Supported Employment Employment Assistance Service Delivery Log Form 4117-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the individual's name in the 'Individual Name' field. This ensures that all entries are accurately attributed.
3. Fill in the 'Date of Service' using the mm/dd/yy format, followed by the 'Local Case No./CARE ID' for proper identification.
4. Record the 'Begin Time' and 'End Time' of service, ensuring to specify a.m. or p.m. as needed.
5. Calculate and enter the 'Total Time' spent on services provided during this session.
6. In the 'Location' section, indicate where the service took place, followed by any relevant comments regarding special events or occurrences.
7. Complete the 'Services Provided' section by selecting appropriate codes that correspond to services rendered, ensuring clarity and accuracy.
8. Finally, have the employee sign in the designated area to validate the log entry.

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