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, ensuring you include both first and last names.
3. Next, input the 'Date of Service' using the mm/dd/yy format for clarity.
4. Fill in the 'Local Case No./CARE ID' to identify the case associated with this service log.
5. Record the 'Begin Time' and 'End Time' of service, selecting a.m. or p.m. as appropriate for each entry.
6. Calculate and enter the 'Total Time' spent on services provided during this session.
7. In the 'Location' section, specify where the assistance was provided.
8. Mark all relevant areas of assistance by checking or initialing next to options like Employment Skills Training and Support and Intervention.
9. Use the 'Comments' section to note any special events or occurrences that took place during service delivery.
10. Finally, ensure all staff initials and signatures are completed at the bottom of the form for verification.

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