MFC Daily Activity Report

              Name   

        Date worked 

                                  

             Month/Day/Year

            e.g., 01/01/2007

Time Spent

Start Time

Hour: Minutes AM/PM

(Example: 8:00 AM)

End Time

Hour: Minutes AM/PM

(Example: 4:10 PM)

Total Time

Total Hour: Minutes

(Example: 7.10 )

Expenses Incurred

Miles driven for the entire day*  

   Additional Expenses for the entire day. Also submit the receipt.

Item Amount Purpose
     
     
     
     
     
     

Comments

 
Important Instructions: This is used for your time card. If you fill out more than one Activity Report in one day because you have made contacts with more people or organizations than one form accommodates, Only fill out the total number of hours on one form per day. If you work a spit shift. fill out two forms with the total # of hours on the second form so that it reflects the entire day.
 

Activity 1

Organization Name*       

Services/Comments

Site Address              
City*                        Other           

       State               Zip             

Contact Name *   Job Title      
Telephone Number       Ext         Mobile Phone     
Type of Activity* Other           
Materials used Other           
Number of materials used    More than one type of material: (list the material and the quantity)
Materials need to be returned to me Yes No
Trainings Only
Number of Participants    Link to Attendance Sheet
       Males                          Females  

Activity 2

Organization Name       

Services/Comments

Site Address   
City                       Other  

       State              Zip  

Contact Name    Job Title  
Telephone Number  Ext   Mobile Phone  
Type of Activity Other  
Materials used Other  
Number of materials used    More than one type of material: (list the material and the quantity)
Materials need to be returned to me Yes No
Trainings Only
Number of Participants    Link to Attendance Sheet
       Males                                                  Females  

Activity 3

Organization Name       

Services/Comments

Site Address   
City                       Other  

       State              Zip  

Contact Name    Job Title 
Telephone Number         Ext         Mobile Phone  
Type of Activity Other  
Materials used Other  
Number of materials used    More than one type of material: (list the material and the quantity)
Materials need to be returned to me Yes No
Trainings Only
Number of Participants    Link to Attendance Sheet
       Males                                                  Females