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DAILY RECORD OF CLINICAL CLOCK HOURS

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									                                                          DAILY RECORD OF CLINICAL CLOCK HOURS

Keep track of hours daily. List the number of hours in the appropriate categories. It is vital that you do this consistently. At the end of each semester, you
will transfer this information onto your personal Microsoft Access program. Please note: Speech-language assessment includes nonstandardized assessment.
Staffings are an important skill but they DO NOT COUNT TOWARDS CLOCK HOURS.

NAME: ____________________________________________                                             LOCATION: _________________________________________

SEMESTER/YEAR: __________________________________                                              SUPERVISOR: _______________________________________




                                                                         Voice & Resonance




                                                                                                                        of Communication
                                                                                                                        Cognitive Aspects




                                                                                                                                                                                                                     (put amount here)
                                                                                                                                            Social Aspects of
                                                                                                                                             Communication

                                                                                                                                                                Communication




                                                                                                                                                                                                  Assessment=A
                                              Articulation &




                                                                                                                                                                                                  Intervention=I

                                                                                                                                                                                                                       Staffing Time
                                                                                                                                                                                                  Prevention=P
                                                                                             Receptive &



                                                                                                           Swallowing
                                                                                             Expressive
                                               Phonology




                                                                                                                                                                  Modalities
                                SOR/OBS




                                                                                              Language
                                                               Fluency




                                                                                                                                                                                Hearing
                                Supervisor
                                  fills in                                                                                                                                                TOTAL
   Date     Client’s Initials    this line                                                                                                                                                HOURS
                & Age




                                                                                                                                                                                                  ←GRANDTOTAL
                                TOTALS:                                                                                                                                                           (excluding staffing time)
                                                                     Date
                                                                 & Age
                                                             Client’s Initials
                                                                       fills in
                                                                      this line
                                                                                       SOR/OBS




GRAND TOTAL:
                                                                     Supervisor




                                               PAGE TOTAL:
                                                                         Articulation &
                                                                          Phonology

                                                                                 Fluency


                                                                 Voice & Resonance


                                                                            Receptive &
                                                                            Expressive
                                                                             Language

                                                                             Swallowing
                                                                                                 PAGE # _______




                                                                   Cognitive Aspects
                                                                   of Communication

                                                                     Social Aspects of
                                                                      Communication

                                                                       Communication
                                                                         Modalities

                                                                                 Hearing
                                                                     TOTAL
                                                                     HOURS




                                                                        Prevention=P
                                                                        Assessment=A
                                                                        Intervention=I

                                                                      Staffing Time
    (excluding staffing time)
                                ←GRAND TOTAL




                                                                    (put amount here)

								
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