Electronic Monitoring Device Check-In Form
Complete this form to record your routine check-in for an electronic monitoring device.
Full Name of Person Checking In
*
First Name
Last Name
Device ID or Serial Number
*
Date of Check-In
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Check-In
*
Hour Minutes
AM
PM
AM/PM Option
Location of Device at Check-In
*
Device Status
*
Operational
Requires Maintenance
Not Functioning
Battery Level (%)
*
Any Issues Detected?
*
No Issues
Yes, Issues Detected
Describe Any Issues (if applicable)
Signature of Person Checking In
*
Submit
Submit
Should be Empty: