Weekly Student Work Log Sheet
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1FORM I – RT WEEKLY STUDENT WORK LOG SHEET
This work log sheet will track how you spent your time at the internship. Please complete a sheet for every week of work
that you complete at your internship site. Submit these forms with your internship reports. They may be faxed to 916-278-
5053 or scanned and emailed to your internship faculty supervisor. FORMS MUST BE SIGNED BY YOUR SUPERVISOR.
Intern Name:_____________________________________________ RPTA SUPERVISOR: ______________________
Week of internship covered by this time sheet: ____________ Dates covered by this time sheet: __________
Total number of hours worked for the reporting period: __________
Estimate the amount of time you spend each week on the
%
following activities (totals should add up to 100%):
Professional Relationships and Responsibilities
Assessment
Plan Interventions and/or Programs
Implement Interventions and/or Programs
Evaluate Outcomes of the Interventions and/or Programs
Document Intervention Services
Treatment Teams and/or Service Providers
Develop and Maintain Programs
Manage TR/RT Services
Awareness and Advocacy
100%
Total
Date
# of Hours
Brief Description of Activities
worked
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
__________________________________________
_______________________________
Signature of Agency Supervisor
Date Signed
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