Record of Activities

Name	What’s your name?
Title	What’s your title?
Employer	For which employer do you work?

Activity Log

Use a new row for each activity. You must include the start and end times for each activity.

Enter the date, activity, start and end times, and the number of hours. In the Hours column, only enter numbers (i.e. 2.75).

To add a new row, click the “Add New Row” button.

To total the number of hours, click the “Update Total” button.

Date	Activity	Start Time	End Time	Hours

Choose or enter date	Write a brief description of your activity	Select Start Time	Select End Time	Enter Number
Choose or enter date	Write a brief description of your activity	Select Start Time	Select End Time	Enter Number
Choose or enter date	Write a brief description of your activity	Select Start Time	Select End Time	Enter Number
Choose or enter date	Write a brief description of your activity	Select Start Time	Select End Time	Enter Number
Choose or enter date	Write a brief description of your activity	Select Start Time	Select End Time	Enter Number

0

To ensure three full months of active working days are reflected on the ROA, extend the period of the ROA by the amount of time used for vacations, illness, holidays or other reasons not worked during the three-month period.

Once you have completed recording activities for a three-month period, print this worksheet and sign and date below.

With my signature, I attest to the accuracy of the record provided above.

Signature	Date