Work Based Learning Monthly Log

Work Based Learning Monthly Log

Berne Union High School
Student Name:
Student Email Address
example@example.com
Grade:
Place of Employment:
Supervisor's Name
Supervisor's Email Address
example@example.com
Work Date Range For This Month

Week 1

Rows	Date	Time In	Time Out	Total Hours	Tasks/Skills Performed
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Week 2

Rows	Date	Time In	Time Out	Total Hours	Tasks/Skills Performed
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Week 3

Rows	Date	Time In	Time Out	Total Hours	Tasks/Skills Performed
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Week 4

Rows	Date	Time In	Time Out	Total Hours	Tasks/Skills Performed
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Week 5

Rows	Date	Time In	Time Out	Total Hours	Tasks/Skills Performed
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

By signing below, the student and worksite supervisor confirm that the dates, times, and total hours recorded on this log accurately represent the student's actual work-based learning participation for the period indicated.
Student Signature
Date

MonthDayYear
Date
Supervisor Signature
WBL Coordinator Signature
Should be Empty: