Community Service Work Log
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2SAMPLE
SAMPLE
THORNTON MUNICIPAL COURT
COMMUNITY SERVICE WORK LOG
THE COMMUNITY SERVICE WORKER (NOT THE JOB SITE) SHALL RETURN THIS FORM
TO THE COURT BY THE DEADLINE GIVEN.
Your Name/
6000000
Name/Summons Number:___
_
______
John Doe
Name of Community Service Worker:_______
______________
Helping Hands-Non-Profit Organization
Work Site Name:____
___
123 Main St., Anywhere, USA
Work Site Address:____
___________
Jane Smith
Signature of person for whom the work was done:____
_______
Jane Smith
Printed Name of person for whom work was done:____
_______
303-555-1212
Contact Phone Number for Job Site:____
_______________
How does this site qualify for Community Service? Check one:
[ X ] Non-Profit Organization [ ] Elderly (non-relative) [ ] Disabled (Non-relative)
WORK LOG – TO BE DOCUMENTED DAILY
Date
Nature of Work Performed
Hours Worked
01/01/03
Sorting Clothes
8:00-5:00= 8 hrs.
01/03/03
Sweeping Floors
8:00-10:00= 2 hrs.
01/04/03
Filing
8:00-2:00= 6 hrs.
01/07/03
Assisting Shoppers
10:30-3:30= 5hrs.
____________________________________________________________
____________________________________________________________
21 hrs TOTAL
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Parent category: Miscellaneous