Santa Clara County Office of Education
COVID-19 Individual Work Log
Employee Name: _____________________________________________________________________________________________
Position Title: _____________________________________________________________________________________________
Program Name: _____________________________________________________________________________________________
Reporting Period: _____________________________________________________________________________________________
How to use this Form
Purpose: Record time spent on Covid-19 related activities that include, but are not limited to distance learning, deployment of staff working from home, reassignments (e.g.
Emergency Operations Center, Communications, backfilling for staff assigned to Covid-19 related activities, program or funding guidance, community food, distribution, child-
care pop ups, policy and procedure changes)
Completed by: Staff impacted by COVID-19 and/or participating in COVID-19 related activities Hours Worked: Report in 15 minute increments. Example: if hours worked is
2hrs 35mins, hours reported will be 2hrs 30min, that is 2.5 hrs; if hours worked is 2hrs 40mins, hours reported will be 2hrs 45mins, that is, 2.75 hrs
Signed By: Employee and immediate supervisor
Submission: Retain a copy and send a copy to Accounting Services to your assigned Program Accountant. If needed, complete and attach additional forms, signatures are
required on each form.
Date Description of COVID-19 Related Activities Hours Worked
Total Number of Hours Worked
Authorized Signatures
Employee Signature ____________________________________________________________________ Date ____________________
Supervisor Signature ____________________________________________________________________ Date ____________________