Supported Employment Employment Assistance Service Delivery Log Form 4117-2026

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 identification purposes.
4. Record the 'Begin Time' and 'End Time' of service, ensuring to specify a.m. or p.m. as needed.
5. In the 'Total Time' section, calculate and enter the total hours worked during this service period.
6. Provide details about the location of service delivery and any relevant comments regarding special events or occurrences.
7. Complete the 'Services Provided' section by selecting appropriate codes that correspond to services rendered during this period.
8. Finally, ensure that staff initials and employee signatures are included for verification and accountability.

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