Infant Sleep-Check Log
Facility: _______________________
Date: ______________
Room: ______________
Provider: ___________________
Four infants · Twelve 15-minute checks per infant · Three-hour nap window. Write actual check times. Record observations and the initials of the person who performed each physical check. Continue on another sheet if needed. Last reviewed: 2026-09-29.
Infant 1 name: _____________________________________
| Time | Infant on back? Y/N | Breathing normal? Y/N | Signs of distress? Notes | Checker initials |
|---|---|---|---|---|
Infant 2 name: _____________________________________
| Time | Infant on back? Y/N | Breathing normal? Y/N | Signs of distress? Notes | Checker initials |
|---|---|---|---|---|
Infant 3 name: _____________________________________
| Time | Infant on back? Y/N | Breathing normal? Y/N | Signs of distress? Notes | Checker initials |
|---|---|---|---|---|
Infant 4 name: _____________________________________
| Time | Infant on back? Y/N | Breathing normal? Y/N | Signs of distress? Notes | Checker initials |
|---|---|---|---|---|