Form 08TW013E (TW-13) revised 3-1-2010 may continue on next page, page 1 of 4
Date:
Case name:
Case number:
County number:
Supervisor/worker number: /
Time and Progress Report
Facility name Date
Participant’s name
Scheduled hours per week Performance month Activity
Part I: Attendance. ALL actual hours of participation must be recorded. Participant
makes appropriate daily entries, which document actual hours in attendance. Do not
include lunch hours and travel time. For persons in Job Search, travel between job
interviews and job applications are part of the activity and can be counted. Participant
initials daily entries in appropriate block(s).
OKDHS use only: This plan of study is approved for homework or study hours.
1
Codes: A = Absent; H = Holiday; W = Weekend/regular day off
Date Time
in
Time
out
Time
in
Time
out
Time
in
Time
out
Total
hours
Partici-
pant's
initials
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
I certify the record of my hours is true and correct.
Signature of participant Phone number Date
1
Statement from instructor, professor, advisor, or class syllabus MUST BE DOCUMENTED in case notes to
allow homework or study hours. Worker enters number of allowed homework or study hours for the plan of study.
______________________/_______
Oklahoma City Community College Career Transitions
Form 08TW013E (TW-13) revised 3-1-2010 may continue on next page, page 2 of 4
Note: Submit pages 1 and 2 to the local human services center no later than the 20th of
the current month. Participant allowances will not be paid in excess of $13.00 per day.
Part II. Progress report. Completed by facility supervisor, instructor, or OKDHS worker.
Facility supervisor, instructor, or OKDHS worker checks the appropriate column to
describe the participant’s performance.
Excellent Satisfactory Needs counseling
Attendance
Punctuality
Work attitude
Quality of work
Progress
Willingness to learn
Follows instructions
Shows initiative
Accepts correction
Relationship with others
Personal appearance
Part III. Facility signature. The appropriate individual signs and dates the form to
indicate approval of the total report.
Signature Title Phone number Date
(405) 682-7844