Behavior Analyst Fieldwork Verification Log
Use this form to document and verify ABA fieldwork hours and supervision activities for a specific reporting period.
Reporting Period Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reporting Period End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Behavior Analyst Full Name
*
First Name
Last Name
Supervisor Full Name
*
First Name
Last Name
Type of Supervision
*
Individual
Group
Both Individual and Group
Total Fieldwork Hours Completed
*
Breakdown of Hours
*
Rows
Direct Hours
Indirect Hours
This Reporting Period
Client Initials (for all clients supervised this period)
Types of Activities Completed
*
Direct Implementation of ABA Programs
Assessment and Data Collection
Supervision/Training
Program Development
Parent/Staff Meetings
Other
Verification Method
*
In-person observation
Video review
Remote/Telehealth session
Record review
Submit Verification Log
Should be Empty: