Student Name: Smart Student
Agency: Learn a Lot Placement
Month: October
Monthly Time/Task Sheet
Field Placement Days: Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
TIME (example: 8 a.m. – 4 p.m.; 10 a.m. – 2 p.m.): 9am – 5pm
# of Reflective Journals handed into Field Instructor: 4
# of field supervision meetings: 4
In the table below please identify: dates you attended your field placement, daily activities that connect to
your learning contract, and amount of time spent at your placement (full day is calculated at 7.5 hours,
half-days and overtime need to be documented separately).
Date
Activities Connected to Learning Contract
Hours
Oct. 3/15
Introduction to agency, met with field instructor, tour of agency , read policy and
procedure manual
7.5
Oct. 5/15
Shadowed a s.w. on home visits. Read examples of documentation s.w. at agency
complete.
7.5
Observed a group on parenting skills (overtime)
Oct. 5/15
3
Attended a team meeting (half-day)
Oct.10/15
4
Total Hours for the Month
Total Placement Hours
Student Signature:
Date:
Field Instructor Signature:
Date:
On-Site Supervisor (if applicable):
Date:
22
82
(i.e. this is
60 hr.
from Sept.
added to
22 hr.
from Oct.)