null,0]
[]
["Domain/Subfunctions Quarter - 2,000 Hr Program","Q1","Q2","Q3","Q4","TOTAL"]
["MARKETING [5%] (Minimum = 100 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,0,0]
[]
["INITIALS","Q1","Q2","Q3","Q4"]
["AIT"]
["PRECEPTOR"]
[]
[]
["PHYSICAL RESOURCE MANAGEMENT"]
[]
[]
[]
[]
["Domain/Subfunctions Quarter ","Q1","Q2","Q3","Q4","TOTAL"]
["PHYSICAL RESOURCE MANAGEMENT 64B10-16.005(2)(d), F.A.C. [10%]"]
["Demonstrates the knowledge of practices to control mold and water damage, and the implications of water damage and mold contamination.",{"$nulls":4},0]
["Understands the requirements for proper ventilation and climate control (heating, ventilation, and air conditioning – HVAC – systems).",{"$nulls":4},0]
["Understands the proper maintenance needs and storage requirements for complex medical equipment. ",{"$nulls":4},0]
["Possesses the ability to run and assess disaster drills (internal and external). ",{"$nulls":4},0]
["Has the ability to develop, implement, and enforce a missing item policy. ",{"$nulls":4},0]
["64B10-16.005(2)(d)1 "]
["Demonstrates ability to develop an equipment inventory. ",{"$nulls":4},0]
["64B10-16.005(2)(d)2 "]
["Demonstrates the knowledge of and ability to apply infection control practices. ",{"$nulls":4},0]
["Possesses the ability to apply proper sanitation practices. ",{"$nulls":4},0]
["Demonstrates a working understanding of facility equipment and related safety practices/ procedures.",{"$nulls":4},0]
["Understands and can apply proper practices for linens and infection control. ",{"$nulls":4},0]
["Demonstrates a working knowledge of drug resistant bacteria (C.Dif, MRSA, and VRE). ",{"$nulls":4},0]
["Understands housekeeping safety and fire prevention. ",{"$nulls":4},0]
["64B10-16.005(2)(d)3"]
["Has a working knowledge of appropriate laundry equipment. ",{"$nulls":4},0]
["Demonstrates a working knowledge of preventative maintenance needs. ",{"$nulls":4},0]
[]
["Domain/Subfunctions Quarter - 2,000 Hr Program","Q1","Q2","Q3",null,"TOTAL"]
["PHYSICAL RESOURCE MANAGEMENT [10%] (Minimum = 200 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,null,0]
[]
[]
["Domain/Subfunctions Quarter - 2,000 Hr Program","Q1","Q2","Q3","Q4","TOTAL"]
["PHYSICAL RESOURCE MANAGEMENT [10%] (Minimum = 200 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,0,0]
[]
[]
["INITIALS","Q1","Q2","Q3","Q4"]
["AIT"]
["PRECEPTOR"]
[]
[]
["LAWS, REGULATORY CODES, AND GOVERNING BOARDS"]
[]
[]
[]
[]
["Domain/Subfunctions Quarter ","Q1","Q2","Q3","Q4","TOTAL"]
["LAWS, REGULATORY CODES, AND GOVERNING BOARDS  64B10-16.005(2)(e), F.A.C [10%]"]
["7 Survey Tasks "]
["I. Demonstrates an understanding of offsite survey preparations. ",{"$nulls":4},0]
["II. Understands the entrance conference and onsite preparatory activities. ",{"$nulls":4},0]
["III. Demonstrates an understanding of the initial tour. ",{"$nulls":4},0]
["IV. Demonstrates an understanding of the process of sample selection. ",{"$nulls":4},0]
["V. Demonstrates a working knowledge of the process of information gathering. ",{"$nulls":4},0]
["VI. Understands the process of information analysis for deficiency determination. ",{"$nulls":4},0]
["VII. Understands the exit conference process. ",{"$nulls":4},0]
["Demonstrates an understanding of the medical records timeline and documentation standards. ",{"$nulls":4},0]
["Demonstrates a working knowledge of the Health Insurance Portability and Accountability Act (HIPAA).",{"$nulls":4},0]
["Understands the plan for communicating HIPAA requirements. ",{"$nulls":4},0]
["Understands the Americans with Disabilities (ADA) law and its application. ",{"$nulls":4},0]
["Possesses an understanding of the impact of local (municipal, county, and special tax district) codes and rules.",{"$nulls":4},0]
["64B10-16.005(2)(e)1 "]
["Understands the survey process. ",{"$nulls":4},0]
["Demonstrates the knowledge of infection control regulations. ",{"$nulls":4},0]
["Knows the state’s (Florida) governing bodies and how they impact the facility and staff. ",{"$nulls":4},0]
["64B10-16.005(2)(e)2 "]
["Understands and can apply federal regulations regarding in-servicing. ",{"$nulls":4},0]
["Understands federal requirements regarding content of personnel files. ",{"$nulls":4},0]
["Understands and can apply federal regulations for nursing functions. ",{"$nulls":4},0]
["Understands and can apply federal regulations for resident Activities Department. ",{"$nulls":4},0]
["Understands and can apply federal regulations for Social Services. ",{"$nulls":4},0]
["Demonstrates an understanding of federal regulations for Dietary in-service education. ",{"$nulls":4},0]
["Understands and can apply federal regulations for Dietary. ",{"$nulls":4},0]
["Understands and can apply federal regulations for Laundry services. ",{"$nulls":4},0]
["Understands and can apply federal regulations for Maintenance. ",{"$nulls":4},0]
[]
[]
[]
["Knows the federal governing bodies and how they impact the facility and staff. ",{"$nulls":4},0]
["64B10-16.005(2)(e)3 "]
["Demonstrates a working knowledge and understanding of Medicare calculation. ",{"$nulls":4},0]
["64B10-16.005(2)(e)4 "]
["Understands the reimbursement basics for respiratory therapy. ",{"$nulls":4},0]
["Understands basic insurance coverages."]
["64B10-16.005(2)(e)5 "]
["Possesses a functional understanding of the legal implications of various activities, procedures, or decisions routinely taken or performed in the facility.",{"$nulls":4},0]
["Understands the reporting requirements of health care licensees. ",{"$nulls":4},0]
[]
["Domain/Subfunctions Quarter - 1,000 Hr Program","Q1","Q2","Q3",null,"TOTAL"]
["LAWS, REGULATORY CODES, AND GOVERNING BOARDS [10%] (Minimum = 100 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,null,0]
[]
["Domain/Subfunctions Quarter - 2,000 Hr Program","Q1","Q2","Q3","Q4","TOTAL"]
["LAWS, REGULATORY CODES, AND GOVERNING BOARDS [10%] (Minimum = 200 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,0,0]
[]
["INITIALS","Q1","Q2","Q3","Q4"]
["AIT"]
["PRECEPTOR"]
[]
[]
["RESIDENT CARE"]
[]
[]
[]
[]
["Domain/Subfunctions Quarter ","Q1","Q2","Q3","Q4","TOTAL"]
["RESIDENT CARE 64B10-16.005(2)(f) F.A.C [20%]"]
["Possesses an understanding of the demographics of the resident population and how resident services are affected.",{"$nulls":4},0]
["Understands the role of Social Services in resident care. ",{"$nulls":4},0]
["Understands the role of Dietary services in resident care. ",{"$nulls":4},0]
["Understands the role of Dining services in resident care. ",{"$nulls":4},0]
["Possesses an understanding of the purpose of dietary resident rounds. ",{"$nulls":4},0]
["Possesses a working knowledge of dietary documentation. ",{"$nulls":4},0]
["Understands the role of Laundry in resident care. ",{"$nulls":4},0]
["Understands the role of Medical Records in resident care. ",{"$nulls":4},0]
["Demonstrates a working knowledge of a records retention schedule. ",{"$nulls":4},0]
["64B10-16.005(2)(f)1 "]
["Possesses the ability to differentiate between the scopes of practice for RNs, LPNs, and CNAs.",{"$nulls":4},0]
["Demonstrates an understanding of the role of the gerontological nurse in caring for aging residents in long-term care, and their families.",{"$nulls":4},0]
["64B10-16.005(2)(f)2 "]
["Possesses a working understanding of customers and programming. ",{"$nulls":4},0]
["Demonstrates an understanding of the components of Rehabilitation Services and their application to residents.",{"$nulls":4},0]
["Understands the relationship of Occupational Therapy and Physical Therapy and co-treatment options for the residents.",{"$nulls":4},0]
["Demonstrates knowledge of the preadmission and admission process service path. ",{"$nulls":4},0]
["Understands the relationship of Nursing to other departments. ",{"$nulls":4},0]
["Understands the relationship of Social Services to other departments. ",{"$nulls":4},0]
["Understands the relationship of Dietary to other departments. ",{"$nulls":4},0]
["Understands the relationship of Laundry to other departments. ",{"$nulls":4},0]
["Understands the relationship of Maintenance to other departments. ",{"$nulls":4},0]
["Possesses knowledge of discharge planning and the appeal process. ",{"$nulls":4},0]
["Understands proper therapy services utilization. ",{"$nulls":4},0]
["64B10-16.005(2)(f)3 "]
["Possess the ability to facilitate the development and application of volunteer programs. ",{"$nulls":4},0]
["Understand resident care policies for restorative and rehabilitative services. ",{"$nulls":4},0]
["Demonstrates knowledge of the customers of Physical Therapy. ",{"$nulls":4},0]
["Demonstrates knowledge of the customers of Occupational Therapy. ",{"$nulls":4},0]
[]
[]
[]
["Demonstrates knowledge of the customers of Speech Therapy. ",{"$nulls":4},0]
["Possesses knowledge of the customer service function. ",{"$nulls":4},0]
["64B10-16.005(2)(f)4 "]
["Demonstrates an understanding of the emotional problems of aging in the lives of residents. ",{"$nulls":4},0]
["Understands the administrator’s role in interacting with family, friends, and loved ones. ",{"$nulls":4},0]
["64B10-16.005(2)(f)5 "]
["Is able to discuss end-of-life issues and the role of the administrator in relating to the resident and their family when faced with death.",{"$nulls":4},0]
["64B10-16.005(2)(f)6 "]
["Understands the interrelationship in a resident’s behavior and their environment, including their intra-psychic and/or physical state.",{"$nulls":4},0]
["Possesses the ability to discuss resident behavior under different environmental or physiological conditions.",{"$nulls":4},0]
["Understands methods for assessing differential functioning (DIF) in the dementia population.",{"$nulls":4},0]
["64B10-16.005(2)(f)7"]
["Demonstrates an understanding of how to access and interpret facility quality indicators and measures.",{"$nulls":4},0]
["64B10-16.005(2)(f)8"]
["Understands concepts of benchmaking.",{"$nulls":4},0]
["64B10-16.005(2)(f)9"]
["Possesses the ability to utilize self-assessment tools to assess facility performance.",{"$nulls":4},0]
[]
["Domain/Subfunctions Quarter - 1,000 Hr Program","Q1","Q2","Q3",null,"TOTAL"]
["RESIDENT CARE [20%] (Minimum = 200 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,null,0]
[]
["Domain/Subfunctions Quarter - 2,000 Hr Program","Q1","Q2","Q3","Q4","TOTAL"]
["RESIDENT CARE [20%] (Minimum = 400 hours)",{"$nulls":4},0]
[" QUARTERLY TOTALS",0,0,0,0,0]
[]
["INITIALS","Q1","Q2","Q3","Q4"]
["AIT"]
["PRECEPTOR"]
[]
[]
["AIT PROGRAM  HOURS SUBMITTED/COMPLETED"]
[]
["AIT - 1000 HOURS"]
["Domain/Subfunctions Quarter ","Q1","Q2","Q3","Q4","TOTAL"]
["PERSONNEL [15%] (Minimum = 150 hours)",0,0,0,0,0]
["FINANCE [15%]  (Minimum = 150 hours)",0,0,0,0,0]
["MARKETING [5%] (Minimum = 50 hours)",0,0,0,0,0]
["PHYSICAL RESOURCE MANAGEMENT [10%] (Minimum = 100 hours)",0,0,0,0,0]
["LAWS, REGULATORY CODES, AND GOVERNING BOARDS [10%] (Minimum = 100 hours)",0,0,0,0,0]
["RESIDENT CARE [20%] (Minimum = 200 hours)",0,0,0,0,0]
[" QUARTERLY TOTALS",0,0,0,0,0]
[]
[]
["AIT - 2000 HOURS"]
["Domain/Subfunctions Quarter ","Q1","Q2","Q3","Q4","TOTAL"]
["PERSONNEL [15%] (Minimum = 300 hours)",0,0,0,0,0]
["FINANCE [15%]  (Minimum = 300 hours)",0,0,0,0,0]
["MARKETING [5%] (Minimum = 100 hours)",0,0,0,0,0]
["PHYSICAL RESOURCE MANAGEMENT [10%] (Minimum = 200 hours)",0,0,0,0,0]
["LAWS, REGULATORY CODES, AND GOVERNING BOARDS [10%] (Minimum = 200 hours)",0,0,0,0,0]
["RESIDENT CARE [20%] (Minimum = 400 hours)",0,0,0,0,0]
[" QUARTERLY TOTALS",0,0,0,0,0]
[]
[]
[]
["NARRATIVE"]
{"$rows_empty":8}
["Indicate the AIT Program and the Quarterly Report completed for the reporting period.","Q1","Q2","Q3","Q4"]
["1000 Hour Program:"]
["2000 Hour Program:"]
[]
["Please complete the following questions when submitting each quarterly report:","YES","NO"]
["1.  Did your work week consist of at least 30 hours a week but no more than 50 hours  a week?"]
["2. Did you work a minimum of 6 hours daily between 7 a.m and 10 p.m.?"]
["3. Did you fill a specific position in the facility during normal working hours of the AIT Program?"]
["4. Are you rotating through various departments during the AIT Program?"]
["5. Over the course of one year, have you worked a minimum of 40 hours, but not more than 160 hours, between the hours of 10 p.m. and 7 a.m.?"]
[]
["The domains of practices are: Personnel; Finance; Marketing; Physical Resource Management; Laws, Regulatory Codes, & Governing Boards; Resident Care"]
[]
["Please write a brief narrative describing relevant learning experiences for the last quarter.  Pages should be typed or printed.  Use a new sheet for each domain; add additional sheets if more space is needed.  This narrative should show how the Administrator-in-Training used the following methods to further his/her training: on-the-job experience, practical work experience within the various departments (# of hours worked in the dept.), meetings attended, surveys completed, written reports, texts or periodicals, visits to other facilities, and academic programs, college, or continuing education seminars.  The purpose of this narrative is to demonstrate how you have had meaningful experiences and participated in projects that relate to the domains of practice."]
[]
[]
["Please indicate the applicable Domain of Practice:  ______________________________________________"]
[]
["AIT Signature: ________________________________________________________                   DATE:"]
[]
["PRECEPTOR Signature: ________________________________________________________  DATE:"]