Copy_of_Exhibit_XI_Congregate_Care_One-on-One_Log.xlsx
XLSX spreadsheet 13 KB Posted
- Attached to
- AZ|CTR078811
- Contract number
- CTR078811
- Issued by
- Arizona
About this file
The document is an Arizona Department of Child Safety (DCS) One on One Supervision Log form, updated on 05/06/2024, designed to track individual service hours for child supervision. This standardized form is specifically tailored for documenting direct service provision in congregate care settings, with spaces to record detailed service-related information for individual participants.
The log template is structured to capture comprehensive service delivery details, including participant identification, authorized weekday and weekend service hours, specific service dates, actual start and end times, total hours provided, staff provider information, and signature verification. A notable feature is the option to indicate when a child is not in school on a weekday, which may impact hour allocation. The form serves as an official record for tracking and validating one-on-one supervision services, ensuring accountability and precise documentation of child care services provided by the Arizona Department of Child Safety.
View the file
Other files
Show all 17
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
1on1 Service Log
| Provider: | Month/Year: |
| Participant Name: | Participant ID#: |
| Authorized Weekday Hours: | |
| Authorized Weekend Hours: |
| Service Date | *Child not in School | Day of the Week | Actual Start Time | Actual End Time | Total Hours | Printed Name | |
| (Staff Providing Services) | Signature | ||||||
| (Staff Providing Services) | Comments |
Note: Signature for hours of supervision verifies the listed times and hours to be a true and accurate account of the services provided for the named client by the listed staff.
*Enter a check mark in the Child not in School column if it is a weekday, but weekend hours are being applied because the child was not in school that day.
&"-,Bold"ARIZONA DEPARTMENT OF CHILD SAFETY One on One Supervision Log
&9 Form Updated 05/06/2024
File details come from the government source that posted it. Updated .