C: ASSESSMENT, TRAINING PLAN DEVELOPMENT, FOLLOW-UP & INFO/REFERRAL HOURS
ASSESSMENT TRAINING PLAN DEVELOPMENT FOLLOW-UP
Name Hours Name Hours Name Hours Name Hours Name Exit Level + Date 3 or 6 mo. Status
                       
                       
                       
                       
                       
                       
                       
                       
                       
    GRAND TOTAL       GRAND TOTAL   IMFORMATION &
REFERRAL HOURS
TOTAL PRACTITIONER HOURS: Comments: Hours: # Clients:

STATUS: E=Employed, NE= Not employed, OLBS= Other LBS training, T/E=Other training/education,
V= Volunteer work LC= Lost contact

**NOTE: The number of direct assessment hours the practitioner records should NOT match the total number of hours the learners record since most of the assessment time is independent work.