DBHS Loss of Instructional Time Log
Students must complete each field (except teacher notes). Logs are to be turned in as requested
Date
Period
Name:
MM/DD
1, 2, 3, or 4
Print
Time
OUT
Time
IN
1/1
1
John Doe
10:20
10:30
Teacher Notes:
Nurse (N), teacher (T - Teacher name),
Student Services (SS), etc.
Initial /
Student
Signature
RR
JD
On time
Reason: Restroom (RR) , Office (O),
DBHS Loss of Instructional Time Log
Students must complete each field (except teacher notes). Logs are to be turned in as requested
Date
Period
Name:
MM/DD
1, 2, 3, or 4
Print
Time
OUT
Time
IN
1/1
1
John Doe
10:20
10:30
Teacher Notes:
Nurse (N), teacher (T - Teacher name),
Student Services (SS), etc.
Initial /
Student
Signature
RR
JD
On time
Reason: Restroom (RR) , Office (O),