Fillable Form

Supervision Hours Log

A weekly log of direct-contact, non-contact, and total supervision hours by site, with Associate and Supervisor signatures.

Associate Information

Associate Name

Week Of

Site 1

Site 2

EHR for Site 1

EHR for Site 2

Enter hours in 15-minute increments (e.g., 0.25, 0.50, 0.75, 1.00).

Direct-Contact Hours (This Week)

Non-Contact Hours (This Week)

Total Hours (This Week)

Associate Signature

Date

Supervisor Signature

Date

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